diabetes mellitus dr. j. pratheeba devi. definition definition diabetes is a metabolic disorder...

DIABETES MELLITUSDIABETES MELLITUS

DR. J. PRATHEEBA DEVIDR. J. PRATHEEBA DEVI

DefinitionDefinition

Diabetes is a metabolic Diabetes is a metabolic disorder disorder

characterized by raised characterized by raised levelslevels

of glucose in the blood.of glucose in the blood.

EpedemiologyEpedemiology

India has around 33 million India has around 33 million people with Diabetis and 19% people with Diabetis and 19% of the worlds diabetic of the worlds diabetic population is from India.population is from India.

ANATOMYANATOMY

AnatomyAnatomy

Insulin ActionInsulin Action Insulin is required Insulin is required

for glucose to enter for glucose to enter the cells of the body the cells of the body where it is utilised it where it is utilised it is as if insulin is a is as if insulin is a key which opens key which opens doors of the cells to doors of the cells to allow glucose to allow glucose to enter. When insulin enter. When insulin is absent or is absent or defective glucose defective glucose cannot enter the cannot enter the cells and remains in cells and remains in blood in high blood in high amounts.amounts.

insulin is a key

Types of diabetesTypes of diabetesType 1 (juvenile diabetes)Type 1 (juvenile diabetes) Pancreas does not produce insulin. Pancreas does not produce insulin.

Occurs in Occurs in young adults and childrenyoung adults and children

Type 2 diabetesType 2 diabetes Pancreas does not produce enough Pancreas does not produce enough

insulin or its action is preventedinsulin or its action is prevented

Gestational diabetes Gestational diabetes Occurs during pregnancyOccurs during pregnancy

HyperglycemiaHyperglycemiaSymptomsSymptoms

Frequent need to urinateFrequent need to urinate

Extreme thirst Extreme thirst

Dry skin or mouth Dry skin or mouth

HungerHunger Blurred visionBlurred vision Drowsiness Drowsiness

Slow healing of wounds or infectionsSlow healing of wounds or infections

Risk factorsRisk factors ObesityObesity

Family history Family history

Sedentary life styleSedentary life style

Hypertension Hypertension

Urine glucose test Urine glucose test

Urine glucose monitoring is a viable, Urine glucose monitoring is a viable, cost-effective way of monitoring cost-effective way of monitoring diabetes control, especially when the diabetes control, especially when the cost of blood glucose monitoring cost of blood glucose monitoring makes it inaccessible or when people makes it inaccessible or when people do not wish to perform blood testing. do not wish to perform blood testing.

Urine glucose stripsUrine glucose strips

Blood sugarBlood sugar

Fasting blood sugar (FBS)Fasting blood sugar (FBS) measures blood glucose after fasting measures blood glucose after fasting for at least 8 hours.. for at least 8 hours..

2-hour postprandial blood sugar2-hour postprandial blood sugar measures blood glucose exactly 2 measures blood glucose exactly 2 hours after meal. hours after meal.

Random blood sugar (RBS)Random blood sugar (RBS) measures blood glucose regardless measures blood glucose regardless of when we eat. of when we eat.

Blood sugar monitoringBlood sugar monitoring

NORMAL VALUESNORMAL VALUES

Fasting -normal -70 -100 mgs%Fasting -normal -70 -100 mgs% -diabetic ->126 mgs %-diabetic ->126 mgs %Post prandial –normal-<140 mgs %Post prandial –normal-<140 mgs % diabetic >200 mgs %diabetic >200 mgs %Values between these normal values is Values between these normal values is

said to be impaired diabeticsaid to be impaired diabetic

Oral glucose tolerance testOral glucose tolerance test

The oral glucose tolerance test The oral glucose tolerance test (OGTT) measures the body's ability (OGTT) measures the body's ability to use glucose, that is the body's to use glucose, that is the body's main source of energy. An OGTT can main source of energy. An OGTT can be used to diagnose prediabetes and be used to diagnose prediabetes and diabetes. An OGTT is most commonly diabetes. An OGTT is most commonly done to check for diabetes that done to check for diabetes that occurs with pregnancy (gestational occurs with pregnancy (gestational diabetes diabetes

procedureprocedure

Eat a balanced diet that contains at least Eat a balanced diet that contains at least 150 to 200 grams (g) of carbohydrate per 150 to 200 grams (g) of carbohydrate per day for 3 days before the test. Fruits, day for 3 days before the test. Fruits, breads, cereals, grains, rice,, and starchy breads, cereals, grains, rice,, and starchy vegetables such as potatoes, beans, and vegetables such as potatoes, beans, and corn are good sources of carbohydrate. corn are good sources of carbohydrate.

Do not eat, drink, smoke, or exercise Do not eat, drink, smoke, or exercise strenuously for at least 8 hours before strenuously for at least 8 hours before your first blood sample is takenyour first blood sample is taken

For the standard glucose tolerance For the standard glucose tolerance test, you will drink 75 g to 100 g; test, you will drink 75 g to 100 g; pregnant women drink 100 g of pregnant women drink 100 g of glucose. glucose.

Blood samples will be collected at Blood samples will be collected at timed intervals of 1, 2, and 3 hours timed intervals of 1, 2, and 3 hours after you drink the glucose. Blood after you drink the glucose. Blood samples may also be taken as soon as samples may also be taken as soon as 30 minutes to more than 3 hours after 30 minutes to more than 3 hours after you drink the glucose.you drink the glucose.

Normal valuesNormal values

Glucose tolerance diagnostic test (for Glucose tolerance diagnostic test (for gestational diabetes)gestational diabetes) 100 g of glucose 100 g of glucose Fasting:Less than 95 mg/dL or 5.2 Fasting:Less than 95 mg/dL or 5.2 mmol/L1-hour:Less than 180 mg/dL or mmol/L1-hour:Less than 180 mg/dL or 10.0 mmol/L2-hour:Less than 155 mg/dL 10.0 mmol/L2-hour:Less than 155 mg/dL or 8.6 mmol/L3-hour:Less than 140 mg/dL or 8.6 mmol/L3-hour:Less than 140 mg/dL or 7.7 mmol/L or 7.7 mmol/L 

Glucose tolerance screening test (75 Glucose tolerance screening test (75 g of glucose) g of glucose) 2-hour:Less than 140 2-hour:Less than 140 mg/dL or 7.8 mmol/Lmg/dL or 7.8 mmol/LHigh valuesHigh values

Glycosylated haemoglobin Glycosylated haemoglobin Clinically, hemoglobin Clinically, hemoglobin

A1c values are used A1c values are used most frequently to most frequently to assess glucose control in assess glucose control in insulin-dependent insulin-dependent diabetics whose glucose diabetics whose glucose levels are very labile and levels are very labile and in whom single blood in whom single blood glucose measurements glucose measurements may not accurately may not accurately reflect the level of reflect the level of control present over the control present over the preceding few weeks. preceding few weeks.

Normal (adult): 4.5% to 5.7%

ComplicationsComplications CardiovascularCardiovascular RenalRenal OcularOcular NeurologicalNeurological DentalDental DermatologicalDermatological Foot amputationFoot amputation

Diabetic retinopathyDiabetic retinopathy

Diabetic nephropathyDiabetic nephropathy

In diabetics there is In diabetics there is damage to the filters and there is damage to the filters and there is proteinuriaproteinuria

Diabetic footDiabetic foot

Diabetic neuropathyDiabetic neuropathy

Diabetic ketoacidosisDiabetic ketoacidosis

ManagementManagement

DietDietExerciseExerciseDrugsDrugs

Diabetic dietDiabetic diet

Diet scheduleDiet schedule

Walking Walking

Oral Anti Diabetic DrugsOral Anti Diabetic Drugs

Insulin secretagogues sulfonyl ureasInsulin secretagogues sulfonyl ureas

Insulin sensitizers metformin Insulin sensitizers metformin

Inhibitors of GI absorption Inhibitors of GI absorption

@_Glucosidaseinhibitors@_Glucosidaseinhibitors

INSULININSULIN

Rapid acting_fast insulin -insulin aspart Rapid acting_fast insulin -insulin aspart lispro lispro

Short acting –actrapidShort acting –actrapid Intermediate acting-Intermediate acting-

protophane,HUMULIN NPHprotophane,HUMULIN NPH Mixed –novomix 30 mixtard 30/70Mixed –novomix 30 mixtard 30/70

Methods of insulin injectionMethods of insulin injection

Novo penNovo pen

Complications of diabetis Complications of diabetis hypoglycemia hypoglycemia

SymptomsSymptoms

Tiredness Tiredness

NervousnessNervousness

HeadacheHeadache

SweatingSweating

TachycardiaTachycardia

Blurred visionBlurred vision

Hypoglycemia managementHypoglycemia management

If patient is conscious –oral glucose is If patient is conscious –oral glucose is preferred preferred

If unconscious -50 ml of 25 % If unconscious -50 ml of 25 % dextrose followed by a maintainence dextrose followed by a maintainence dose of 10%dextrose dose of 10%dextrose