This document provides an overview of diabetes mellitus. It begins by defining diabetes as a metabolic disorder characterized by high blood glucose levels due to either lack of insulin production or insulin resistance. It then discusses the different types of diabetes (type 1 and type 2), risk factors, clinical manifestations, diagnostic testing, management including nutrition, exercise, and pharmacotherapy, and complications. A meta-analysis is summarized that found disease management programs involving care from diabetes managers can significantly reduce hemoglobin A1C levels compared to usual care, especially when the manager can modify treatment.

1. Presented by
Karan choudhary
CON AIIMS JODHPUR
Diabetes Mellitus

2. INTRODUCTION
Diabetes - comes from the Greek
word from “siphon” which means
passing through urine
Mellitus – comes from the Latin word
which means - sugar

3. Continue,,
• According to the Indian Council of Medical Research Indian Diabetes
study a India currently has 63 million people with diabetes.
• India represents the world's second largest diabetes population after
China.
• The majority of people with diabetes (>90%) have Type 2 diabetes
(T2DM).

4. NORMAL ANATOMY AND PHYSIOLOGY
•It is also called as sweet
gland /mix gland of body.
•Weight - 50-60 gram
•Situation -situated in left
hypochondriac region.
•Leaf like structure.

5. EXOCRINE PANCREAS
The exocrine pancreas secrete pancreatic juice /pancreatic enzyme
and bicarbonate.
The secretions of the exocrine portion of the pancreas are collected in
the pancreatic duct, which joins the common bile duct and enters the
duodenum at the ampulla of Vater. Surrounding the ampulla is the
sphincter of Oddi, which partially controls the rate at which secretions
from the pancreas and the gallbladder enter the duodenum.

6. Endocrine Pancreas
The endocrine part of the pancreas, are collections
of cells embedded in the pancreatic tissue. They
are composed of alpha, beta, and delta cells

7. INSULIN-
•Release by beta cell of pancreas
•Insuline is a anabolic hormone so decrease

8. GLUCAGON
It is a counter regulatory hormone of
insulin.,secrete by alpha 2 cell of pancreas.
It promote gluconeogenesis.

9. SOMATOSTATIN
It release by delta cell of pancreas which
decrease secretion of insulin glucagon and
growth hormone.

10. Definition of Diabetes Melitus.
diabetes mellitus is metabolic disorder
(anabolic) in which partial or complete
de
fi
ciency of insulin characterised by altered
metabolism of carbohydrate , fat, and
protein menifested by
hyperglycemia,polyuria,and hypercalcemia.

11. Types of Diabetes Mellitus
Type 1st diabetes mellitus Type 2nd diabetes mellitus
Type 1st diabetes mellitus Type 2nd diabetes mellitus
It is a condition
characterised by
complete or absolute
lack of insulin in body,
so body depend on
exogenous insulin. And
altered metabolism of
carbohydrate protein
and fat
It is a condition
characterised by partial
deficiency of insulin so
sufficient insulin
produce for metabolism
of fat and protein not for
carbohydrate so body
depend on oral
hypoglycaemic agent

12. Type 1st diabetes mellitus Type 2nd diabetes mellitus
Cause Cause
Autoimmune disease
Destruction beta cell
of pancreas
Traumatic pancreatic
injury.
Pancreatomy
Drugs
hereditary
Increase demand of
insulin
High sweet intake
Decrease insulin
secretion

13. RISK FACTORS
Family history of diabetes
Obesity
Age ≥45 years
Hypertension
History of gestational diabetes or delivery
of a baby over 9 Ib

14. Clinical Manifestations
•Hyperglycemia
•Polyuria
•polyphasia
•polydipsia
•Glycosuria
•Weight loss
•Hyperlipidemia
•Hypertension
•Increase serum cholesterol level
•Poor wound healing
•Wet gangrene

15. Contd,,
•Blurred vision
•Snow flake cataract
•Hyperkalemia
•Cardiac dysrhythmia
•Hyponatremia
•Hypercalcemia
•Hypermagnesemia
•Hypophosphatamia

16. Diagnostic finding
History collection
Phvsical Examination
Laboratory examination
•Oral glucose tolerance test (OGTT)
•Glucose memory test/Australian test
•Urine analysis- to detect type of diabetes
mellitus
•Pancreatic angiography

17. Management of diabetes mellitus
The treatment of diabetes is a combination of nutritional therapy,
exercise and pharmacotherapy.
Pharmacotherapy: The pharmacotherapy treatment of diabetes depends
upon the type of diabetes.
Oral hypoglycaemic agent-
Bugainides
Metformin
Sulfonylurea -
The sulphonylureas stimulate insulin secretion by the beta cell of
pancreas.
glipizide, glimepiride.

18. Contd,,
Insulin therapy-
1. Very short acting insulin
Example- lispro humalog, glulisine
2.Short acting insulin - humaline R (regular insulin)
3.Intermediate acting insulin-humaline N (NPH)/
lente
4.Long acting- glargine/ultralente
5.Very long acting insulin- mixtard

19. Side effects of insulin therapy
•Hypoglycaemia
•Lipodystropy,
•lipohypertrophy
•Down phenomena
•Somagyi phenomena

20. NUTRITIONAL MANAGEMENT
Nutrition, diet, and weight control are the foundation of diabetes
management.
Nutritional Composition of the Diet: The nutrition should contain
carbohydrate, fats and protein intake in the right amount. The caloric
intake should be an average 30 Kcal /kg body weight.
•low carbohydrate diet is given
•Fat intake: low fat diet is given
• In overweight persons or those with dyslipidemia, fat intake should
be reduced to as low as 15% of the caloric intake
• Intake of protein should be 10 to 20% of the total daily caloric
intake.
•Potassium restricted diet is given.

21. Exercise
Exercise lowers the blood glucose level,
encourages weight loss, reduces cardiovascular
risks, improves circulation and muscle tone,
decreases total cholesterol and triglyceride
levels, and decreases insulin resistance and
glucose intolerance .
Instruct the client with diabetes mellitus to
monitor the blood glucose level before, during,
and after exercising.

22. Complication
Complication of type 1st diabetes mellitus.
•Diabetes ketoacidosis
•Diabetes retinopathy
•Diabetes nephropathy
•Diabetes neuropathy
Complication of type 2nd diabetes mellitus.
Hyperglycaemic hyperosmolar non ketotic
syndrome.

23. Summary

24. CONCLUSION
Diabetes is a very complicated disease. It is easy to
diagnosis and it is difficult to treat Laboratory
plays an important part in the diagnosis and care of
diabetic patients its complications can be reduced
through proper awareness and timely treatment.
Three major complications are related to blindness,
kidney damage and heart attack. It is important to
keep the blood glucose levels of patients under
strict control for avoiding the complications.

25. Research article
Effectiveness of disease management
programs for improving diabetes care: a
meta-analysis.

26. Abstract
Background We conducted a meta-analysis of randomized controlled
trials to assess the effectiveness of disease-management programs for
improving glycemic control in adults with diabetes mellitus and to study
which components of programs are associated with their effectiveness.
Methods
We searched several databases for studies published up to December
2009. We included randomized controlled trials involving adults with
type 1 or 2 diabetes that evaluated the effect of disease-management
programs on glycolated hemoglobin concentrations. We performed a
meta regression analysis to determine the effective components of the
programs.

27. Results
We included 41 randomized controlled trials in our
review. Across these trials, disease-management
programs resulted in a significant reduction in
hemoglobin Arc levels The finding was robust in the
sensitivity analyses based on quality assessment.
Programs in which the disease manager was able to
start or modify treatment with or without prior
approval from the primary care physician resulted in
a greater improvement in hemoglobin levels

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