The document outlines diabetes mellitus, covering its definition, prevalence, types, symptoms, and management strategies. It highlights the increasing global prevalence, the role of the pancreas in insulin production, and the various medications and dietary approaches for diabetes management. Additionally, it includes a case study emphasizing the importance of personalized dietary plans and adherence to treatment for better health outcomes.

1. A
presentation
on
DIABETES MELLITUS

2. OUTLINE
 Definition
 Prevalence
 The pancreas
 Types of Diabetes
 Symptoms of diabetes mellitus
 Diagnostic criteria for DM
 Risk factors
 Complications of diabetes
 Management of diabetes
 Physical activity in diabetes
 Case study

3. Definition
Diabetes (DYE-ah-BEE-teez) mellitus: a group of
metabolic disorders characterized by hyperglycemia and
disordered insulin metabolism.
It is defined as Fasting Blood Sugar ≥ 126mg/dL or Random
Blood Sugar ≥200mg/dL
Diabetes = siphon (in Greek), referring to the excessive
passage of urine that is characteristic of untreated diabetes
Mellitus = sweet, honey-like
Insulin

4. PREVALENCE of diabetes
 One of four priority non-communicable diseases (NCDs) targeted
by world leaders. Globally:
 DM caused 1.5million death in 2012
 43% of these deaths occur under the age of 70
 The prevalence of DM among adults has risen from 108 million
(4.7%) in 1980 to 422 million (8.5%) in 2014 (WHO, 2016)
 DM will be the 7th leading cause of death in 2030 (Mathers and
Loncars, 2006)

5. THE PANCREAS
1
2
3

6. FUNCTIONS OF THE PANCREAS
Exocrine Functions
 contains exocrine glands that produce enzymes important to
digestion.
 trypsin and chymotrypsin
 Amylase
 lipase
Endocrine functions
 consists of islet cells (islets of Langerhans) that create and
release important hormones directly into the bloodstream
 Insulin
 Glucagon
 Other hormones; amylin, somatostatin, & pancreatic polypeptide

7. TYPES OF DIABETES MELLITUS
 Type 1 Diabetes :
 Type 2 Diabetes
 Gestational Diabetes (GDM)
 Impaired Glucose Tolerance (IGT) and Impaired Fasting
Glyceamia (IFG)
 Other types (drug-induced, pancreatitis)

8. Feature Type 1 Type 2
Prevalence in diabetic
population
5% to 10% of cases 90% to 95% of cases
Age of onset <30 years >45 years (increasing in
children and adolescents)
Associated conditions Autoimmune diseases, viral
infection, inherited
factors
Obesity, aging, inherited
factors
Major defect Destruction of pancreatic
beta cells;
insulin deficiency
Insulin resistance; insulin
deficiency (relative to
needs)
Insulin secretion Little or none Varies; may be normal,
increased, or decreased
Requirement for insulin
therapy
Always Sometimes
Other names Juvenile-onset diabetes
Insulin-dependent diabetes
mellitus (IDDM)
Ketosis-prone diabetes
Adult-onset diabetes
Noninsulin-dependent
diabetes mellitus
(NIDDM)
Ketosis-resistant diabetes
Features of Type 1 and Type 2 Diabetes

9. PATHOPHYSIOLOGY OF DM

10. DIABETIC METABOLISM

11. RISK FACTORS

12. testing FOR blood sugar levels
•Wash your hands or clean your finger or
other site with alcohol. If you are using
alcohol, let it dry before you prick your finger.
•Prick the site with a lancing device.
•Put a little drop of blood on a test strip.
•Follow the instructions for inserting the test
strip and using the blood glucose meter.
•The blood glucose meter reads your blood
sugar level.
•Blood Glucose Meter

13. Fasting blood
glucose
mg/dL
Random
glucose
mg/dL
2hr-Oral
Glucose
Tolerance
Test
mg/dL
Glycosylated
Haemoglobin
A1C (HbA1C)
(%)
Normal < 100 < 200 < 140
Pre-
diabetes
100 -126
(IFG)
140 – 199 5.7% - 6.4%
Diabetes ≥ 126 ≥ 200 ≥ 200 ≥6.5%
DIAGNOStic criteria

14. ACUTE COMPLICATIONS OF DIABETES
Diabetic Ketoacidosis in Type 1 Diabetes
Hyperosmolar Hyperglycemic State in Type 2
Diabetes
Hypoglycemia

15. Chronic complications of diabetes mellitus
Chronic complications
Macrovascular Microvascular
Peripheral
vascular
diseases
Ischaemic
heart disease
Stroke
Retinopathy
Neuropathy
Nephropathy

16. COMPLICATIONS OF DIABETES

17. DIABETIC FOOT
Grade 0 – No ulcer in the high risk foot
Grade 1 – Superficial ulcer involving the full
skin thickness but not underlying tissues
Grade 2 – Deep ulcer, penetrating down the
ligaments and muscle, but no bone involvement
or abscess formation
Grade 3 – deep ulcer with cellulitis or abscess
formation, often with osteomyelitis
Grade 4 – Localized gangrene
Grade 5 – extensive gangrene involving the
whole foot

18. Management of diabetes
Diabetes management – Lifelong treatment which involves:
Proper timing of medications
Dietary Management
Physical exercise

19. Class Generic name (brand name) Mechanism of
action
Time taken
Sulfonylureas Gliclazide (Diamicron)
Glimepiride (Amaryl)
Glyburide (Diabeta)
Stimulate the
pancreas to
produce more
insulin
Before meals
(≤30 minutes)
Meglitinides Nateglinide (Starlix)
Repaglinide (GlucoNorm)
Stimulate the
pancreas to
produce more
insulin
Before meals
(≤15 minutes)
Biguanides 1. Metformine (Glucophage)
2. Metformine with extended
release (Glumetza)
Reduce the
production of
glucose by the liver
1. During
meals
2. At Dinner
MEDICATIONS – Oral Hypoglycemic Agents

20. Class Generic name
(brand name)
Mechanism of action Time taken
Thiazolinidediones 1. Pioglitazone
(Actos)
2. Rosiglitazone
(Avandia)
Increase insulin
sensitivity of the body
cells and reduce
gluconeogenesis in
the liver
With or
without food,
at the same
each day
Alpha-glucosidase
inhibitors
Acarbose
(Glucobay)
Slow the absorption
of carbohydrates
(sugar) ingested
With the first
mouthful of
meal
MEDICATIONS – Oral Hypoglycemic Agents

21. Diet-drug interactions
Gastro-
intestinal
Effect
Interactions with Dietary
substances
Metabolic
Effects
Sulfonylureas Nausea,
vomiting,
cramps,
diarrhoea
Avoid using with alcohol due to a
toxic reaction that causes flushing,
throbbing head and neck pain,
shortness of breath, palpitations,
and sweating.
Avoid using with dietary supplements
that contain ginseng, garlic,
fenugreek, coriander, celery, as they
may increase risk of Hypoglycemia
Hypoglycemia,
weight gain,
allergic skin
reactions
Biguanides
(metformin)
Abdominal
pain, nausea,
vomiting,
diarrhoea,
metallic taste,
anorexia
—
Asymptomatic
vitamin B12
deficiency.

22. Gastro-intestinal
Effect
Interact
ions
with
Dietary
substan
ces
Metabolic Effects
Thiazolidinediones — — Weight gain, fluid retention,
edema, Increased of
bladder cancer
(Pioglitazone ), increased
risk of non-fatal heart
attack (Rosiglitazone)
Alpha-glucosidase inhibitors Abdominal pain,
nausea, Bloating
and flatulence,
cramps, diarrhea.
— Elevated liver enzymes,
hyperbilirubinemia
Diet-drug interactions (2)

23. Rapid-acting: For meals eaten at same time with the injection
Short-acting: For meals eaten within 30-60 mins
Intermediate acting: Covers insulin needs for about half the
day or overnight
Long –acting: Covers insulin needs for about one full day. This
type is often combined, when needed, with rapid- or short-acting
insulin
Premix: Combine specific amounts of intermediate-acting and
short-acting insulin in one bottle or insulin pen. (The numbers
following the brand name indicate the percentage of each type of
insulin)
MEDICATIONS – INSULIN

24. Onset: The length of time before insulin reaches the bloodstream and begins to
lower blood sugar.
Peak: The time period when it best lowers blood sugar
Duration: How long insulin continues to work.
SAMPLES OF INSULIN
Types & Brand
names
Onset Peak Duration
Lispro, Aspart,
Glulisine (R)
15-30mins 30-90mins 3-5hours
Regular, Novolin
(S)
30 min. -1 hour 2-5 hours 5-8 hours
NPH (N) (I) 1-2 hours 4-12 hours 18-24 hours
Detemir,
glargine (L)
1-1 1/2 hours No peak time.
Insulin is delivered
at a steady level.
20-24hours
Humulin 70/30 (P) 30 min. 2-4 hours 14-24 hours

25. •Disposable insulin injection
•Insulin pump
•Insulin pen
•Insulin Inhaler
Insulin delivery

26. Medical nutrition therapy : goals
Maintenance of as near normal BG levels as possible, by balancing food,
medication, and physical activity
Provision of adequate calories for maintaining or attaining reasonable
weight, growth/development in children and adolescent.
Prevention and treatment of the acute or chronic complications of
diabetes Mellitus
Achievement of optimal serum lipid levels
Improvement of overall health through optimal nutrition using the
Dietary Guidelines

27. Calorie distribution
Carbohydrate
50%-60% of total calorie/day
Protein
15% - 20% of total calorie/day
Fats
15% - 35% of total calorie/day

28. Calorie counting
For a dietary prescription of 1800kcal:
Carbohydrate
50 × 2000 = 1200kcal 900 = 225g
100 4
Protein
20 × 1800 = 360kcal 360 = 90g
100 4
Fat
25 × 1800 = 540kcal 540 = 60g
100 9

29. INSULIN DISTRIBUTION
Total daily insulin dose
Basal Insulin replacement Bolus Insulin replacement
(40% - 50%)
(50% - 60%)
•1 unit of insulin 10 – 15grams of carbohydrate
•1 unit of insulin 50mg/dl of blood glucose
•1/10th unit of insulin 15grams of carbohydrate (in children)
N.B.: Depending on activity level, I unit of insulin 4-30g of
carbohydrate

30. Total daily INSULIN requirement (tdir)
Total daily insulin requirement can be calculated using the formula
below :
TDIR = Weight in pounds ÷ 4 OR Weight in Kg × 0.55
For a reference man of 70kg OR 160pounds;
160 = 40 units OR 70 × 0.55 = 38.5 units
4
For 40 units;
Basal insulin = 40 × 40 = 16 units
100
Bolus insulin = 40 – 16 = 24units
 Breakfast, Lunch, Dinner = 24units = 8 units per meal
3

31. For 300g of carbohydrate, the amount of insulin required:
1 unit of Insulin 15g of CHO
X 300g of CHO
X = 300 = 20 units of insulin
15
insulin calculation

32. High blood sugar correction
•To calculate insulin need for HBS correction:
Insulin need = Actual blood sugar level – Target blood sugar level
For example:
If a patient’s blood sugar is 220mg/dl and the target blood sugar is
120mg/dl
Insulin need for correction = 220 – 120 = 100mg/dl
Since 1 unit of insulin 50mg/dl blood sugar
Therefore; 100mg/dl ÷ 50mg/dl = 2units of insulin

33. Meal Food
Items
Qty (g) Handy
measure
Energy
value
(kcal)
Pro
(g)
Fat
(g)
CHO
(g)
Breakfast Bread 90 3 slices 199.6 6.38 - 47.6 63.69
Margarine 10 1 leveled Tbsp 73 0.02 8.07 0.07
Boiled egg 60 1 medium size 71 7 5.85 0.8
Tea 2 1 tea bag 2.16 0.39 0.04 0.06
Whole powder
milk
40 4 Tbsp 198 10.36 10.64 15.16
Snack Apple 150 1 medium size 79.5 0.45 0.3 17.1
Lunch Boiled yam 220 2 thin slices 242 1.32 - 59.4 65.94
vegetables 100 25 2 - 5.1
Stew 40 1 serving
spoon
47.6 3.84 3 1.44
Beef 60 2 pieces 120 14 1 0
Snack Watermelon 250 #50 worth 72.5 1.25 0.5 15.5
Dinner Pap 300 2 bowls 91.95 2.55 - 18.9 62.15
Moi-moi 300 2 small wraps 243.5 16.75 16.75 43.25
Boiled chicken 90 2 pieces 241.2 19.8 18 -
TOTAL 1706.8 86.1 64.2 224.4

34. FOODS ALLOWED FREELY
All leafy vegetables, Tea, Lettuce, Garden eggs, Cucumbers,
cabbage, onions, tomatoes
FOODS ALLOWED IN LIMITED AMOUNT
Milk, butter, margarine, egg, potatoes, rice, yam, bread,
plantain, orange, grapefruits, carrots, apples, beans,
moin-moin, akara, agidi, amala, pounded yam, plain
biscuit
FOODS TO BE AVOIDED
Beverages, sweets, chocolate,

35. Physical activity in type 1 dm
Adjust food intake and insulin therapy to prevent hypoglycemia during
physical activity
Checked blood glucose levels both before and after an activity
Insulin doses that precede exercise often need to be reduced
substantially
FBS below 100mg/dL before an activity; consume carbohydrate
FBS levels are 250 mg/dL or higher; No strenuous exercise
FBS levels are 300mg/dL or higher or ketosis is present; No physical
activity

36. Physical activity in type 2 dm
Regular physical activity can improve the metabolic outcomes associated with type
2 diabetes:
Before an exercise program is planned, a medical evaluation should be done
Types of activity recommended should depend on complications present.
Only mild or moderate exercise may be prescribed at first
Persons with retinopathy should avoid heavy lifting or straining
Discourage strenuous exercise in persons with nephropathy
In persons with peripheral neuropathy, be cautious repetitive weight-bearing
exercises.
proper hydration should be encouraged before and during exercise

37. CASE STUDY
Bio-Data
Name: K.X.
Address: 4, Ayo Fanimokun Street, Agege, Lagos
Sex: Male
Age: 64years
Social Hx:
A retiree, married with children, who relocated from the north to
Lagos.
Family Hx:
Positive of diabetes (parents)
Past Medical Hx:
Patient has been diagnosed of DM about 5 years ago. Surgery0,
Hypertension0, Asthma0

38. CASE STUDY
Drug Hx:
Nil
Clinical assessment
A middle-age man, conscious, not underweight, not pale, not
dehydrated, with bilateral pedal oedema
Biochemical assessment
K+: 3.3mmol/L (3.5-5.1) FBS: 145 mg/dL
Na+: 132mmol/L (136-145) HbA1c: 8.9%
Cl-: 93mmol/L (98-107) Creatinine: 96 (57-113umol/L)
Urea: 11.5mmol/L (1.9-9.1)
Medical Diagnosis
A case of biventricular failure 20 to dilated cardio-myopathy and
electrolyte imbalance

39. CASE STUDY
Medical treatment
•Sc clexane 40mg daily
•Tab slow K 600mg t.d.s.
•Tab betaloc-201 25mg daily
•IV torsemide 20mg daily
Diet Hx:
Meal skipping
Meal Frequency/day: Twice (Breakfast and Lunch)
Food dislikes: Rice, yam, eba
Food preferences: beans, vegetables, tea, lime, organ meats
(Food likes and dislikes are based on dietary misconceptions)
No alcohol, no tobacco, drinks herbs occasionally
Nutrition Diagnosis
Hyperglycemic crisis as a result of poor management control as
evidenced by blood glucose profile

40. CASE STUDY
PLAN:
•Place on 1800kcal diet/day
•Commence 0.8g of protein/KgIBW/day
•Give dietary allowance for in-between meals (fruits and vegetables)
•Counsel patient on foods allowed, those to avoid and importance of
proper portioning to suit drug regimen
•Provide substitutes for foods to avoid
•Correct patient’s dietary misconception about DM
•Encourage patient to discontinue meal skipping
•Educate patient about dietary prescription and the need for adherence
•Request for serum albumin, protein and lipid profile for further dietary
management

41. Prognosis:
•Compliance to dietary advice by patient
•FBS Range: 85 – 115mg/dL
•RBS Range: 145-190mg/dL
•Leg sore healed after a week

42. Selected REFERENCES
Columbia University Medical Center. (2017). The Pancreas and Its Functions
http://columbiasurgery.org/pancreas/pancreas-and-its-functions (retrieved
13/03/17)
Diabetes Quebec (2015). Antidiabetic Drugs. www.diabete.qc.ca
Mahan, L. K. and Escott-Stump, S. (2008). Krause’s Food and Nutrition
Therapy. Elsevier; Philadephia
Mathers, C.D., and Loncar, D. (2006) Projections of global mortality and
burden of disease from 2002 to 2030. PLoS Med, 3(11):e442
National Institute of Diabetes and Digestive and Kidney Diseases (2016)
Diabetes https://www.niddk.nih.gov/health-
information/diabetes/overview/symptoms-causes (Retrieved 14/02/2017)
Roth, R. A. (2011). Nutrition and Diet therapy. 10th ed. Indiana/Purdue
university; Fort Wayne