Introduction

• Diabetes mellitus is an important disorder of carbohydrate metabolism.

However, fat and protein metabolism are also affected in diabetic condition.

• It is a chronic multisystem disease characterized by hyperglycemia related to

abnormal insulin production, impaired insulin utilization or both.

• India is fast gaining the title of diabetic capital of the world with 77 million
people with diabetes. The prevalence of diabetes is 8.9% in adults with higher
levels found in the southern part of the country and urban areas.
There are two major clinical classes of the disease :
• Type-I or insulin dependent diabetes mellitus (IDDM) was also known as juvenile
onset diabetes and accounts for about 5-10% of people with diabetes.

Type I generally affects people under 40 years of age, although it can occur in any
age.

• Type - II or non-insulin dependent diabetes mellitus (NIDDM) was also known as

adult onset diabetes and accounts for about 90-95% of people with diabetes.
Although the disease is less frequently in children but the incidence is increasing due
to increasing prevalence of obesity in childhood.
 Clinical manifestation
i. Decreased permeability of the cell membrane for glucose resulting in the
accumulation of glucose in the blood. This condition is known as
hyperglycemia. Glucose concentration increases as high as 500 mg/100 ml of
blood.

ii. Polyuria: This means excretion of increased quantity of urine. This is to

excrete the additional quantity of glucose in urine (glucosuria).
iii. Polydipsia: The excessive thirst which leads to increased consumption of
water. This condition is known as polydipsia. This is to replace the volume of
water excreted due to polyuria.

iv. Polyphagia: Excessive appetite leads to polyphagia and increased intake of

food. This is to replace the lost nourishment.

v. Weight loss occurs in people with type I diabetes.

vi. Fatigue

Recurrent infections, prolonged wound healing, visual changes seen in type II.
 Complications
• Diabetic ketoacidosis: it is caused by profound deficiency of insulin and is
characterized by hyperglycemia, ketosis, acidosis, and dehydration.

• It is most likely to occur in people with type I DM but may be seen in people
with type II DM in case of severe illness or stress.

• Retinopathy : it refers to the process of microvascular damage to the retina as a

result of chronic hyperglycemia, nephropathy and hypertension in patients with
diabetes.
• Nehropathy: it is a microvascular complication associated with damage
to the small blood vessels that supply the glomeruli of the kidney.

• Neuropathy: diabetes related neuropathy is nerve damage that occurs

because of the metabolic derangements associated with diabetes
mellitus.

• Angiopathy : Chronic complication associated with diabetes where there

is damage to the blood vessels.
Diagnostic findings

1. HbA1C of 6.5% or higher

2. Fasting plasma glucose level greater than or equal to 126mg/dl.

3. Two-hour plasma glucose level greater than or equal to 200mg/dl.

 Management
• Drug therapy:
• Insulin for type I diabetes mellitus
• Oral and non-insulin injectable agents
• Biguanides eg., Metrformin
• Sulfonylureas eg., Glipizide
• Alpha-Glucosidase inhibitors eg., Acarbose
Nutritional therapy
• The overall goal of nutritional therapy is to assist the people with
diabetes n making healthy nutritional choices that lead to achieving
or maintaining safe and healthy blood glucose levels.
Exercise
• The ADA recommends that people with diabetes engage in
atleast 150min/week in moderate intensity aerobic physical
activity.

• Monitoring blood glucose - It is a critical part of diabetes

management. Self monitoring of blood glucose enables the
patient to make decisions regarding food intake, activity
pattern and medication doses.