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Diabetes Mellitus

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Diabetes Mellitus

  1. 1. Diabetes
Mellitus By Pete
Kelly 

Diabetes
Specialist
Nurse
  2. 2. Any
burning
ques9ons?
  3. 3. Defini9on‘Diabetes
Mellitus
is
a
chronic
disease
caused
bydeficiency
in
produc9on
of
insulin
by
the
pancreas,
or
by
the
ineffec9veness
of
the
insulin
produced’ World Health Organisation 2002
  4. 4. Defini9on‘Diabetes
Mellitus
is
a
chronic
disease
caused
bydeficiency
in
produc9on
of
insulin
by
the
pancreas,
or
by
the
ineffec9veness
of
the
insulin
produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON
  5. 5. Defini9on‘Diabetes
Mellitus
is
a
chronic
disease
caused
bydeficiency
in
produc9on
of
insulin
by
the
pancreas,
or
by
the
ineffec9veness
of
the
insulin
produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON
  6. 6. Defini9on‘Diabetes
Mellitus
is
a
chronic
disease
caused
bydeficiency
in
produc9on
of
insulin
by
the
pancreas,
or
by
the
ineffec9veness
of
the
insulin
produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON MELLITUS = MEANS SUGAR, SWEET OR HONEY
  7. 7. UK
Prevalence• Currently
2.8
million
people
are
diagnosed
with
diabetes• Further
850,000
who
don’t
know
they
have
diabetes• By
2010
it
is
an9cipated
there
will
be
3
million
diagnosed Diabetes
UK
2009• Within
EU
~
es9mated
to
be
25
million
people
with
 diabetes
and
the
same
amount
undiagnosed• In
Plymouth
there
at
least
12,000
people
diagnosed





Type
2
diabetes
and
a
further
1,000
diagnosed

  8. 8. Diagnosis
of
Diabetes
Mellitus. 




Diabetes
symptoms
(polyuria,
polydipsia) Random Laboratory venous plasma glucose > 11.1 mmol/l. Random Laboratory fasting venous plasma glucose > 7.0 mmol/l. Advisable to have two tests results to confirm diagnosis, or one oral glucose tolerance test.  Oral glucose tolerance test (OGTT). Patient takes 75g oral glucose and two hours later has bloods taken, if venous plasma glucose >11.1 mmol/l, Diabetes is diagnosed. More recently the WHO have agreed to use the HbA1c as a method of diagnosis
  9. 9. Types
of
diabetes• Type
One• Type
Two• Mature
onset
of
diabetes
in
young
(MODY)• Gesta9onal
diabetes
mellitus• Secondary
to
gene9c
condi9ons
  10. 10. The
physiology
of
normal
blood
 • The
pancreas
controls
blood
glucose
levels. • It
lies
behind
the
stomach. • The
pancreas
does
two
jobs:
 
 
 1.
Produces
pancrea9c
juices
which
aids
food
diges9on.Alpha cells release Glucagons, which increases blood glucoseby prompting the release of glucose (from the Liver) into theblood.Beta cells release Insulin, a hormone which encouragesthe absorption of glucose into muscle cells, fat cells, andconnective tissue cells etc, this reduces blood sugars.
  11. 11. Causes
and
Risk
FactorsType 1 Type 2
  12. 12. Causes
and
Risk
FactorsType 1 Type 2
  13. 13. Causes
and
Risk
FactorsType 1 Type 2 • Being overweight •Close member of the family has type 2 diabetes •Waist measurement •Hypertension •POS and being overweight •Impaired glucose tolerance •Gestational diabetes •Mental health problems
  14. 14. Complications of all types
  15. 15. Complications of all types Vascular disease Ischaemic heart disease Gangrene / amputations Nerve Damage (Neuropathy) Eye Disease (Retinopathy) Cataracts Blindness Renal disease (Nephropathy)
  16. 16. Newly
diagnosedType 1Diet, exercise + InsulinType 2Diet and exercise for 3 months ↓Oral hyperglycaemic agent:Sulphonylurea for those not overweight (eg. Gliclazide, Glibenclamide)Biguanide for those overweight (eg. Metformin)Can use together if not individually effective ↓Newer agents – Glitazones, Gliptins and GLP-1 ↓ Insulin Metformin can also be added if patient is overweight
  17. 17. Diabetes
diet
  18. 18. Hypoglycaemia
  19. 19. HypoglycaemiaClassed
as
a
blood
sugar
below
4mmols/l.Symptoms
of
a
hypoglycaemic
event. Swea9ng
 Shaking Drowsiness Vagueness Mood
changes
  20. 20. Treatment
of
a
Hypoglycaemic
 Episode.
  21. 21. Treatment
of
a
Hypoglycaemic
 Episode.• If
the
pa9ent
is
conscious
provide
4
dextrose
tablets
or
 20mls
of
polycal
or
50mls
of
lucozade.• If
the
pa9ent
is
conscious
but
confused
or
uncoopera9ve
 treat
with
Glucogel
(Hypostop).• Provide
a
carbohydrate
snack
when
the
pa9ent
is
alert
 again.
(ie
sandwiches,
toast
or
bowl
of
cereal.• Con9nue
to
test
the
blood
sugar
every
20
minutes
un9l
 stable.• Expect
higher
blood
sugars
that
day• Remember
do
not
omit
the
next
insulin
dose
a






reduc9on
may
be
required.

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