Diabetes mellitus

3. Diabetes mellitus, often simply
referred to as diabetes, is a group of
metabolic diseases in which a person
has high blood sugar, either because
the body does not produce enough
insulin, or because cells do not respond
to the insulin that is produced. This
high blood sugar produces the classical
symptoms of polyuria (frequent
urination), polydipsia (increased thirst)
and polyphagia(increased hunger).

4. Type 1 DM,(IDDM) OR Juvenile diabetes
Type 2 ( NIDDM ) OR Adult onset
diabetes
Gestational diabetes
Congenital diabetes
Cystic fibrosis
Monogenic diabetes

5.  Type 1 diabetes
Type 1 diabetes mellitus is
characterized by loss of the insulin-
producing beta cells of the islets of
Langerhans in the pancreas, leading to
insulin deficiency. This type can be
further classified as immune-mediated
or idiopathic.

6. The majority of type 1 diabetes is of the
immune-mediated nature, in which
beta cell loss is a T-cell-mediated
autoimmune attack There is no known
preventive measure against type 1
diabetes,
diabetes can affect children or adults,
but was traditionally termed "juvenile
diabetes" because a majority of these
diabetes cases were in children.

7. Type 2 diabetes
Type 2 diabetes mellitus is characterized by
insulin resistance, which may be combined
with relatively reduced insulin secretion.
The defective responsiveness of body tissues
to insulin is believed to involve the insulin
receptor. However, the specific defects are
not known.
Diabetes mellitus cases due to a known
defect are classified separately. Type 2
diabetes is the most common type.

8. Gestational diabetes mellitus (GDM)
It is resembles type 2 diabetes in several
respects, involving a combination of
relatively inadequate insulin secretion and
responsiveness.
It occurs in about 2%–5% of all pregnancies
and may improve or disappear after delivery.
Gestational diabetes is fully treatable,
but requires careful medical supervision
throughout the pregnancy. About 20%–50%
of affected women develop type 2 diabetes
later in life.

9. Etiologic Classification of Diabetes
Mellitus
I. Type 1 diabetes (cell destruction, usually
leading to absolute insulin deficiency)
A.Immune-mediated
B.Idiopathic
II. Type 2 diabetes (may range from
predominantly insulin resistance with relative
insulin deficiency to a predominantly insulin
secretary defect with insulin resistance)

10. Other specific causes of the types of
diabetes
•Genetic defects of cell function Genetic
defects in insulin action.

11. •Diseases of the exocrine pancreas—
pancreatitis, pancreatectomy, neoplasia,
cystic fibrosis, fibrocalculous pancreatopathy,
•Endocrinopathies-acromegaly, Cushing's
syndrome, glucagonoma, hyperthyroidism,
somatostatinoma, aldosteronoma

12. •Drug- or chemical-induced-Vacor,
pentamidine, nicotinic acid, glucocorticoids,
thyroid hormone, diazoxide, -adrenergic
agonists, thiazides, phenytoin, interferon,
protease inhibitors, clozapine
•Infections—congenital rubella,
cytomegalovirus.

13. Other genetic syndromes sometimes
associated with diabetes—Down's
syndrome,Turner's syndrome

14. Other etiologies for DM
Specific genetic defects in insulin
secretion or action,
Metabolic abnormalities that impair
insulin secretion,
Mitochondrial abnormalities
DM can result from pancreatic
exocrine disease when the majority
of pancreatic islets are destroyed.

15. •Hormones that antagonize insulin action
can also lead to DM. Thus, DM is often a
feature of Endocrinopathies
• such as acromegaly and Cushing's
disease.
•Viral infections have been implicated in
pancreatic islet destruction but are an
extremely rare cause of DM.

17. •Polyuria
•Polydipsia
•polyphegia
•Weight loss
•Lethargy
•weakness
•Fluctuation in blood glucose level lead to
Blurred Vision
•Boils/abscesses
•Skin itching problem
•Others tingling sensation in skin

18. Body pains do not away by the
pain killers
Delay wound healing
Increased glucose level lead to
agitation,irritability,
inattention,confusion ,coma

20. Diagnostic test:
Fasting plasma glucose = preferred test:
Positive test is glycemia of 126mg/dL or
higher after fasting at least 8 hours

Random plasma glucose of 200mg/dL or
higher along with symptoms of diabetes

Post prandial glucose of 80 to 130 mg /dl
higher along with symptoms of diabetes

21.  Oral glucose tolerance test (OGTT) plasma glucose of
200mg/dL or higher done 2 hours after ingestion of 75
grams of glucose in water
 Diabetic urine tests

22. Complication:
Acute Complications of Uncontrolled
Diabetes:
(all directly caused by hyperglycemia)
--Polydypsia due to plasma glucose
hyperosmolarity
--Polyuria due to excess fluid intake and
glucose-induced osmotic diuresis
Weight loss due to calories loss as
glycosuria,leaving a negative calorie
balance
•--

23. Polyphagia due to glucosuria and
negative calorie balance
Poor wound healing, gingivitis, blurred
vision
Chronic Complications of Uncontrolled
Diabetes:
MACRO VASCULAR
Athrosclerosis
IHD
Stroke
Peripheral vascular disease

24. Micro vascular Diseases of
Diabetes
Diabetic Retinopathy
Nephropathy
Neuropathy
Diabetic foot

25. End stage Complications of
Uncontrolled Diabetes
1. Diabetic Ketoacidosis
2. Non ketotic hyperosmolarity

27. ORAL HYPOGLYCAEMIC MEDICATIONS
There are currently five classes of
oral anti-diabetic agents:
 Biguanides
Insulin Secretagogues – Sulphonylureas
Insulin Secretagogues – Non-
sulphonylureas
α-glucosidase inhibitors
Thiazolidinediones (TZDs)

28. Biguanides reduce hepatic glucose
output and increase uptake of
glucose by the periphery, including
skeletal muscle.
Example: metformin

29. Sulfonylureas were the first widely
used oral anti-hyperglycaemic
medications. They are insulin
secretagogues, triggering insulin
release by inhibiting the KATP
channel of the pancreatic beta
cells

30. First-generation agents
tolbutamide (Orinase brand name
)
acetohexamide (Dymelor)
tolazamide (Tolinase)
chlorpropamide (Diabinese)

31. Second-generation agents
glipizide (Glucotrol)
glyburide or glibenclamide
(Diabeta, Micronase, Glynase)
glimepiride (Amaryl)
gliclazide (Diamicron)
glycopyramide
gliquidone

32. Nonsulfonylurea secretagogues
Meglitinides
TYPES OF DRUGS:
repaglinide (Prandin)
nateglinide (Starlix)

33. Alpha-glucosidase inhibitors
TYPES OF DRUGS
miglitol (Glyset)
acarbose (Precose/Glucobay)
voglibose

34. Thiazolidinedione
pioglitazone
troglitazone

36. Short-term use:
Acute illness, surgery, stress and
emergencies
Pregnancy
Breast-feeding
Insulin may be used as initial
therapy in type 2 diabetes

37. in marked hyperglycaemia
Severe metabolic decompensation
(diabetic ketoacidosis, hyperosmolar
nonketotic coma, lactic acidosis,
severe hypertriglyceridaemia)

38. Long-term use:
If targets have not been reached
after optimal dose of combination
therapy, consider change to multi-
dose insulin therapy.


40. SURGICAL MANAGEMENT :
ISLET CELLS TRANSPLANATATION
:Insulin producing B cells taken
from donors pancreas &
transferred into a person with
diabetes, once transplanted the
donor islets begin to make &
release insulin actively & regulating
level of sugar in the blood

42. Nursing management:
NURSING DIAGNOSIS:
1) Deficient Fluid VolumeMay be
related to Osmotic diuresis (from
hyperglycemia
2) Nutrition: less than body
requirements May be related to
Insulin deficiency: decreased
uptake/utilization of glucose by the
tissues

43. 3) Risk for Infection, [sepsis] Risk
factors may include High glucose
levels, decreased leukocyte
function, alterations in circulation
Preexisting respiratory infection, or
UTI
4) Risk for disturbed Sensory
Perception, Risk factors may
include Endogenous chemical
alteration: glucose/insulin