Diabetes Mellitus Shama shabbir 3459

Diabetes MellitusDefinition

A multisystem disease related to: Abnormal

insulin production, or

Impaired insulin utilization, or

Both of the above

Leading cause of heart disease, stroke, adult blindness, and non-traumatic lower limb

amputations

Normal Insulin Metabolismo Insulin

Produced by the cells in the islets of Langherans of the pancreas

Facilitates normal glucose range of 3.9 – 6.7 mmol/L

Normal Insulin Metabolism

Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell

Analogous to a “key” that unlocks the cell door to allow glucose in

Types of Diabetes There are major

3 types of diabetesType 1 diabetesType 2 DiabetesGastational Diabetes

Type 1 Diabetes Mellitus

Formerly known as “juvenile onset” or “insulin dependent” diabetes

Most often occurs in people under 30 years of age

Peak onset between ages 11 and 13

Type 1 Diabetes Mellitus

Pancrease can no longer produce insulineSymptomsWeight lossPolydipsia (excessive thirst)Polyuria (frequent urination)Polyphagia (excessive hunger)Weakness and fatigueKetoacidosis

Type 2 Diabetes Mellitus Accounts for 90%

of patients with diabetes

Usually occurs in people over 40 years old

80-90% of patients are overweight

Type 2 Diabetes Mellitus

• Insulin resistance• Body tissues

do not respond to insulin

• Results in hyperglycemia

• Decreased (but not absent) production of insulin

Type 2 Diabetes Mellitus• Non-specific

symptoms• Fatigue• Recurrent

infections• Prolonged wound

healing• Visual changes

Gestational Diabetes Develops during

pregnancy Detected at 24 to 28

weeks of gestation Associated with risk

for cesarean delivery, perinatal death, and neonatal complications

Management of Diabetes

• Diet and ExerciseA

• Oral hypoglycaemic therapyB

• Insulin TherapyC

Management of DMThe major components of the treatment of diabetes are:

Diet

Diet is a basic part of management in every case. Treatment cannot be effective unless adequate attention is given to ensuring appropriate nutrition.

Dietary treatment should aim at:◦ ensuring weight control◦ providing nutritional

requirements◦ allowing good glycaemic

control with blood glucose levels as close to normal as possible

◦ correcting any associated blood lipid abnormalities

Diet Dietary fat should provide 25-35% of

total intake of calories but saturated fat intake should not exceed 10% of total energy. Cholesterol consumption should be restricted and limited to 300 mg or less daily.

Protein intake can range between 10-15% total energy (0.8-1 g/kg of desirable body weight). Requirements increase for children and during pregnancy. Protein should be derived from both animal and vegetable sources

Diet Carbohydrates provide 50-60% of

total caloric content of the diet. Carbohydrates should be complex and high in fibre.

Excessive salt intake is to be avoided. It should be particularly restricted in people with hypertension and those with nephropathy

Exercise

Together with dietary treatment, a programme of regular physical activity and exercise should be considered for each person. Such a programme must be aimed to the individual’s health status and fitness. People should, however, be educated about the potential risk of hypoglycaemia and how to avoid it.

Physical activity promotes weight reduction and improves insulin sensitivity, thus lowering blood glucose levels.

Self-Care Patients should be

educated to practice self-care. Self-care should include

◦ Blood glucose monitoring◦ Body weight monitoring◦ Foot-care◦ Personal hygiene◦ Healthy lifestyle/diet or physical

activity◦ Identify targets for control◦ Stopping smoking