This document provides an overview of diabetes mellitus (DM), including its anatomy, physiology, epidemiology, classification, diagnosis, complications, and treatment. It discusses the two main types of DM - type 1 caused by beta cell destruction leading to insulin deficiency, and type 2 caused by insulin resistance and impaired insulin secretion. Key facts include that DM affects over 382 million people worldwide, is classified based on etiology, and can be diagnosed through blood glucose and A1C levels. Treatment involves lifestyle changes, glucose-lowering medications like insulin and sulfonylureas, and managing complications to control blood sugar levels.
The document discusses diabetes mellitus (DM), including its classification into types 1 and 2, gestational diabetes, and other types. It covers the anatomy and functions of the pancreas, which produces insulin and digestive enzymes. Diagnostic criteria for DM include hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests. Complications of uncontrolled DM are also mentioned. Treatment involves lifestyle changes, insulin therapy, and managing comorbidities.
Nursing Management · Monitor blood sugar and use a sliding scale to treat high levels of glucose · Educate patient about diabetes · Examine feet .
Diagnosis involves measuring blood glucose levels. Ongoing specialized assessment and evaluation for complications are essential for diabetes management.
The document discusses diabetes, including:
- Diabetes is a group of metabolic disorders characterized by hyperglycemia due to defects in insulin secretion or action.
- India currently has 63 million people with diabetes, the second highest number after China.
- There are two main types of diabetes - type 1 caused by beta cell destruction leading to insulin deficiency, and type 2 caused by insulin resistance and relative insulin deficiency.
- Treatment involves diet, exercise, oral medications like metformin and sulfonylureas, and sometimes insulin therapy. The goal is to control blood sugar levels and prevent complications like damage to eyes, kidneys, nerves, and blood vessels.
Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
Screening Models for Anti-Diabetic Drugs.Nisar Ali
in this slide, You will get to know about different screening Invivo and Invitro models used for screening of Anti-Diabetic drugs used in Pharmacology.
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
Alpha-amylase inhibitors: alternative approach for the treatment of type 2 di...RajdeepaKundu
This document discusses alpha-amylase inhibitors as an alternative treatment for type 2 diabetes. It begins by introducing diabetes and its causes and symptoms. It then discusses the different types of diabetes and current diabetes medication options. Finally, it focuses on alpha-amylase inhibitors, explaining that they work by inhibiting the alpha-amylase enzyme involved in starch digestion, which helps control post-meal blood sugar spikes for type 2 diabetes patients.
This document is a case study submitted by Reynel Dan L. Galicinao to their professor Prof. Maricar M. Mutia at Misamis University's Graduate School. It discusses diabetes mellitus-II with chronic kidney disease-IV, covering topics like insulin secretion and function, classifications of diabetes, diagnostic tests, and general procedures and treatment modalities. Key points include the different types of diabetes, factors that affect insulin and blood glucose levels, laboratory tests used to diagnose and monitor diabetes, and nursing considerations for administering those tests.
The document discusses diabetes mellitus (DM), including its classification into types 1 and 2, gestational diabetes, and other types. It covers the anatomy and functions of the pancreas, which produces insulin and digestive enzymes. Diagnostic criteria for DM include hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests. Complications of uncontrolled DM are also mentioned. Treatment involves lifestyle changes, insulin therapy, and managing comorbidities.
Nursing Management · Monitor blood sugar and use a sliding scale to treat high levels of glucose · Educate patient about diabetes · Examine feet .
Diagnosis involves measuring blood glucose levels. Ongoing specialized assessment and evaluation for complications are essential for diabetes management.
The document discusses diabetes, including:
- Diabetes is a group of metabolic disorders characterized by hyperglycemia due to defects in insulin secretion or action.
- India currently has 63 million people with diabetes, the second highest number after China.
- There are two main types of diabetes - type 1 caused by beta cell destruction leading to insulin deficiency, and type 2 caused by insulin resistance and relative insulin deficiency.
- Treatment involves diet, exercise, oral medications like metformin and sulfonylureas, and sometimes insulin therapy. The goal is to control blood sugar levels and prevent complications like damage to eyes, kidneys, nerves, and blood vessels.
Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
Screening Models for Anti-Diabetic Drugs.Nisar Ali
in this slide, You will get to know about different screening Invivo and Invitro models used for screening of Anti-Diabetic drugs used in Pharmacology.
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
Alpha-amylase inhibitors: alternative approach for the treatment of type 2 di...RajdeepaKundu
This document discusses alpha-amylase inhibitors as an alternative treatment for type 2 diabetes. It begins by introducing diabetes and its causes and symptoms. It then discusses the different types of diabetes and current diabetes medication options. Finally, it focuses on alpha-amylase inhibitors, explaining that they work by inhibiting the alpha-amylase enzyme involved in starch digestion, which helps control post-meal blood sugar spikes for type 2 diabetes patients.
This document is a case study submitted by Reynel Dan L. Galicinao to their professor Prof. Maricar M. Mutia at Misamis University's Graduate School. It discusses diabetes mellitus-II with chronic kidney disease-IV, covering topics like insulin secretion and function, classifications of diabetes, diagnostic tests, and general procedures and treatment modalities. Key points include the different types of diabetes, factors that affect insulin and blood glucose levels, laboratory tests used to diagnose and monitor diabetes, and nursing considerations for administering those tests.
Includes Information about Pharmacotherapeutic of Diabetes Mellitus, all details about etiology, Pathophysiology, pharmacology, treatment, current clinical trials on DM etc.
This document defines and describes various types of diabetes. It begins by defining diabetes mellitus as a chronic disease related to abnormal insulin production or utilization. The two most common types are type 1 and type 2 diabetes. Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells and requires lifelong insulin treatment. Type 2 diabetes is caused by insulin resistance and relative insulin deficiency and accounts for over 90% of diabetes cases. Other types discussed include gestational diabetes and secondary/prediabetes. The document provides detailed information on the pathogenesis, clinical presentation, diagnosis and management of the different diabetes types.
Diabetes mellitus and diabetes insipidusShweta Sharma
This document provides information on diabetes mellitus and diabetes insipidus. It discusses the types, causes, signs and symptoms, diagnostic evaluation, and management of both conditions. Diabetes mellitus is characterized by high blood glucose levels due to insufficient insulin production or action. Diabetes insipidus is caused by a deficiency of antidiuretic hormone, resulting in excessive urine production and thirst. The document outlines the different etiologies, pathophysiology, clinical presentation, and treatment approaches for diabetes mellitus and diabetes insipidus.
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel.
Diabetes mellitus is a chronic disease characterized by high blood glucose levels resulting from insufficient insulin production or utilization. It manifests as two primary types: type 1 autoimmune disease destroying pancreatic beta cells and type 2 metabolic disease caused by insulin resistance. Complications include microvascular and macrovascular diseases, diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, and chronic renal failure. Nursing care focuses on stabilizing glucose levels, educating patients on self-care, and optimizing therapeutic regimen management through addressing potential barriers.
Diabetes mellitus, disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar (glucose) in the blood.
To know more about diabetes mellitus click on the below link
https://docmode.org/about/
https://docmode.org/lectures/
The Presentation gives a detailed idea of Medicinal Chemistry and Pharmacology of Hypoglycemic agents useful for undergraduate and postgraduate students in Pharmacy, Medicine, Nursing, Pharmacology and Medicinal Chemistry
diabetes Millitus in children , causes ,diagnosis and treatmentmiroelsayed1
This document provides an overview of diabetes mellitus in children. It defines diabetes as a metabolic disorder characterized by high blood sugar levels. The main types of diabetes in children are type 1, type 2, and gestational diabetes. Type 1 diabetes is caused by the body's immune system destroying insulin-producing cells. Symptoms, diagnosis, treatment including insulin administration, complications like diabetic ketoacidosis, and future treatments are discussed. Effective management requires a team approach involving medical professionals like endocrinologists, dietitians, nurses, and the patient/family.
Type 1 diabetes is an autoimmune disease where the body's immune system attacks and destroys the beta cells in the pancreas that produce insulin. It most commonly affects children and adolescents. The patient, Rachel, was diagnosed with type 1 diabetes based on her symptoms of weight loss, increased thirst and urination, and a blood glucose level over 200 mg/dL. She was prescribed a regimen of glargine insulin in the morning and evening and Apidra insulin before meals based on her carbohydrate intake to manage her condition. Strict adherence to insulin therapy and blood glucose monitoring is necessary to prevent complications and achieve optimal glycemic control.
1) DPP-4 inhibitors are a class of oral anti-diabetic drugs that work by inhibiting the DPP-4 enzyme and increasing incretin levels.
2) A recent study showed DPP-4 inhibitors provide effective glycemic control with a low risk of hypoglycemia in elderly patients with diabetes.
3) Linagliptin has a unique non-renal elimination pathway and does not require dose adjustment in patients with renal or hepatic impairment.
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
ueda2012 -incretin based therapy of type 2 diabetes mellitus_d.adelueda2015
(1) Sitagliptin is an oral dipeptidyl peptidase-IV (DPP-IV) inhibitor that works by inhibiting the breakdown of glucagon-like peptide-1 (GLP-1), allowing endogenous GLP-1 to remain active for longer and improve glycemic control. (2) In clinical trials comparing sitagliptin to sulfonylurea as an add-on to metformin, sitagliptin provided comparable reductions in HbA1c levels over 52 weeks and two years with a lower risk of hypoglycemia and weight gain. (3) The efficacy of sitagliptin in reducing HbA1c was associated with higher
This document discusses diabetes mellitus and the nurse's role in managing it. It defines diabetes as a group of diseases involving problems with the hormone insulin that can occur when the pancreas produces little or no insulin or the body does not respond appropriately to insulin. It then discusses the types of diabetes (type 1, type 2, gestational), risk factors, signs and symptoms, tests, and complications. Finally, it outlines the necessary skills for nurses in diabetes management, including analytical skills, communication skills, attention to detail, and interpersonal skills to effectively provide care and make appropriate treatment adjustments.
This document provides information about diabetes mellitus (DM) and diabetic ketoacidosis (DKA). It discusses the main types of DM including type 1, type 2, and gestational diabetes. Type 1 results from pancreatic failure to produce insulin, type 2 from insulin resistance, and gestational occurs in pregnant women. Worldwide, 382 million people have DM. Management focuses on diet, exercise, medication and monitoring to control blood sugar levels. Insulin is used to treat type 1 and sometimes type 2 DM, while other classes of oral medications are also used to treat type 2.
This document provides information about diabetes mellitus (DM) and diabetic ketoacidosis (DKA). It discusses the main types of DM including type 1, type 2, and gestational diabetes. Type 1 results from pancreatic failure to produce insulin, while type 2 begins with insulin resistance and can later include insulin deficiency. Gestational diabetes occurs in pregnant women without prior history. The document also covers epidemiology, pathophysiology, diagnosis, management, treatment options including insulin, oral medications, diet/exercise, and complications of uncontrolled diabetes.
Type 1 diabetes is caused by the immune system destroying insulin-producing cells. Type 2 diabetes is caused by insulin resistance and relative insulin deficiency. Gestational diabetes occurs during pregnancy due to increased insulin needs. Diabetes is managed through diet, exercise, medication including insulin, and monitoring of blood sugar levels. Complications of uncontrolled diabetes include foot ulcers and infections, ketoacidosis, and other conditions.
This document provides information on diabetes mellitus. It begins with objectives of reviewing the anatomy of the pancreas and classifications, signs, and treatments of diabetes. It then covers the anatomy of the pancreas and classifications of diabetes types I and II. Key differences and clinical manifestations are described for each type. Complications are identified including cardiovascular, renal, and neurological issues. The document concludes with nursing diagnoses and interventions for managing diabetes.
This document provides a summary of diabetes mellitus (DM), including its definition, presentation, classifications, complications, investigations, and management. DM results from lack of or diminished insulin effectiveness and is characterized by hyperglycemia. There are two main types: type 1 DM is insulin-dependent while type 2 DM is non-insulin dependent initially but may eventually require insulin. Complications can include infections, neuropathy, retinopathy, and vascular diseases. Management involves lifestyle changes like diet and exercise as well as medications and insulin to manage blood glucose levels and prevent complications.
Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar levels resulting from defects in insulin secretion or action. There are three main types of diabetes: type 1 diabetes where the body does not produce insulin; type 2 diabetes where the body does not produce enough insulin or cells do not respond properly to insulin; and gestational diabetes which develops during pregnancy. Risk factors include heredity, obesity, age, and unhealthy lifestyle habits. Symptoms include increased thirst, hunger, urination, fatigue, and weight loss. Treatment involves diet, exercise, medication including insulin injections, and blood sugar monitoring. Complications can affect the kidneys, nerves, eyes, and heart if not properly managed.
This document summarizes benign prostatic hyperplasia (BPH). It discusses the pathology and pathogenesis of BPH, including that it affects glandular epithelium, stromal cells, and causes increased growth. It also covers the symptomatology, evaluation, and various treatment options for BPH including watchful waiting, medical therapy, and prostatectomies. Surgical treatments discussed are transurethral resection of the prostate (TURP), retropubic prostatectomy (RPP), and transvesical prostatectomy (TVP).
This document provides an introduction to pathology. It defines pathology as the study of disease through scientific methods and examines the mechanisms of disease from etiology to clinical manifestation. The key points are:
1. Pathology studies the etiology, pathogenesis, morphologic changes, and functional derangements that result from disease processes.
2. Diseases are examined through diagnostic techniques including histopathology, cytopathology, and biochemical/immunological testing to identify structural and molecular alterations.
3. The natural course of a disease involves stages from initial exposure through biological onset, clinical onset, potential resolution or death.
Includes Information about Pharmacotherapeutic of Diabetes Mellitus, all details about etiology, Pathophysiology, pharmacology, treatment, current clinical trials on DM etc.
This document defines and describes various types of diabetes. It begins by defining diabetes mellitus as a chronic disease related to abnormal insulin production or utilization. The two most common types are type 1 and type 2 diabetes. Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells and requires lifelong insulin treatment. Type 2 diabetes is caused by insulin resistance and relative insulin deficiency and accounts for over 90% of diabetes cases. Other types discussed include gestational diabetes and secondary/prediabetes. The document provides detailed information on the pathogenesis, clinical presentation, diagnosis and management of the different diabetes types.
Diabetes mellitus and diabetes insipidusShweta Sharma
This document provides information on diabetes mellitus and diabetes insipidus. It discusses the types, causes, signs and symptoms, diagnostic evaluation, and management of both conditions. Diabetes mellitus is characterized by high blood glucose levels due to insufficient insulin production or action. Diabetes insipidus is caused by a deficiency of antidiuretic hormone, resulting in excessive urine production and thirst. The document outlines the different etiologies, pathophysiology, clinical presentation, and treatment approaches for diabetes mellitus and diabetes insipidus.
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel.
Diabetes mellitus is a chronic disease characterized by high blood glucose levels resulting from insufficient insulin production or utilization. It manifests as two primary types: type 1 autoimmune disease destroying pancreatic beta cells and type 2 metabolic disease caused by insulin resistance. Complications include microvascular and macrovascular diseases, diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, and chronic renal failure. Nursing care focuses on stabilizing glucose levels, educating patients on self-care, and optimizing therapeutic regimen management through addressing potential barriers.
Diabetes mellitus, disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar (glucose) in the blood.
To know more about diabetes mellitus click on the below link
https://docmode.org/about/
https://docmode.org/lectures/
The Presentation gives a detailed idea of Medicinal Chemistry and Pharmacology of Hypoglycemic agents useful for undergraduate and postgraduate students in Pharmacy, Medicine, Nursing, Pharmacology and Medicinal Chemistry
diabetes Millitus in children , causes ,diagnosis and treatmentmiroelsayed1
This document provides an overview of diabetes mellitus in children. It defines diabetes as a metabolic disorder characterized by high blood sugar levels. The main types of diabetes in children are type 1, type 2, and gestational diabetes. Type 1 diabetes is caused by the body's immune system destroying insulin-producing cells. Symptoms, diagnosis, treatment including insulin administration, complications like diabetic ketoacidosis, and future treatments are discussed. Effective management requires a team approach involving medical professionals like endocrinologists, dietitians, nurses, and the patient/family.
Type 1 diabetes is an autoimmune disease where the body's immune system attacks and destroys the beta cells in the pancreas that produce insulin. It most commonly affects children and adolescents. The patient, Rachel, was diagnosed with type 1 diabetes based on her symptoms of weight loss, increased thirst and urination, and a blood glucose level over 200 mg/dL. She was prescribed a regimen of glargine insulin in the morning and evening and Apidra insulin before meals based on her carbohydrate intake to manage her condition. Strict adherence to insulin therapy and blood glucose monitoring is necessary to prevent complications and achieve optimal glycemic control.
1) DPP-4 inhibitors are a class of oral anti-diabetic drugs that work by inhibiting the DPP-4 enzyme and increasing incretin levels.
2) A recent study showed DPP-4 inhibitors provide effective glycemic control with a low risk of hypoglycemia in elderly patients with diabetes.
3) Linagliptin has a unique non-renal elimination pathway and does not require dose adjustment in patients with renal or hepatic impairment.
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
ueda2012 -incretin based therapy of type 2 diabetes mellitus_d.adelueda2015
(1) Sitagliptin is an oral dipeptidyl peptidase-IV (DPP-IV) inhibitor that works by inhibiting the breakdown of glucagon-like peptide-1 (GLP-1), allowing endogenous GLP-1 to remain active for longer and improve glycemic control. (2) In clinical trials comparing sitagliptin to sulfonylurea as an add-on to metformin, sitagliptin provided comparable reductions in HbA1c levels over 52 weeks and two years with a lower risk of hypoglycemia and weight gain. (3) The efficacy of sitagliptin in reducing HbA1c was associated with higher
This document discusses diabetes mellitus and the nurse's role in managing it. It defines diabetes as a group of diseases involving problems with the hormone insulin that can occur when the pancreas produces little or no insulin or the body does not respond appropriately to insulin. It then discusses the types of diabetes (type 1, type 2, gestational), risk factors, signs and symptoms, tests, and complications. Finally, it outlines the necessary skills for nurses in diabetes management, including analytical skills, communication skills, attention to detail, and interpersonal skills to effectively provide care and make appropriate treatment adjustments.
This document provides information about diabetes mellitus (DM) and diabetic ketoacidosis (DKA). It discusses the main types of DM including type 1, type 2, and gestational diabetes. Type 1 results from pancreatic failure to produce insulin, type 2 from insulin resistance, and gestational occurs in pregnant women. Worldwide, 382 million people have DM. Management focuses on diet, exercise, medication and monitoring to control blood sugar levels. Insulin is used to treat type 1 and sometimes type 2 DM, while other classes of oral medications are also used to treat type 2.
This document provides information about diabetes mellitus (DM) and diabetic ketoacidosis (DKA). It discusses the main types of DM including type 1, type 2, and gestational diabetes. Type 1 results from pancreatic failure to produce insulin, while type 2 begins with insulin resistance and can later include insulin deficiency. Gestational diabetes occurs in pregnant women without prior history. The document also covers epidemiology, pathophysiology, diagnosis, management, treatment options including insulin, oral medications, diet/exercise, and complications of uncontrolled diabetes.
Type 1 diabetes is caused by the immune system destroying insulin-producing cells. Type 2 diabetes is caused by insulin resistance and relative insulin deficiency. Gestational diabetes occurs during pregnancy due to increased insulin needs. Diabetes is managed through diet, exercise, medication including insulin, and monitoring of blood sugar levels. Complications of uncontrolled diabetes include foot ulcers and infections, ketoacidosis, and other conditions.
This document provides information on diabetes mellitus. It begins with objectives of reviewing the anatomy of the pancreas and classifications, signs, and treatments of diabetes. It then covers the anatomy of the pancreas and classifications of diabetes types I and II. Key differences and clinical manifestations are described for each type. Complications are identified including cardiovascular, renal, and neurological issues. The document concludes with nursing diagnoses and interventions for managing diabetes.
This document provides a summary of diabetes mellitus (DM), including its definition, presentation, classifications, complications, investigations, and management. DM results from lack of or diminished insulin effectiveness and is characterized by hyperglycemia. There are two main types: type 1 DM is insulin-dependent while type 2 DM is non-insulin dependent initially but may eventually require insulin. Complications can include infections, neuropathy, retinopathy, and vascular diseases. Management involves lifestyle changes like diet and exercise as well as medications and insulin to manage blood glucose levels and prevent complications.
Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar levels resulting from defects in insulin secretion or action. There are three main types of diabetes: type 1 diabetes where the body does not produce insulin; type 2 diabetes where the body does not produce enough insulin or cells do not respond properly to insulin; and gestational diabetes which develops during pregnancy. Risk factors include heredity, obesity, age, and unhealthy lifestyle habits. Symptoms include increased thirst, hunger, urination, fatigue, and weight loss. Treatment involves diet, exercise, medication including insulin injections, and blood sugar monitoring. Complications can affect the kidneys, nerves, eyes, and heart if not properly managed.
This document summarizes benign prostatic hyperplasia (BPH). It discusses the pathology and pathogenesis of BPH, including that it affects glandular epithelium, stromal cells, and causes increased growth. It also covers the symptomatology, evaluation, and various treatment options for BPH including watchful waiting, medical therapy, and prostatectomies. Surgical treatments discussed are transurethral resection of the prostate (TURP), retropubic prostatectomy (RPP), and transvesical prostatectomy (TVP).
This document provides an introduction to pathology. It defines pathology as the study of disease through scientific methods and examines the mechanisms of disease from etiology to clinical manifestation. The key points are:
1. Pathology studies the etiology, pathogenesis, morphologic changes, and functional derangements that result from disease processes.
2. Diseases are examined through diagnostic techniques including histopathology, cytopathology, and biochemical/immunological testing to identify structural and molecular alterations.
3. The natural course of a disease involves stages from initial exposure through biological onset, clinical onset, potential resolution or death.
This document provides an overview of preeclampsia and eclampsia. It begins with an introduction and outlines risk factors and classifications. It then describes clinical features such as hypertension and proteinuria. The pathophysiology section explains how abnormal placentation leads to reduced blood flow and imbalance of prostaglandins. Complications are also discussed, including renal failure, pulmonary edema, and intrauterine growth restriction. The document provides information on diagnosis and management of preeclampsia and eclampsia.
This seminar presentation discusses hypersensitivity reactions, which are exaggerated or inappropriate immune responses to benign antigens. It covers the objectives, mechanisms, classification, complications, and references related to hypersensitivity reactions. There are four main types of hypersensitivity reactions: Type I involves IgE antibodies and mast cell degranulation, Type II involves antibody-mediated cell cytotoxicity, Type III involves immune complex formation and deposition, and Type IV involves T-cell mediated reactions. The presentation provides examples and details of each type of hypersensitivity reaction and their clinical implications.
This document discusses inflammation. It defines inflammation as the body's local response to injury or infection aimed at eliminating the cause of injury and initiating repair. The cardinal signs of inflammation are redness, swelling, heat, pain, and loss of function. The early response involves vasodilation and increased permeability, causing swelling. The late response involves neutrophils in acute inflammation and macrophages in chronic cases, which work to destroy pathogens and initiate healing. Understanding inflammation is important for diagnosing conditions like appendicitis and treating diseases.
This document provides an overview of hyaline membrane disease (HMD), also known as respiratory distress syndrome (RDS), for nursing students. It defines RDS as a lack of pulmonary surfactant, outlines its pathophysiology and risk factors. The document discusses the clinical presentation of RDS, including respiratory distress, radiographic findings and laboratory abnormalities. It also covers diagnosis, differential diagnoses, treatment including surfactant replacement and supportive care, complications and prevention of RDS through antenatal corticosteroids.
1. Acute inflammation is rapid in onset and short in duration, characterized by fluid and protein exudation and neutrophil accumulation. Chronic inflammation is slower in onset and longer lasting, characterized by mononuclear cell infiltration, ongoing tissue destruction, and attempts at repair through fibrosis.
2. The key features of acute inflammation are vasodilation, increased vascular permeability, and recruitment of leukocytes from the blood vessels to the site of injury. Chronic inflammation features mononuclear cell infiltration, persistent tissue damage, and attempts to repair through fibrosis and angiogenesis.
3. Granulomatous inflammation is a pattern of chronic inflammation seen with certain infections, featuring focal collections of activated macrophages that develop an epithelial-like appearance known
Cellular injury can result in adaptation, reversible injury, irreversible injury leading to necrosis or apoptosis, or intracellular accumulation. The outcome depends on the injurious agent and cell type. Adaptations include hypertrophy, hyperplasia, atrophy, and metaplasia. Reversible injury includes fatty changes and pigment accumulation. Necrosis is cell death resulting from hypoxia, free radicals, membrane damage, or calcium influx. There are several types of necrosis including coagulative, liquefactive, fat, caseous, and gangrenous. Apoptosis is programmed cell death that does not cause inflammation.
This document discusses pelvic inflammatory disease (PID) and ectopic pregnancy. It defines PID as an infection of the upper female genital tract that spreads to involve the uterus, fallopian tubes, and ovaries. Common causes are Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis. Risk factors include multiple sexual partners and past gynecological procedures. Symptoms can range from mild to severe abdominal pain. Diagnosis involves clinical exams and tests. Complications include infertility and ectopic pregnancy. Ectopic pregnancy is defined as implantation outside the uterus, most commonly in the fallopian tube. Causes may include anatomical obstructions or abnormalities in the fallop
The document discusses acid-base balance and disturbances. It defines the two main buffer systems - metabolic (kidneys) and respiratory (lungs) - that work to maintain blood pH between 7.35-7.45. Five primary acid-base imbalances are described: metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis, and mixed disturbances. Diagnosis involves blood tests including arterial blood gases and electrolytes to classify the disturbance based on pH, PCO2, and bicarbonate levels. Treatment focuses on addressing the underlying cause rather than just the pH effect.
This document provides an overview of autoimmune diseases. It defines autoimmune diseases as conditions where the immune system mistakenly attacks and destroys healthy body tissue. The causes include genetic factors, environmental triggers like infections, and defects in immunologic tolerance. Some specific autoimmune diseases discussed are rheumatoid arthritis, type 1 diabetes, Hashimoto's thyroiditis, Graves' disease, myasthenia gravis, and systemic sclerosis. The mechanisms, clinical features, pathology, and treatment options are described for each condition.
Patient safety is a fundamental principle of healthcare. Adverse events may result from problems in practice, products, procedures or systems. Improving patient safety demands a complex, system-wide effort involving performance improvement, risk management, infection control, safe clinical practices, and a safe environment of care. Unsafe injections expose millions of people to infections worldwide each year. Ensuring single-use injection devices and safety boxes are available in every healthcare facility can prevent reuse and unsafe waste disposal.
The document discusses integumentary disorders and provides information on the anatomy and functions of the skin. It describes common skin conditions like eczema, acne, and psoriasis. Eczema is characterized by redness, dryness, and itching. Acne presents as inflamed papules and pustules on the face and back. Psoriasis causes thickened red patches covered with silvery scales. The document outlines signs, causes, and management approaches for various dermatological disorders and skin lesions.
A nebulizer converts liquid medication into a mist that can be inhaled directly into the lungs, allowing for rapid onset of medication effects. There are different types of nebulizers that administer medication via mouthpiece or mask. Nebulizers are commonly used to treat conditions involving airflow obstruction like asthma. Proper use involves preparing equipment and medication, positioning the patient, administering the treatment, and monitoring for side effects.
This document provides an overview of the endocrine system, including the major glands and hormones. It describes the hypothalamus and pituitary glands which regulate many other endocrine glands. Other glands covered include the thyroid, parathyroid, adrenal, pancreas, ovaries, testes, thymus, and pineal. The document outlines how to assess endocrine disorders and lists some common laboratory studies. It also provides details on diabetes mellitus, describing the main types of diabetes including type 1, type 2, and gestational diabetes.
This document provides guidance on performing a cardiac and abdominal examination. It outlines the objectives, symptoms, and physical examination techniques for assessing the cardiovascular and abdominal systems. The cardiovascular section covers inspection of the jugular veins, palpation of pulses, auscultation of heart sounds, and measurement of blood pressure. The abdominal section reviews inspection, auscultation, percussion and palpation techniques. Proper examination order and identification of normal versus abnormal findings are emphasized.
This document summarizes several endocrine system disorders including hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism, Cushing's syndrome, Conn's syndrome, Addison's disease, and pituitary adenomas. It provides epidemiological data on certain disorders and describes associated symptoms, diagnostic evaluations, and medical management approaches. Multiple endocrine neoplasia syndromes are also briefly discussed.
This document provides guidance on effectively breaking bad news to patients. It discusses the importance of this communication skill for healthcare professionals. The document outlines best practices for setting, perception checking, invitation, knowledge sharing, exploring the patient's response, and summarizing. Key aspects include ensuring privacy, empathy, clarity, and allowing time for the patient's questions and reactions. The SPIKES protocol is presented as a framework for structuring the discussion. Examples of both best practices and things to avoid are also highlighted.
2 Assessment of patient with respiratory disorder.pptxMohammedAbdela7
This document provides guidelines for performing a physical examination of the thorax and lungs. It begins by outlining the session objectives and general examination guidelines. It then discusses pertinent history data to obtain, such as cough characteristics and sputum type/color. The physical exam involves inspection, palpation, percussion, and auscultation of the chest. Inspection evaluates breathing patterns, respiratory distress signs, and overall appearance. Palpation assesses tracheal position, chest expansion, tactile fremitus, and tenderness. Percussion and auscultation are also performed to evaluate the lungs. Proper equipment, patient positioning, and exam techniques are emphasized throughout.
This document provides an overview of critical thinking, evidence-based medicine, and how to practice evidence-based medicine. It defines critical thinking as the process of conceptualizing and evaluating information to guide beliefs and actions. Evidence-based medicine is defined as integrating the best research evidence with clinical expertise and patient values/circumstances. The history of evidence-based medicine is discussed, from Cochrane's work in the 1970s highlighting gaps between research and practice, to Guyatt coining the term "evidence-based medicine" in 1991 and Sackett explaining the combination of research, expertise, and patient factors in 1996. The five steps to practice evidence-based medicine are described as developing questions, finding evidence, appraising evidence, integrating
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
3. 1/1/2020 Prof. Dr. RS Mehta 3
Anatomy and physiology of Pancrease
• Pancreas is a narrow, 6 inch long gland that
lies posterior and inferior to stomach on left
side of abdominal cavity.
• Pancreas extends laterally and superiorly
across abdomen from the curve of
duodenum to spleen.
• The head of pancreas, which connects to the
duodenum, is the widest region.
• The glandular tissue surrounds many small
ducts that drain into the central pancreatic
duct.
4. 1/1/2020 Prof. Dr. RS Mehta 4
Functions
Pancreas is a dual-function gland, having features of
both endocrine and exocrine glands.
Endocrine
• Pancreas with endocrine function is made of million
cell called islets of Langerhans.
• Four main cell types in the islets: α alpha cells-
glucagon(increase glucose in blood), β beta cells-
insulin (decrease glucose in blood), Δ delta cells-
somatostatin (regulates/stops α and β cells) and PP
cells , or γ (gamma) cells, secrete pancreatic
polypeptide.
6. 1/1/2020 Prof. Dr. RS Mehta 6
Exocrine
• Secretes pancreatic fluid that contains digestive
enzymes that pass to small intestine.
• These enzymes help to further break down
carbohydrates, proteins and lipids (fats) in the chyme.
• Digestive enzymes include trypsin, chymotrypsin,
pancreatic lipase, and pancreatic amylase, and are
produced and secreted by acinar cells of the exocrine
pancreas.
• Specific cells lining pancreatic ducts, called
centroacinar cells, secrete bicarbonate- and salt-rich
solution into the small intestine.
9. 1/1/2020 Prof. Dr. RS Mehta 9
Introduction
• Diabetes Mellitus (DM) refers to a group of common
metabolic disorders that share the phenotype of
hyperglycemia.
• Caused by complex interaction of genetics and
environmental factor.
• Factors – reduced insulin secretion, decreased glucose
utilization, and increased glucose production.
10. 1/1/2020 Prof. Dr. RS Mehta 10
Epidemiology
According to International Diabetes
South EastAsia:
382 million people have diabetes in
Federation,
the world
and more than 72.1 million people in the South East
Asia Region; by 2035 this will rise to 123 million.
There were 674,120 cases of diabetes in Nepal in
2013.
11. 1/1/2020 Prof. Dr. RS Mehta 11
Classification
• Type 1 diabetes (due to β-cell destruction, usually
leading to absolute insulin deficiency).
secretory defect on the background of
• Type 2 diabetes (due to a progressive insulin
insulin
resistance).
• Gestational diabetes mellitus (diabetes diagnosed
during pregnancy that is not clearly overt diabetes).
• Diabetes mellitus associated with other conditions
or causes.
12. 1/1/2020 Prof. Dr. RS Mehta 12
Prediabetes
Categories of increased risk for Diabetes (prediabetes)*
FBG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG)
OR
2-h PG in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0
mmol/L) (IGT)
OR
A1C 5.7–6.4%
*For all three tests, risk is continuous, extending below the lower limit of the
range and becoming disproportionately greater at higher ends of the range.
13. Diagnosis
Criteria for the diagnosis of Diabetes Mellitus
A1C ≥ 6.5%. The test should be performed in a laboratory using a method that is NGSP
certified and standardized to the DCCT assay.*
OR
FPG ≥ 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.*
OR
Two-hour PG ≥ 200 mg/dL (11.1 mmol/L) during an OGTT. The test should be
performed as described by the WHO, using a glucose load containing the equivalent of 75 g
anhydrous glucose dissolved in water.*
OR
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a
random plasma glucose ≥ 200 mg/dL (11.1 mmol/L).
*In the absence of unequivocal hyperglycemia, result should be confirmed by repeat
testing.
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14. 1/1/2020 Prof. Dr. RS Mehta 14
Type 1 Diabetes
• Type 1diabetes was previously called insulin-dependent
diabetes or also called juvenile-onset diabetes, as it
often begins in childhood.
• Type 1 diabetes is characterized by destruction of the
pancreatic beta cells, leading to absolute insulin
deficiency.
• It is thought that combined genetic, immunologic and
possibly environmental (eg, viral) factors contribute to
beta cell destruction.
15. 1/1/2020 Prof. Dr. RS Mehta 15
DM Type 1 Pathology
Genetic Factor
• It is generally accepted that genetic susceptibility is a
underlying factor in the development of type 1
diabetes.
• People do not inherit type 1 diabetes itself; rather,
they inherit a genetic predisposition or tendency,
toward developing type 1 diabetes.
• This genetic tendency has been found in people with
certain HLA(human leukocyte antigen) types.
16. 1/1/2020 Prof. Dr. RS Mehta 16
contd….
• One proposal is that reduced exposure to
microorganisms in early childhood limits maturation
of the immune system and increases susceptibility to
autoimmune disease (the 'hygiene hypothesis').
• Stress may precipitate type 1 diabetes by stimulating
the secretion of counter-regulatory hormones and
possibly by modulating immune activity.
• Dietary factors may also be important.
• Various nitrosamines (found in smoked and cured
meats) and coffee have been proposed as potentially
diabetogenic toxins.
17. 1/1/2020 Prof. Dr. RS Mehta 17
Clinical Features
• Polyuria: Caused by osmotic diuresis secondary to
hyperglycemia
• Thirst: response to the hyperosmolar state and dehydration
• Fatigue and weakness: may be caused by muscle wasting
from the catabolic state of insulin deficiency, hypovolemia,
and hypokalemia
• Extreme hunger with unintended weight loss
• Muscle cramps: caused by electrolyte imbalance
• Blurred vision: Glucose and its metabolites cause osmotic
swelling of the lens, altering its normal focal length
• Feeling numbness or tingling in feet
18. 1/1/2020 Prof. Dr. RS Mehta 18
Diagnosis
Age: before the age of 30. The incidence is 12 to 14
cases per 1,00,000 people younger than 20 years and
1 case per 500 people younger than 16 years.
Blood Tests:
• Fasting blood test (126 mg/dL (7 mmol/L) or higher
on two separate tests, is considered diabetes).
• (HbA1c) test: 6.5% or higher
• RBS level: 200 mg/dL (11.1 mmol/L) or higher
19. 1/1/2020 Prof. Dr. RS Mehta 19
Contd…
Immunologic Markers:
• Islet cell autoantibodies (ICAs) are a composite of
several different antibodies directed at pancreatic islet
molecules such as glutamic acid
decarboxylase(GAD), insulin and IA-2/ICA-512 and
serve as a marker of the autoimmune process of type
1 DM.
• Testing for ICAs can be useful in classifying the type
of DM as type 1 and in identifying nondiabetic
individuals at risk for developing type 1 DM.
Urine test: Ketone bodies
20. 1/1/2020 Prof. Dr. RS Mehta 20
Treatment
Insulin Therapy
1.Rapid acting insulin
• The rapid acting insulin is used as a bolus dosage.
• The action onsets in 15 minutes with peak actions in 30 to 90
minutes.
Drugs: Humalog or lispro, Novolog or aspart,Apidra or glulisine
2. Short acting insulin
• Short acting insulin action onsets within 30 minutes with the peak
action around 2 to 4 hours.
Drugs: Regular (R) humulin or novolin, V
elosulin (for use in the
insulin pump)
3. Intermediate acting insulin I
• Action onsets within 1 to 2 hours with peak action of 4 to 10 hours.
• Drugs: NPH (N)
21. 1/1/2020 Prof. Dr. RS Mehta 21
4. Long acting insulin
• It is usually given around bedtime.
• Action onset is roughly 1 to 2 hours with a sustained action
of 24 hours.
Drugs: Lantus (insulin glargine), Levemir (insulin detemir)
5. Premixed insulin
• Combination of specific proportions of intermediate-acting
and short-acting insulin in one bottle or insulin pen.
• These products are generally taken two or three times a day
before mealtime.
• Action onset is 30minutes to 4hours with sustained action
up to 24hours.
Drugs: Humulin 70/30, Novolin 70/30, Novolog 70/30,
Humulin 50/50, Humalog mix 75/25
22. 1/1/2020 Prof. Dr. RS Mehta 22
Treatment
• Dietary plan
• Regular check up of blood sugar levels: Blood
glucose to the near normal range, approximately 80–
140 mg/dl
• Physically active or exercise
• Controlling blood pressure
• Monitoring cholesterol levels
• Transplantation of Pancreas
• Transplantation of Islet cells
23. 1/1/2020 Prof. Dr. RS Mehta 23
Prevention
Immunosuppressive drugs
• CyclosporineA
• Anti-CD3 antibodies, including teplizumab and
otelixizumab, had suggested evidence of preserving
insulin production (as evidenced by sustained C-peptide
production) in newly diagnosed type 1 diabetes patients.
Diet
• Some research has suggested breastfeeding decreases the
risk in later life.
• Giving children 2000 IU of Vitamin D during their first
year of life is associated with reduced risk of type 1
diabetes, though the causal relationship is obscure.
24. 1/1/2020 Prof. Dr. RS Mehta 24
Type 2 Diabetes
• was previously referred to as non-insulin dependent diabetes
mellitus or adult onset diabetes.
• is a more complex condition than type 1 diabetes as there is a
combination of resistance to the actions of insulin in liver and
muscle together with impaired pancreatic β-cell function
leading to 'relative' insulin deficiency.
• Insulin resistance appears to come first, and leads to elevated
insulin secretion in order to maintain normal blood glucose
levels.
• However, in susceptible individuals the pancreatic β cells are
unable to sustain the increased demand for insulin and a
slowly progressive insulin deficiency develops.
25. 1/1/2020 Prof. Dr. RS Mehta 25
contd…
Insulin resistance
• refers to decreased tissue sensitivity to insulin.
• Normally, insulin binds to special receptors on cell surfaces
and initiates a series of reactions involved in glucose
metabolism.
• In type 2 diabetes, these intracellular reactions are diminished,
thus rendering insulin less effective at stimulating glucose
uptake by the tissues and at regulating glucose release by the
liver.
• The exact mechanisms that lead to insulin resistance and
impaired insulin secretion in type 2 diabetes are unknown,
although genetic factors are thought to play a role.
26. 1/1/2020 Prof. Dr. RS Mehta 26
contd…
Impaired pancreatic β-cell function
• Insulin secretion and sensitivity are interrelated.
• In type 2 DM, insulin secretion initially increases in response
to insulin resistance to maintain normal glucose tolerance.
• Initially, the insulin secretory defect is mild and selectively
involves glucose-stimulated insulin secretion.
• The response to other nonglucose secretagogues, such as
arginine, is preserved.
• Eventually, the insulin secretory defect progresses to a state of
grossly inadequate insulin secretion.
• The reason for the decline in insulin secretory capacity in type
2 DM is unclear.
• The assumption is that a second genetic defect—superimposed
on insulin resistance—leads to beta cell failure.
27. 1/1/2020 Prof. Dr. RS Mehta 27
Pathophysiology
• Type 2 DM is characterized by impaired insulin secretion, insulin
resistance, excessive hepatic glucose production, and abnormal
fat metabolism.
• Obesity (particularly visceral or central) is very common in type
2 DM.
• In the early stages of the disorder, glucose tolerance remains
near-normal, despite insulin resistance, because the pancreatic
beta cells compensate by increasing insulin output.
• As insulin resistance and compensatory hyperinsulinemia
progress, the pancreatic islets in certain individuals are unable to
sustain the hyperinsulinemic state.
• A further decline in insulin secretion and an increase in hepatic
glucose production lead to overt diabetes with fasting
hyperglycemia.
• Ultimately, beta cell failure may ensue.
28. 1/1/2020 Prof. Dr. RS Mehta 28
Risk factors for DM type 2
• Family history of diabetes (i.e., parent or sibling with type 2
diabetes): Both parents have type 2 DM, the risk approaches
40%.
• Obesity (BMI ≥25 kg/m2)
• Habitual physical inactivity
• Race/ethnicity (e.g., African American, Latino, Native
American,AsianAmerican, Pacific Islander)
29. 1/1/2020 Prof. Dr. RS Mehta 29
contd…
• History of GDM or delivery of baby >4 kg (>9 lb)
• Hypertension (blood pressure ≥140/90 mmHg)
• HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a
triglyceride level >250 mg/dL (2.82 mmol/L)
• Polycystic ovary syndrome
• History of vascular disease
30. 1/1/2020 Prof. Dr. RS Mehta 30
Treatment of DM type 2
• Type 2 diabetes management should begin with
Medical nutrition therapy (MNT).
• An exercise regimen to increase insulin sensitivity
and promote weight loss should also be instituted.
• Pharmacologic approaches to the management of
type 2 DM include oral glucose-lowering agents,
insulin, and other agents that improve glucose
control.
• Type 2 DM is a progressive disorder, requires
multiple therapeutic agents and often insulin
31. 1/1/2020 Prof. Dr. RS Mehta 31
Glucose-Lowering Agents
Sulfonylureas
• Primary action is directly stimulating the pancreas to
secrete insulin.
• Therefore, a functioning pancreas is necessary for
these agents to be effective, and they cannot be used
in patients with type 1 diabetes.
• These agents improve insulin action at the cellular
level and may also directly decrease glucose
production by the liver.
• The sulfonylureas can be divided into first- and
second-generation categories.
33. 1/1/2020 Prof. Dr. RS Mehta 33
Biguanides
• It produces antidiabetic effects by facilitating
insulin’s action on peripheral receptor sites.
• Therefore, it can be used only in the presence of
insulin.
• There is some evidence that it also impairs glucose
absorption by the gut and inhibits hepatic
gluconeogenesis.
• Increases susceptibility to lactic acidosis.
• Contraindicate in patients with impaired renal or
hepatic function and in those who drink alcohol in
excess.
Drug: Metformin
34. 1/1/2020 Prof. Dr. RS Mehta 34
contd…
Alpha Glucosidase Inhibitors
• work by delaying the absorption of glucose in the
intestinal system, resulting in a lower postprandial
blood glucose level.
• must be taken immediately before a meal, making
therapeutic adherence.
• Side effects are diarrhea and flatulence.
• Drug: Acarbose (Precose)
35. 1/1/2020 Prof. Dr. RS Mehta 35
Thiazolidinediones
• enhance insulin action at the receptor site without
increasing insulin secretion from the beta cells of the
pancreas.
• may affect liver function; therefore, liver function studies
must be performed (monthly for the first 12 months of
treatment, and quarterly thereafter).
Drug: Pioglitazone (Actos), rosiglitazone (Avandia)
Meglitinides
• lower the blood glucose level by stimulating insulin
release from the pancreatic beta cells.
• Its effectiveness depends on the presence of functioning
beta cells.
Drug: Repaglinide (Prandin), nateglinide (Starix)
36. 1/1/2020 Prof. Dr. RS Mehta 36
• DDP 4 Inhibitors Drugs: sitagliptin, Saxagliptin,
Vildagliptin, Linagliptin
• GLP-1 analogues: GLP-1 analogues have been
found to be particularly effective in helping to
improve blood glucose levels by stimulating insulin
secretion and helping with weight loss.
Drugs:
• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Liraglutide (Victoza)
• Lixisenatide (Lyxumia)
37. 1/1/2020 Prof. Dr. RS Mehta 37
Prevention of DM type 2
• Lifestyle modifications and pharmacologic agents prevent
or delay the onset of DM.
• Weight loss of 7% of body weight and increasing physical
activity to at least 150 min/week of moderate activity
such as walking.
• The Diabetes Prevention Program (DPP) demonstrated
that intensive changes in lifestyle (diet and exercise for 30
min/d five times per week) in individuals with delayed
the development of type 2 DM by 58% and
• Metformin prevented or delayed diabetes by 31%.
38. 1/1/2020 Prof. Dr. RS Mehta 38
Gestational Diabetes
• Refers to hyperglycaemia occurring for the first time during
pregnancy.
• During normal pregnancy, insulin sensitivity is reduced
through the action of placental hormones (human placental
lactogen, estrogen, and cortisol) and this affects glucose
tolerance.
• GDM occurs in ͠ 4% of pregnancies in the United States
• Most women revert to normal glucose tolerance post-partum
but have a substantial risk (30–60%) of developing DM later
in life.
39. 1/1/2020 Prof. Dr. RS Mehta 39
DETECTION & DIAGNOSIS OF GESTATIONAL
DIABETES MELLITUS (GDM)
Recommendations for diabetes in Pregnancy
Screen for undiagnosed type 2 diabetes at the first prenatal visit in those with risk
factors, using standard diagnostic criteria.
Screen for GDM at 24–28 weeks of gestation in pregnant women not previously
known to have diabetes.
Screen women with GDM for persistent diabetes at 6–12 weeks postpartum,
using the OGTT and nonpregnancy diagnostic criteria.
Women with a history of GDM should have lifelong screening for the
development of diabetes or prediabetes at least every 3 years.
Further research is needed to establish a uniform approach to diagnosing GDM.
40. 1/1/2020 Prof. Dr. RS Mehta 40
contd…
Treatment
• Dietary and life style modification
• Insulin therapy
41. 1/1/2020 Prof. Dr. RS Mehta 41
Other conditions or causes
• Genetic defects of β-cell function
• Genetic defects of insulin action (e.g. leprechaunism,
lipodystrophies)
• Pancreatic disease (e.g. pancreatitis, pancreatectomy,
neoplastic disease, cystic fibrosis, fibrocalculous
pancreatopathy)
• Excess endogenous production of hormonal
hormone-
syndrome;
thyroid
antagonists to insulin (e.g. growth
acromegaly; glucocorticoids- Cushing's
catecholamines- phaeochromocytoma;
hormones-thyrotoxicosis)
42. 1/1/2020 Prof. Dr. RS Mehta 42
Contd…..
• Drug-induced (e.g. corticosteroids, thiazide
diuretics, phenytoin)
• Viral infections (e.g. congenital rubella, mumps)
• Uncommon forms of immune-mediated diabetes
• Associated with genetic syndromes (e.g. Down's
syndrome; Klinefelter's syndrome; Turner's
syndrome
43. 1/1/2020 Prof. Dr. RS Mehta 43
Complications
Hypoglycemia (insulin reaction):
• occurs when the blood glucose falls to less
than 50 to 60 mg/dL (2.7 to 3.3 mmol/L).
• caused by too much insulin
little
or oral
food, or
hypoglycemic agents, too
excessive physical activity.
44. 1/1/2020 Prof. Dr. RS Mehta 44
Clinical Manifestations
• grouped into two categories: adrenergic symptoms and central nervous system
(CNS) symptoms.
In mild hypoglycemia, as the blood glucose level falls, the sympathetic nervous
system is stimulated, resulting in a surge of epinephrine and norepinephrine.
This causes symptoms such as sweating, tremor, tachycardia, palpitation,
nervousness, and hunger.
In moderate hypoglycemia
• Fall in blood glucose level deprives the brain cells of needed fuel for
functioning.
• Signs of impaired function of the CNS may include inability to concentrate,
headache, lightheadedness, confusion, memory lapses, numbness of the lips and
tongue, slurred speech, impaired coordination, emotional changes, double
vision, and drowsiness.
• Any combination of these symptoms (in addition to adrenergic symptoms) may
occur with moderate hypoglycemia.
45. 1/1/2020 Prof. Dr. RS Mehta 45
Contd…
In severe hypoglycemia
• CNS function is so impaired that the patient needs the
assistance.
• Symptoms may include disoriented behavior,
seizures, difficulty arousing from sleep, or loss of
consciousness.
• Also can cause a coma and even death.
46. 1/1/2020 Prof. Dr. RS Mehta 46
Management of Hypoglycemia
• Immediate treatment must be given when hypoglycemia
occurs. The usual recommendation is 15 g of a fast-
acting concentrated source of carbohydrate .
• The equivalency of 15 grams of glucose (approximate
servings) are:
Three or four commercially prepared glucose tablets
4 to 6 glass of fruit juice or regular soda
6 to 10 Life Savers or other hard candies
2 to 3 teaspoons of sugar or honey
• Injection of glucagon or intravenous glucose.
47. 1/1/2020 Prof. Dr. RS Mehta 47
Diabetic Ketoacidosis
• It is sometimes the first indication that a person has
type 1 diabetes, and can be a serious complication of
lack of insulin.
• It occurs when the body cannot use sugar (glucose) as
a fuel source because there is no insulin or not
enough insulin.
• Fat is used for fuel instead. When fat breaks down,
waste products called ketones build up in the body.
48. 1/1/2020 Prof. Dr. RS Mehta 48
Signs and symptoms of DKA
• Frequent urination
• Extreme thirstiness
• Abdominal pain
• Weight loss
• Deep, rapid breathing
• Fruity smell on breath (Smell of ketones being
released from body)
• Confusion
• Weakness- Muscle stiffness or aches
• Nausea and vomiting
49. 1/1/2020 Prof. Dr. RS Mehta 49
Chronic or Long-term Diabetes
Complications
Microvascular Complications
• Eye disease
• Retinopathy (nonproliferative/proliferative)
• Macular edema
• Neuropathy
• Sensory and motor (mono- and polyneuropathy)
• Autonomic
• Nephropathy
51. 1/1/2020 Prof. Dr. RS Mehta 51
Criteria for testing for diabetes in asymptomatic adult individuals
Testing should be considered in all adults who are overweight (BMI ≥25 kg/m2) and have
additional risk factors:
• physical inactivity
• first-degree relative with diabetes
• high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian
American)
• women who delivered a baby weighing >9 lb or were diagnosed with GDM
• hypertension (≥140/90 mmHg or on therapy for hypertension)
• HDL cholesterol level <35 mg/dL and/or a triglyceride level >250 mg/dL
• women with polycystic ovarian syndrome
• other clinical conditions associated with insulin resistance (e.g., severe obesity,
acanthosis nigricans)
• history of CVD
In the absence of the above criteria, testing for diabetes should begin at age 45 years.
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.
If results are normal, testing should be repeated at least at 3-year intervals, with
consideration of more frequent testing depending on initial results (e.g., those with
prediabetes should be tested yearly) and risk status.
52. 1/1/2020 Prof. Dr. RS Mehta 52
Testing for type 2 diabetes in asymptomatic children*
Criteria
• Overweight (BMI >85th percentile for age and sex, weight for height >85th
percentile, or weight >120% of ideal for height)
Plus any two of the following risk factors:
• Family history of type 2 diabetes in first- or second-degree relative
• Race/ethnicity (Native American, African American, Latino, Asian American,
Pacific Islander)
• Signs of insulin resistance or conditions associated with insulin resistance (
hypertension, dyslipidemia, polycystic ovarian syndrome, or small-for-
gestational-age birth weight)
• Maternal history of diabetes or GDM during the child’s gestation
Age of initiation: age 10 years or at onset of puberty, if puberty occurs at a younger age
Frequency: every 3 years
*Persons aged 18 years and younger.
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Patient Education
1. Diabetes Education
• Self-monitoring of blood glucose
• Urine ketone monitoring (type 1 DM)
• Insulin administration: Insulin Therapy and insulin
preparations, types, time course of action, selecting and
rotating the injection site, complications of insulin therapy
(insulin lipodystrophy, local and systemic allergic reaction)
• Guidelines for diabetes management during illnesses
• Management of hypoglycemia
• Foot and skin care
• Diabetes management before, during, and after exercise and
• Risk factor modifying activities.
54. 1/1/2020 Prof. Dr. RS Mehta 54
contd…
2. Nutrition
• Medical nutrition therapy (MNT) is a term used by the ADA to describe
the optimal coordination of caloric intake with other aspects of diabetes
therapy (insulin, exercise, weight loss). The ADA has issued
recommendations for three types of MNT.
• Primary prevention measures of MNT are directed at preventing or
delaying the onset of type 2 DM in high-risk individuals (obese or with pre-
diabetes) by promoting weight reduction.
• Secondary prevention measures of MNT are directed at preventing or
delaying diabetes related complications in diabetic individuals by
improving glycemic control.
• Tertiary prevention measures of MNT are directed at managing diabetes-
related complications (cardiovascular disease, nephropathy) in diabetic
individuals. For example, in individuals with diabetes and chronic kidney
disease, protein intake should be limited to 0.8 g/kg of body weight per day.
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Nutritional Recommendation for Adults with
Diabetes
Fat
• 20–35% of total caloric intake
• Saturated fat <7% of total calories
• <200 mg/d of dietary cholesterol
• Two or more servings of fish per week provide
omega-3 polyunsaturated fatty acids
• Minimal trans fat consumption
56. 1/1/2020 Prof. Dr. RS Mehta 56
Contd…
Carbohydrate
• 45–65% of total caloric intake (low-carbohydrate
diets are not recommended)
• Amount and type of carbohydrate important (amount
of carbohydrate determined by estimating grams of
carbohydrate in diet; glycemic index reflects how
consumption of a particular food affects the blood
glucose).
• Sucrose-containing foods may be consumed with
adjustments in insulin dose
57. 1/1/2020 Prof. Dr. RS Mehta 57
Contd…
Protein
• 10–35% of total caloric intake (high-protein diets are
not recommended)
Other components
• Fiber-containing foods
glucose
• Non nutrient sweeteners
Alcohol
may reduce postprandial
58. 1/1/2020 Prof. Dr. RS Mehta 58
Contd…
3. Exercise
• For individuals with type 1 or type 2 DM, exercise is
also useful for lowering plasma glucose (during and
following exercise) and increasing insulin sensitivity.
• In patients with diabetes, the ADA recommends 150
min/ week (distributed over at least 3 days) of aerobic
physical activity.
• In patients with type 2 DM, the exercise regimen
should also include resistance training (weight lifting)
59. 1/1/2020 Prof. Dr. RS Mehta 59
Guidelines for ongoing medical care for
patients with diabetes
• Self-monitoring of blood glucose (individualized frequency)
• A1C testing (two to four times per year)
• Patient education in diabetes management (annual)
• Medical nutrition therapy and education (annual)
• Eye examination (annual)
• Foot examination (one to two times per year by physician;
daily by patient)
• Screening for diabetic nephropathy (annual)
• Blood pressure measurement (quarterly)
• Lipid profile and serum creatinine (estimate GFR) (annual)
• Influenza/pneumococcal immunizations
• Consider antiplatelet therapy
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Nursing Management
Assessment
1. Obtain a history of current problems, family history,
and general health history.
• Has the patient experienced polyuria, polydipsia,
polyphagia, and any other symptoms?
– Number of years since diagnosis of diabetes
– Family members diagnosed with diabetes, their
subsequent treatment, and complications
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Contd…
2. Perform a review of systems and physical examination to assess for
signs and symptoms of diabetes, general health of patient, and
presence of complications.
– General: recent weight loss or gain, increased fatigue, tiredness,
anxiety
– Skin: skin lesions, infections, dehydration, evidence of poor wound
healing
– Eyes: changes in vision- floaters, halos, blurred vision, dry or
burning eyes, cataracts, glaucoma
– Mouth: gingivitis, periodontal disease
– Cardiovascular: orthostatic hypotension, cold extremities, weak
pedal pulses, leg claudication
– GI: diarrhea, constipation, early satiety, bloating, increased
flatulence, hunger or thirst
– Genitourinary (GU): increased urination, nocturia, impotence,
vaginal discharge
– Neurologic: numbness and tingling of the extremities, decreased
pain and temperature perception, changes in gait and balance
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Nursing Diagnosis
• Imbalanced Nutrition: More than Body Requirements related
to intake in excess of activity expenditures
• Fear related to insulin injection
• Risk for Injury (hypoglycemia) related to effects of insulin,
inability to eat
• Activity Intolerance related to poor glucose control
• Deficient Knowledge related to use of oral hypoglycemic
agents
• Risk for Impaired Skin Integrity related to decreased sensation
and circulation to lower extremities
• Ineffective Coping related to chronic disease and complex
self-care regimen
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Nursing Interventions
Improving Nutrition
• Assess current timing and content of meals.
• Advise patient on the importance of an individualized
meal plan in meeting weight-loss goals.
• Discuss the goals of dietary therapy for the patient.
• Setting a goal of a 10% (of patient's actual body
weight) weight loss over several months, reducing
blood sugar and other metabolic parameters.
• Explain the importance of exercise in
maintaining/reducing body weight.
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Teaching about insulin
• Assist patient to reduce fear of
verbalization of fears regarding
injection by encouraging
insulin injection, and
identifying supportive coping techniques.
• Demonstrate and explain thoroughly the procedure for insulin
self-injection.
• Help patient to master technique by taking a step-by-step
approach.
– Allow patient time to handle insulin and syringe to become
familiar with the equipment.
– Teach self-injection first to alleviate fear of pain from
injection
• Review dosage and time of injections in relation to meals,
activity, and bedtime based on patient's individualized insulin
regimen
65. 1/1/2020 Prof. Dr. RS Mehta 65
Improving activity tolerance
• Advise patient to assess blood glucose level before and
after strenuous exercise.
• Instruct patient to plan exercises on a regular basis each
day.
• Encourage patient to eat a carbohydrate snack before
exercising to avoid hypoglycemia.
• Advise patient that prolonged strenuous exercise may
require increased food at bedtime to avoid nocturnal
hypoglycemia.
• Instruct patient to avoid exercise whenever blood glucose
levels exceed 250 mg/day and urine ketones are present.
Patient should contact health care provider if levels
remain elevated.