The document provides an overview of the history, definitions, classifications, signs and symptoms, complications, diagnosis, treatment, and management of diabetes mellitus. It discusses the role of insulin and pancreas in regulating blood sugar levels and classifies diabetes into types 1, 2, gestational, and pre-diabetes. The document also outlines dietary, exercise, medication-based, and self-management recommendations for diabetes.

2. By
Zahraa Esmat Sayed Mahmoud Ali
Under Supervision of
Prof.Dr.Mona Khalil Abdel_Kader.
Professor of nutrition
Nutrition and Food Science Deprtment.
Faculty of Home Economic.
Helwan University.
Prof.Dr.Rawia Rizk Abd El Ghany.
Professor of nutrition
Nutrition and Food Science Deprtment.
Faculty of Home Economic.
Helwan University

3. Introduction
Diabetes mellitus were described 3000 years ago
by the ancient Egyptians. In the 2nd Century AD,
Aretaeus gave an excellent description of diabetes.
Thomas Willis in the 17th Century detected the
sweet test of urine. Mathew in the 18th Century
showed that the sugar in urine comes from the
blood.

4. Minkowski and Von Mering discovered that
disease of the pancreas is responsible for
diabetes to develop in the 19th century.
In the 19th century treatment of diabetes
was confined to food regulation which
reduced urination but did not prevent
wasting and complications.

5. They convinced
themselves that they
had discovered the
active pancreatic
hormone which
normalizes the blood
sugar.

6. The first person to be
treated with insulin
was Leonard
Thompson (1908-
1935). The first
injection was in 11
January 1922

7. Definition of diabetes
Diabetes mellitus, often
simply referred to as diabetes,
it is a group of metabolic
diseases in which a person has
high blood sugar, either
because the body does not
produce enough insulin, or
because cells do not respond
to the insulin that is produced
in the body .

8.  Insulin is an endocrine hormone
secreted in the body to control
the level of sugar; starch and
other food are converted into
glucose required as energy for
daily life.
 A pancreas is the gland which
secret and releases the insulin
hormone; as a result the normal
sugar level is maintained in the
body. As per WHO guidelines the
normal sugar level for a normal
person is 60 – 100mg/dl (Before
taking any food for the day, hence
this value is called Fasting Blood
Glucose).

9. Classifications of diabetes

10. Impaired fasting
glucose (IFG):
Commonly known as pre-
diabetes refers to a condition in
which the fasting blood glucose
level is consistently elevated
above what is considered normal
levels; however, it is not high
enough to be diagnosed as
diabetes mellitus.

11. Impaired glucose tolerance (IGT):
•It is a pre-diabetic state
of hyperglycemia that is
associated with insulin
resistance and increased risk
of cardiovascular pathology.
•IGT may precede type 2
diabetes mellitus by many
years. It is also a risk factor
for mortality.

12. Type 1 Diabetes:
Type 1 diabetes mellitus is
characterized by loss of the insulin
producing beta cells of the islets of
langerhans in the pancreas leading to
insulin deficiency.
Individuals with type 1 diabetes are
usually dependent on exogenous
insulin and are at risk for
ketoacidosis.

13. Gestational Diabetes:
It is any degree of glucose intolerance
identified during pregnancy and may
improve or disappear after delivery.

14. Type 2 Diabetes
 It is caused by insulin resistance
with a relative, but not absolute,
deficiency of insulin.
 The etiology of type 2 diabetes
is uncertain.
 Individuals with type 2 diabetes
are not prone to ketoacidosis and
may be asymptomatic.
 It commonly detected after 40

15. Diabetic ketoacidosis (DKA)

16. Signs and symptoms of diabetes

18. Complications of diabetes

20. Diagnosis of diabetes

24. Treatment of diabetes

26. Basic educational requirements
The person with diabetes should acquire adequate knowledge
and skills in the following:
Individual therapy targets.
Individual nutritional requirements and meal planning.
Type and extent of exercise and physical activity.
Interaction of food intake and physical activity with oral
hypoglycaemic drugs/insulin.
Improvements in lifestyle, for example harmful effects of
smoking, obesity and alcohol intake.
Self-monitoring and significance of results and actions to be taken
How to cope with emergencies (illness, hypoglycaemia)
How to avoid complications and detect them at an early stage, e.g.
how to take care of the feet.

28. Monitoring Glycaemic control
Glycaemic control should always
be monitored. The absence of
symptoms alone should not be
taken as an indicator of good
control.
Self-monitoring should be
encouraged.
Methods and frequency of
monitoring depend on the type of
treatment, the local facilities
available, and therapy targets set.

29. A number of factors influence glycemic responses
to foods, including:
 the amount of carbohydrate.
 type of sugar (glucose, fructose, sucrose, lactose).
 nature of the starch (amylose, amylopectin, resistant
starch), cooking and food processing (degree of starch
gelantinization, particle size, cellular form).
 food form, as well as other food components (fat and
natural substances that slow digestion—lectins,
phytates, tannins, and starch-protein and starch-lipid
combinations).

30. Guidelines for a healthy diet Healthy eating is an important
part of your plan to help manage your diabetes.
The list below from the American Diabetes Association
offers some healthy eating guidelines:
Fruits and vegetables
Most fruits, like apples, oranges,
bananas, and grapes, are fine to eat.
Let your health care team know if
you have any fruit allergies so they
can leave those fruits out of your
meal plan.
Make sure you eat no starchy
vegetables, such as lettuce, spinach,
tomatoes, and broccoli.

31. Whole grains
Whole grains are grains that have
not been processed, so they are
healthier for you.
Choose brown rice or whole wheat
pasta as healthier options.
Lean meat
These are cuts of meat that contain
less fat. When you eat beef or pork,
choose cuts that end in ―loin,‖ such as
sirloin or tenderloin.
When you eat chicken or turkey,
remove the skin before cooking.

32. Fish and seafood
Fish and seafood are nutritious and
are healthier for you than red meat.
Eat them 2 or 3 times a week. Do
not eat seafood, however, if you are
allergic to it.
Dairy
Choose skim milk and nonfat or
low-fat yogurt and cheese.
Small amounts of saturated fats
and cholesterol
When cooking, use liquid oils instead
of solid fats like butter, shortening, or
lard. If you are trying to lose weight,
limit the amount of fat you eat.

33. Water
Drink lots of water—it’s the healthiest thing
to drink when you’re thirsty. If you want a
little variety, try calorie-free drinks. Stay
away from regular soda, fruit juice, and any
other drinks that contain sugar.

34. Exercise

35. Some of the benefits of exercise are:
 Increased muscle tone/improved appearance
 Improved circulation
 Lowered blood pressure
 Decreased feelings of stress and tension
 Lowered level of ―bad‖ (LDL) blood cholesterol
 Increased level of ―good‖ (HDL) blood
cholesterol
 Decreased blood sugar
Decreased risk of osteoporosis
Easier weight loss
 Improved insulin sensitivity.

36. Pharmacological treatment
phpp

37. Oral Pharmacological Treatment of
Type 2 Diabetes
 Pharmacological therapy is recommended after 6-12 weeks
if an individualized meal plan, activity, and weight loss trial
(if needed) have failed to control blood glucose (BG). If the
BG remains above 126 mg/dl fasting and over 200 mg/dl 1-
2 hours postprandial, pharmacological treatment should be
initiated.
There are currently 8 classifications of oral therapy for type 2
diabetes :
• Sulfonylureas
• Meglitinides
• D-Phenylalanine Derivatives
• Bile Acid Sequestrant

38. • Biguanides
• Thiazolidinediones
• Alpha Glucosidase
Inhibitors
• DPP-4 Inhibitors

40. Clinical assessment:
 Signs and symptoms of diabetes.
 Risk factors of cardiovascular diseases, such as smoking,
hypertension, obesity, hyperlipidaemia and family history.
 Symptoms of cardiovascular complications including angina
and heart failure.
 Visual symptoms.
 Symptoms of neuropathic complications such as numbness,
pain, muscle weakness, gastrointestinal symptoms including
diarrhoea, impotence and bladder dysfunction.
 Drug history.
 past history
 Gestational history.
 Blood pressure

41. Anthropometric measurements:
A complete examination is part of the
minimum requirements. Certain aspects of
the physical examination should receive
special attention. These include:
•Height and weight measurements.
•BMI (Body Mass Index).
•Waist circumference.

42. Dietary assessment should include:
Diet history.
24 hours (recall or record).
Food frequency.
Laboratory assessment should include:
A blood glucose measurement as a minimum requirement to
confirm the diagnosis
Urine examination for ketones, protein and glucose
Serum creatinine measurement in all hypertensive patients and
those with proteinuria
Electrocardiography and measurement of total serum
cholesterol and triglycerides in high-risk individuals
HBAIC measurement and quantitative measurement of urine
protein as optional investigations that may be performed as part
of the initial assessment where facilities and resources allow.

43. RECOMMENDATIONS
Attain and maintain optimal metabolic outcomes including:
•Blood glucose levels in the normal range or as close to
normal as is safely possible to prevent or reduce the risk
for complications of diabetes.
•A lipid and lipoprotein profile that reduces the risk for
macrovascular disease.
•Blood pressure levels that reduce the risk for vascular
disease.

44. Prevent and treat the chronic complications of diabetes. Modify
nutrient intake and lifestyle as appropriate for the prevention and
treatment of obesity, dyslipidemia, cardiovascular disease,
hypertension, and nephropathy.
Improve health through healthy food choices and physical
activity.
Address individual nutritional needs taking into consideration
personal and cultural preferences and lifestyle while respecting
the individual’s wishes and willingness to change.

45. Less than 10% of energy intake should be derived from
saturated fats. Some individuals (i.e., persons with LDL
cholesterol ≥100 mg/dl) may benefit from lowering saturated fat
intake to <7% of energy intake .
To lower LDL cholesterol, energy derived from saturated fat can
be reduced if weight loss is desirable or replaced with either
carbohydrate or monounsaturated fat when weight loss is not a
goal.
For persons with diabetes, especially those not in optimal
glucose control, the protein requirement may be greater than the
Recommended Dietary Allowance, but not greater than usual
intake.

46.  Carbohydrate and monounsaturated fat together should provide
60–70% of energy intake. However, the metabolic profile and
need for weight loss should be considered when determining the
monounsaturated fat content of the diet.
The long-term effects of diets high in protein and low in
carbohydrate are unknown. Although such diets may produce
short-term weight loss and improved glycemia, it has not been
established that weight loss is maintained long-term. The long-
term effect of such diets on plasma LDL cholesterol is also a
concern.