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Diabetes Mellitus

Diabetes Mellitus. Diabetes Mellitus is a group of metabolic diseases characterized by elevated levels of glucose in blood (hyperglycemia) Diabetes Mellitus results from defects in : insulin secretion insulin action or both of them. Diabetes Mellitus

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Diabetes Mellitus

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  1. Diabetes Mellitus • Diabetes Mellitus is a group of metabolic diseases characterized by elevated levels of glucose in blood (hyperglycemia) • Diabetes Mellitus results from defects in : • insulin secretion • insulin action • or both of them

  2. Diabetes Mellitus Normally a certain amount of glucose circulates in the blood The major sources of this glucose are : absorption of ingested food in the (GI) tract formation of glucose by the liver from food substances

  3. Diabetes Mellitus • Insulin a hormone produced by the pancreas , controls the level of glucose in the blood by regulating the production and storage of glucose • In the diabetic state ,the cells may stop responding to insulin, or the pancreas may stop producing insulin entirely

  4. Diabetes mellitus • This leads to hyperglycemia, which may result in acute metabolic complications such as : • Diabetic Ketoacidosis (DKA) • Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

  5. Diabetes Mellitus • Diabetic Ketoacidosis (DKA) : • a metabolic derangement in type 1 diabetes that results from a deficiency of insulin • highly acidic ketone bodies are formed, resulting in acidosis, usually requires hospitalization for treatment, and is usually caused by non adherence to insulin therapy, concurrent illness, or infection

  6. Diabetes Mellitus • Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) : • a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an intercurrent illness that raises the demand for insulin ; associated with polyuria and dehydration

  7. Diabetes Mellitus • Long-term effects of hyperglycemia contribute to: • macrovascular complications such as: (coronary artery disease, cerebrovascular disease, and peripheral vascular disease ) • chronic microvascular complications such as : (nephropathy in the kidney, retinopathy in the eye ) • Neuropathic complications (diseases in the nerves)

  8. Diabetes Mellitus • Risk factors for diabetes mellitus : • family history for diabetes • obesity • age >45 years • hypertension • HDL cholesterol level <35mg/dl • glyceride level >250mg/dl

  9. Diabetes Mellitus • Classification of diabetes: • Type 1 (insulin-dependent diabetes mellitus) • Type 2 (non-insulin-dependent diabetes mellitus) • Gestational diabetes mellitus

  10. Diabetes mellitus • Type 1 diabetes (IDDM) : A metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of langerhans in the pancreas

  11. Diabetes Mellitus • Type 2 diabetes (NIDDM) : a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance

  12. Diabetes Mellitus • Gestational diabetes : • Gestational diabetes is any degree of glucose intolerance with its onset during pregnancy • Hyperglycemia develops during pregnancy because of the secretion of placental hormones which causes insulin resistance • Gestational diabetes occurs in up to 14%of pregnant women and increases their risk for hypertensive disorders during pregnancy

  13. Diabetes Mellitus • Initial management includes dietary modification and blood glucose monitoring • If hyperglycemia persists, insulin is prescribed • Oral antidiabetic agents should not be used during pregnancy

  14. Diabetes Mellitus • Physiology/Pathophysiology : All of the following result in hyperglycemia : • Impaired insulin secretion from (pancreas) • Increased basal hepatic glucose production from (liver) • Decreased insulin-stimulated glucose uptake(muscle) • Gastrointestinal absorption of glucose (GIT)

  15. Diabetes Mellitus • Clinical Manifestation of (DM) : • Three (Ps): (1)Polyuria (increased urination) (2)Polydipsia (increased thirst) (3)Polyphagia (increased appetite) • Fatigue and weakness • Sudden vision changes • Tingling and numbness in hands or feet • Dry skin • Slow wound healing • Weight loss, nausea and vomiting

  16. Diabetes Mellitus • Assessment and Diagnostic findings : • Fasting plasma glucose (FPG) >126mg/dl • Random plasma glucose >200mg/dl • Oral glucose tolerance test • Intravenous glucose tolerance test

  17. Diabetes Mellitus • Laboratory Examination : • Hgb(A1C) • Fasting lipid profile • Test for microalbuminuria • Serum creatinine level • Urine analysis • electrocardiogram

  18. Diabetes Mellitus • There are five components of diabetes management : (1)Nutritional management (2)Exercise (3)Monitoring glucose levels and ketones (4)Pharmacologic therapy (5)Education

  19. Diabetes Mellitus (1)Nutritional management of the diabetic patient includes the following goals : • Providing all the essential food constituents(eg, vitamins, minerals) necessary for optimal nutrition • Meeting energy needs • Maintaining reasonable weight • Decreasing serum lipid levels • Preventing wide daily fluctuations in blood glucose level

  20. Diabetes Mellitus (2) Exercise : • Exercise is extremely important in managing diabetes because of its effects on lowering blood glucose and reducing cardiovascular risk factors • Exercise lowers the blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization

  21. Diabetes Mellitus (3)Monitoring glucose levels and ketones : • Blood glucose monitoring is a cornerstone of diabetes management, and self –monitoring of blood glucose (SMBG) levels by patients has altered diabetes care • Frequent (SMBG) enables people with diabetes to adjust the treatment regimen to obtain optimal blood glucose control

  22. Diabetes Mellitus (4)Pharmacologic therapy : • Insulin therapy • Insulin preparations : (1) human insulin preparation (2)animal insulin preparation

  23. Diabetes Mellitus • Complications of insulin therapy : • Local allergic reactions • Systemic allergic reactions • Insulin lipodystrophy • Insulin resistance • Morning hyperglycemia

  24. Diabetes Mellitus • Alternative methods of insulin delivery : • Insulin pens • Jet injectors • Insulin pumps : for continuous subcutaneous insulin infusion • Implantable and inhalant insulin delivery • Transplantation of pancreatic cells

  25. Diabetes Mellitus • Oral anti diabetic agent : • Sulfonylureas (orinase, micronase ) • Biguanides (glucovance) • Alpha glycosidase inhibitor (precose) • Meglitinides (prandin, starix)

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