IntroductionThis presentation will help you

– better understand and manage your diabetes. – It covers the three main forms of diabetes, type 1 and type

2,. – how your body metabolizes sugar, – How to control diabetes– the fundamentals of nutrition and exercise. – up-to-date information about recent innovations in

treatment and – most importantly, you'll see that it's not just possible to

live with diabetes; it's possible to live well.

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• Insulin is the principal hormone in the body – It plays a key role in all forms

of diabetes mellitus.– It regulates uptake of glucose

from the bloodstream into every muscle and all fat cells,

– But not into the cells of the central nervous system.

• Deficiency of insulin or insensitivity of its receptors – Causes Diabetes Miletus

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When our body functions normally …

The normal food processing cycle

• food is converted to glucose before it is used by the blood and body as fuel.

• As a result, blood glucose levels in the body rise.

• In response to this, the Pancreas release Insulin into the blood.

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When our body functions normally …

The different organs involved in the normal food processing cycle

• about two-thirds of the body's cells use Insulin to

• absorb glucose from the blood

• To use as fuel and • To convert to other

needed chemicals, or • for storage.

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Normal glucose absorption

Insulin binds to receptors on the cell membrane, much as a key fits into a lock, signal glucose transporters

Glucose transporters move to the cell membrane and bind to glucose.

Glucose enters the cell.

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When the system fails to absorb glucose….

Type 1 Diabetes

Type 2 Diabetes

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An immune system attack severely limits the ability of the pancreas to produce insulin Glucose cannot enter the cells.

• Cells develop a resistance to insulin. Glucose builds up in the bloodstream.

When the insulin is high/ low• Higher insulin levels increase certain

processes, like– cell growth and duplication, – protein synthesis, and – fat storage.

• If the amount of insulin available is insufficient due to – insulin insensitivity or resistance - poor

response of the cells– defective insulin, then glucose will

• neither be absorbed properly by those body cells that require it

• nor will it be stored appropriately in the liver and muscles.

• The net effect – – persistent high levels of blood glucose, – poor protein synthesis, and – other metabolic derangements, such as

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When the body begins to malfunction…• Glucose, after food is absorbed

from the intestines– and distributed to all the body

cells through the bloodstream.

• The glucose concentration in the blood – body keeps constant and avoids

extra glucose right after every meal

– and starves the body between the meals and overnight.

The defective food processing cycle

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When the body begins to malfunction…

• When glucose in the body is excess – stored in the liver and muscles as

glycogen.

• When glucose is in short supply, – the body stimulates to eat food

and/or mobilizes the stored glycogen.

• To maintain a constant blood-glucose level,– the body relies on pancreas to

produce two hormones insulin and glucagon

Insulin vs Glucagon cycle – A comparison10Gokul

Diabetes mellitusDiabetes mellitus (or simply diabetes) is a condition when: • the organism begins to malfunction – metabolic disorder• levels of the hormone insulin in the blood become insufficient• the body cells fail to respond to the insulin that is produced, or both. • as a result, blood sugar levels grow abnormally high (hyperglycaemia)• This is Diabetes and is not curable.

Types of DiabetesDiabetes mellitus – Three main forms (WHO): I. type 1, II. type 2

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SYMPTOMS• The characteristic symptoms are • excessive thirst and increased fluid

intake (polydipsia) attempting to compensate for increased urination,

• blurred vision due to high blood glucose effects on the eye's optics,

• unexplained weight loss, and • lethargy.

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CAUSES of Diabetes mellitus• Type 1 diabetes - when the pancreatic cells are

destroyed due to autoimmune system of the body.• Type-2 diabetes - when due to high levels of blood

sugar, the body is unable to utilize it’s insulin and move blood sugar into the cells to produce energy.

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Diabetes - a genetic source?• Partly inheritance - Both type 1 and

type 2 diabetes. • At least 10 genes found - links to the

causes of Type-2 diabetes.

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How genes influence Diabetes?• Type 1 diabetes is triggered

– by some (mainly viral) infections,– by stress or environmental exposure (such as exposure

to certain chemicals or drugs).

• Type 2 diabetes - a stronger inheritance pattern.• If first relatives have type 2 diabetes• risk of developing type 2 diabetes is much higher. • This risk increases with increase in number of relatives

with diabetes.

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diagnosisRecurrent or persistent hyperglycaemia during

Diabetes mellitus is diagnosed by any one of the following methods:• fasting plasma glucose level

• at or above 126 mg/dL (7.0 mmol/l). • plasma glucose

• at or above 200 mg/dL (11.1 mmol/l) two hours after a 75 g oral glucose load.

• random plasma glucose • at or above 200 mg/dL (11.1 mmol/l).

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Diabetes screening• Diabetes screening is recommended

– at various stages of life, and – For those with any of several risk factors.

• Diabetes screening could be – a random blood glucose test, – a fasting blood glucose test, – a blood glucose test two hours after 75 g of

glucose, or – a more formal glucose tolerance test.

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Incidence of diabetes between men and women

Relation between BMI and incidence of diabetes

Prevalence of diabetes between men and women across age

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Impact of Diabetes on other diseases - complications

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Complications from Diabetes• Careless treatment or its poor

management lead to serious complications …..

• Diabetes causes: • Damage to eyes• heart disease and stroke, • retinal damage (blindness), • chronic renal (kidney) failure, • Poor healing of wounds (gangrene)• amputations• Impotence and difficulty passing urine in

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Acute complications from DiabetesIf Diabetes is not

controlled properly,acute complications

may occur, like• dehydration• hypoglycemia, • ketosis, • acidosis.• Coma and • Even death 22

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TREATMENT• Type 1 diabetes directly treatable

– only with injected insulin (insufficient or no insulin from pancreas)

– dietary and lifestyle changes

• Type 2 diabetes requires– dietary treatment together with

• tablets • injections and, • frequent insulin supplementation.

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Prevention• Other health problems that

accelerate the toxic effects of diabetes are– obesity, – high blood pressure, and – lack of regular exercise.– elevated cholesterol levels, – smoking,

• Women with high bp must be careful. They have a threefold greater risk of developing diabetes.

• For people with well-controlled blood sugar levels, the complications of diabetes are far less common and less severe,

• it is vital that for prevention of diabetes to organize– Patient education, – His understanding of the

disease, and – His participation in

treatment.

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Lifestyle changes - Type 1 diabetes• Make Changes in lifestyle

– take drugs to reduce pressure. – take an appropriate diet, – quit smoking, – Exercise more, – wear diabetic socks,

• to avoid higher risks of cardiovascular disease,

• to control blood pressure and cholesterol

• Combine the use of regular and/or synthetic insulin for better results

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Lifestyle changes - Type 2 diabetes• Reduce the risk of long term complications:

This is achievable by combining – diet, – exercise and – weight loss (type 2), – various oral diabetic drugs (type 2 only), and– insulin use – when not responding to oral

medications (more for type 2 than type 1).

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Conclusion• Diabetes mellitus is

• a chronic disease, • without a cure.

• Emphasize on role for • patient education, • dietetic support, • sensible exercise, • self glucose monitoring (both

short and long term glucose blood levels within normal standards).

• avoid short and long-term diabetes-related problems

• Careful control to reduce the risk of long term complications.

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Some tips for avoiding complications

• Keep blood sugar levels as close to normal as possible• Keep blood pressure under 130/80 mm Hg.• Aim to keep LDL (unhealthy) cholesterol levels under 100

mg/dl, • Aim to keep HDL (healthy) cholesterol levels over 40 mg/dl, • Aim to keep triglyceride levels under 150 mg/dl.• Practice good foot care (see "Damage to the feet and legs").• Regularly visit your doctor to assess overall health• Check for ways to reduce your risk and avoid any complications.• Exercise and walk daily.

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Any questions?

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