ACKNOWLEDGEMENT

I would like to express my special gratitude to my biology

teacher Mr. Sankha Chakraborty as well as own Principal Mr.
Banamali Biswal who gave me the golden opportunity to do this
project on the topic "Case study on Diabetes Mellitus" and also
for their guidance and encouragement in carrying out this
project work. This project also helped me in gaining a lot of
knowledge as I did research and I came to know about so many
things. I'm really thankful to them. Secondly, I would also like to
thank my parents and friends who helped me a lot in finalizing
this project within limited time frame.
CERTIFICATE
This is to certify that I, Mahima Mahapatra have
successfully completed the project prescribed by CBSE
(DAV PUBLIC SCHOOL, MIDNAPORE) under the guidance
of Mr. Sankha Chakraborty for the partial fulfillment of
my project during the academic session 2021-22

__________ ____________ ____________

Signature of Signature of Signature of

Principal Subject Teacher External

 INDEX

 AIM
 INTRODUCTION
 CAUSES
 COMPLICATIONS
 SIGNS & SYMPTOMS
 PREVENTION CARE &
TREATMENT
 CASE STUDIES
 AIM
To study about diabetes mellitus

 It is a disease, in which the body’s

ability to produce or respond to the
hormone insulin is impaired,
resulting in abnormal metabolism of
carbohydrates and elevated levels
of glucose in the blood.
INTRODUCTION
Diabetes Mellitus ("diabetes" for short) is a serious
disease that occurs when your body has difficulty
properly regulating the amount of dissolved sugar
(glucose) in your blood stream. It is unrelated to a
similarly named disorder "Diabetes Insipidus".
Common types of diabetes:-
 There are three main types of diabetes

 Type 1 diabetes can develop at any age, but occurs most

frequently in children and adolescents. When you have type 1
diabetes, your body produces very little or no insulin, which means
that you need daily insulin injections to maintain blood glucose
levels under control.
 Type 2 diabetes is more common in adults and accounts for
around 90% of all diabetes cases. When you have type 2 diabetes,
your body does not make good use of the insulin that it produces.
The cornerstone of type 2 diabetes treatment is healthy lifestyle,
including increased physical activity and healthy diet. However,
over time most people with type 2 diabetes will require oral drugs
and/or insulin to keep their blood glucose levels under control..
 Gestational diabetes (GDM) is a type of diabetes that
consists of high blood glucose during pregnancy and is associated
with complications to both mother and child. GDM usually
disappears after pregnancy but women affected and their children
are at increased risk of developing type 2 diabetes later in life.
Causes of diabetes
Different causes are associated with each type of diabetes .

Type 1 diabetes
Doctors don’t know exactly what causes type 1 diabetes. For some reason, the immune system
mistakenly attacks and destroys insulin-producing beta cells in the pancreas Genes may play a
role in some people. It’s also possible that a virus sets off the immune system attack.

Type 2 diabetes
Type 2 diabetes stems from a combination of genetics and lifestyle factors. Being overweight or
obese increases your risk too. Carrying extra weight, especially in our belly makes our cells more
resistant to the effects of insulin on your blood sugar.

This condition runs in families. Family members share genes that make them more likely to get
type 2 diabetes and to be overweight.

Gestational diabetes
Gestational diabetes is the result of hormonal changes during pregnancy. The placenta produces
hormones that make a pregnant woman’s cells less sensitive to the effects of insulin. This can
cause high blood sugar during pregnancy.

Women who are overweight when they get pregnant or who gain too much weight during their
pregnancy are more likely to get gestational diabetes.
COMPLICATONS OF DIABETES
Long-term complications of diabetes develop gradually. The longer you
have diabetes — and the less controlled your blood sugar — the higher
the risk of complications. Eventually, diabetes complications may be
disabling or even life-threatening. Possible complications include:

 Cardiovascular disease. Diabetes dramatically increases the

risk of various cardiovascular problems, including coronary artery disease with chest pain
(angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have
diabetes, you're more likely to have heart disease or stroke.

 Nerve damage (neuropathy). Excess sugar can injure the

walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your
legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of
the toes or fingers and gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the
nerves related to digestion can cause problems with nausea, vomiting, diarrhea or
constipation. For men, it may lead to erectile dysfunction.

 Kidney damage (nephropathy). The kidneys contain

millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood.
Diabetes can damage this delicate filtering system. Severe damage can lead to kidney
failure or irreversible end-stage kidney disease, which may require dialysis or a kidney
transplant.

 Eye damage (retinopathy). Diabetes can damage the blood

vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also
increases the risk of other serious vision conditions, such as cataracts and glaucoma.

 Foot damage. Nerve damage in the feet or poor blood flow to the feet
increases the risk of various foot complications. Left untreated, cuts and blisters can
develop serious infections, which often heal poorly. These infections may ultimately
require toe, foot or leg amputation.
  Skin conditions. Diabetes may leave you more susceptible to skin
problems, including bacterial and fungal infections.

 Hearing impairment. Hearing problems are more common in

people with diabetes.


 Alzheimer's disease. Type 2 diabetes may increase the risk of

dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater
the risk appears to be. Although there are theories as to how these disorders might be
connected, none has yet been proved.

 Depression. Depression symptoms are common in people with type 1 and

type 2 diabetes. Depression can affect diabetes management.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies.

However, untreated or uncontrolled blood sugar levels can cause
problems for you and your baby.
Complications in your baby can occur as a result of gestational diabetes, including:

 Excess growth. Extra glucose can cross the placenta, which triggers your
baby's pancreas to make extra insulin. This can cause your baby to grow too large
(macrosomia). Very large babies are more likely to require a C-section birth.

 Low blood sugar. Sometimes babies of mothers with gestational

diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own
insulin production is high. Prompt feedings and sometimes an intravenous glucose
solution can return the baby's blood sugar level to normal.

 Type 2 diabetes later in life. Babies of mothers who have

gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in
life.
  Death. Untreated gestational diabetes can result in a baby's death either before or
shortly after birth.

SIGNS & SYMPTOMS

Diabetes symptoms vary depending on how much your blood sugar is

elevated. Some people, especially those with prediabetes or type 2
diabetes, may sometimes not experience symptoms. In type 1 diabetes,
symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes
are:

 Increased thirst
 Frequent urination
 Extreme hunger
 Unexplained weight loss
 Presence of ketones in the urine (ketones are a byproduct of the
breakdown of muscle and fat that happens when there's not
enough available insulin)
 Fatigue
 Irritability
 Blurred vision
 Slow-healing sores
  Frequent infections, such as gums or skin infections and vaginal
infections

Type 1 diabetes can develop at any age, though it often appears during
childhood or adolescence. Type 2 diabetes, the more common type, can
develop at any age, though it's more common in people older than 40.

DIAGNOSIS
Tests for type 1 and type 2 diabetes and
prediabetes
 Glycated hemoglobin (A1C) test. This blood test, which
doesn't require fasting, indicates your average blood sugar level for the past
two to three months. It measures the percentage of blood sugar attached to
hemoglobin, the oxygen-carrying protein in red blood cells.

The higher your blood sugar levels, the more hemoglobin you'll have with
sugar attached. An A1C level of 6.5% or higher on two separate tests
indicates that you have diabetes. An A1C between 5.7 and 6.4 % indicates
prediabetes. Below 5.7 is considered normal.

If the A1C test results aren't consistent, the test isn't available, or you have certain
conditions that can make the A1C test inaccurate — such as if you are pregnant or
have an uncommon form of hemoglobin (known as a hemoglobin variant) — your
doctor may use the following tests to diagnose diabetes:
  Random blood sugar test. A blood sample will be taken at
a random time. Regardless of when you last ate, a blood sugar
level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles
per liter (mmol/L) — or higher suggests diabetes.
 Fasting blood sugar test. A blood sample will be taken
after an overnight fast. A fasting blood sugar level less than 100
mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from
100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If
it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you
have diabetes.
 Oral glucose tolerance test. For this test, you fast
overnight, and the fasting blood sugar level is measured. Then you
drink a sugary liquid, and blood sugar levels are tested periodically
for the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
A reading of more than 200 mg/dL (11.1 mmol/L) after two hours
indicates diabetes. A reading between 140 and 199 mg/dL (7.8
mmol/L and 11.0 mmol/L) indicates prediabetes.

If type 1 diabetes is suspected, your urine will be tested to look for the
presence of a byproduct produced when muscle and fat tissue are used
for energy because the body doesn't have enough insulin to use the
available glucose (ketones). Your doctor will also likely run a test to see
if you have the destructive immune system cells associated with type 1
diabetes called autoantibodies.

Tests for gestational diabetes

Doctor will likely evaluate the risk factors for gestational diabetes early
in pregnancy:

 If there is a high risk of gestational diabetes — for

example, if you were obese at the start of pregnancy; had
gestational diabetes during a previous pregnancy; or have a
 mother, father, sibling or child with diabetes — doctor may test
for diabetes at first prenatal visit.
 At average risk of gestational diabetes , have a
screening test for gestational diabetes sometime during your
second trimester — typically between 24 and 28 weeks of
pregnancy.

Doctor may use the following screening tests:

 Initial glucose challenge test. begin the glucose challenge

test by drinking a syrupy glucose solution. One hour later, have a
blood test to measure blood sugar level. A blood sugar level below
140 mg/dL (7.8 mmol/L) is usually considered normal on a
glucose challenge test, although this may vary at specific clinics or
labs.

If blood sugar level is higher than normal, it only means have a

higher risk of gestational diabetes. Doctor will order a follow-up
test to determine if you have gestational diabetes .

 Follow-up glucose tolerance testing. For the follow-up

test, be asked to fast overnight and then have your fasting blood
sugar level measured. Then drink another sweet solution — this
one containing a higher concentration of glucose —and blood
sugar level will be checked every hour for a period of three hours.

If at least two of the blood sugar readings are higher than the
normal values established for each of the three hours of the test,
you'll be diagnosed with gestational diabetes.
PREVENTION
Type 1 diabetes can't be prevented. However, the same healthy lifestyle
choices that help treat prediabetes, type 2 diabetes and gestational
diabetes can also help prevent them:

 Eat healthy foods. Choose foods lower in fat and calories and
higher in fiber. Focus on fruits, vegetables and whole grains. Strive
for variety to prevent boredom.
 Get more physical activity. Aim for about 30 minutes of
moderate aerobic activity on most days of the week, or at least 150
minutes of moderate aerobic activity a week.
 Lose excess pounds. If you're overweight, losing even 7% of
your body weight — for example, 14 pounds (6.4 kilograms) if
you weigh 200 pounds (90.7 kilograms) — can reduce the risk of
diabetes.

To keep weight in a healthy range, focus on permanent changes to

your eating and exercise habits. Motivate yourself by remembering
the benefits of losing weight, such as a healthier heart, more
energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as

metformin (Glumetza, Fortamet, others) may reduce the risk of type 2
diabetes — but healthy lifestyle choices remain essential. Have your
blood sugar checked at least once a year to check that you haven't
developed type 2 diabetes.

MEDICATION
Medications for type 1 diabetes
 Insulin
o Short-acting insulin
o Rapid-acting insulins
o Intermediate-acting insulin
o Long-acting insulins
o Combination insulins
 Amylinomimetic drug
Other drugs
People with type 1 and type 2 diabetes often need to take other
medications to treat conditions that are common with diabetes.

These drugs can include:

 aspirin for heart health.
 drugs for high cholesterol.
 high blood pressure medications.
 SURGERY
Diabetes is associated with increased requirement for surgical
procedures and increased postoperative morbidity and mortality. The
stress response to surgery and the resultant hyperglycemia, osmotic
diuresis, and hypoinsulinemia can lead to perioperative ketoacidosis or
hyperosmolar syndrome. Hyperglycemia impairs leukocyte function and
wound healing. The management goal is to optimize metabolic control
through close monitoring, adequate fluid and caloric repletion, and
judicious use of insulin.

Patients with diabetes undergo surgical procedures at a higher rate than

do nondiabetic people.1,2 Major surgical operations require a period of
fasting during which oral antidiabetic medications cannot be used. The
stress of surgery itself results in metabolic perturbations that alter
glucose homeostasis, and persistent hyperglycemia is a risk factor for
endothelial dysfunction,3 postoperative sepsis,4 impaired wound
healing,5,6 and cerebral ischemia.7 The stress response itself may
precipitate diabetic crises (diabetic ketoacidosis [DKA], hyperglycemic
hyperosmolar syndrome [HHS]) during surgery or postoperatively, with
negative prognostic consequences. HHS is a well known postoperative
complication following certain procedures, including cardiac bypass
surgery, where it is associated with 42% mortality.9,10
Furthermore, gastrointestinal instability provoked by anesthesia,
medications, and stress-related vagal overlay can lead to nausea,
vomiting, and dehydration. This compounds the volume contraction that
may already be present from the osmotic diuresis induced by
hyperglycemia, thereby increasing the risk for ischemic events and acute
renal failure. Subtle to gross deficits in key electrolytes (principally
potassium, but also magnesium) may pose an arrhythmogenic risk,
which often is superimposed on a milieu of endemic coronary artery
disease in middle-aged or older people with diabetes.

CONCLUSION

Diabetes mellitus is growing to epidemic

proportions, leading to devastating
complications if not treated well. There
are many challenges in the successful
treatment of diabetes mellitus because
of personal and economic costs incurred
in diabetes therapy.
CARE & TREATMENT
1. Lose extra weight
Losing weight reduces the risk of diabetes. People in one large study
reduced their risk of developing diabetes by almost 60% after losing
approximately 7% of their body weight with changes in exercise and
diet.

The American Diabetes Association recommends that people with

prediabetes lose at least 7% to 10% of their body weight to prevent
disease progression. More weight loss will translate into even greater
benefits.

Set a weight-loss goal based on your current body weight. Talk to your
doctor about reasonable short-term goals and expectations, such as a
losing 1 to 2 pounds a week.

2. Be more physically active

There are many benefits to regular physical activity. Exercise can help
you:
  Lose weight
 Lower your blood sugar
 Boost your sensitivity to insulin — which helps keep your blood
sugar within a normal range

Goals for most adults to promote weight loss and maintain a healthy
weight include:

 Aerobic exercise. Aim for 30 minutes or more of moderate to

vigorous aerobic exercise — such as brisk walking, swimming,
biking or running — on most days for a total of at least 150
minutes a week.
 Resistance exercise. Resistance exercise — at least 2 to 3 times a
week — increases your strength, balance and ability to maintain an
active life. Resistance training includes weightlifting, yoga and
calisthenics.
 Limited inactivity. Breaking up long bouts of inactivity, such
as sitting at the computer, can help control blood sugar levels.
Take a few minutes to stand, walk around or do some light activity
every 30 minutes.

3. Eat healthy plant foods

Plants provide vitamins, minerals and carbohydrates in your diet.
Carbohydrates include sugars and starches — the energy sources for
your body — and fiber. Dietary fiber, also known as roughage or bulk, is
the part of plant foods your body can't digest or absorb.

Fiber-rich foods promote weight loss and lower the risk of diabetes. Eat
a variety of healthy, fiber-rich foods, which include:

 Fruits, such as tomatoes, peppers and fruit from trees

 Nonstarchy vegetables, such as leafy greens, broccoli and
cauliflower
 Legumes, such as beans, chickpeas and lentils
  Whole grains, such as whole-wheat pasta and bread, whole-grain
rice, whole oats, and quinoa

The benefits of fiber include:

 Slowing the absorption of sugars and lowering blood sugar levels

 Interfering with the absorption of dietary fat and cholesterol
 Managing other risk factors that affect heart health, such as blood
pressure and inflammation
 Helping you eat less because fiber-rich foods are more filling and
energy rich

Avoid foods that are "bad carbohydrates" — high in sugar with little
fiber or nutrients: white bread and pastries, pasta from white flour, fruit
juices, and processed foods with sugar or high-fructose corn syrup.

4. Eat healthy fats

Fatty foods are high in calories and should be eaten in moderation. To
help lose and manage weight, your diet should include a variety of foods
with unsaturated fats, sometimes called "good fats."

Unsaturated fats — both monounsaturated and polyunsaturated fats —

promote healthy blood cholesterol levels and good heart and vascular
health. Sources of good fats include:

 Olive, sunflower, safflower, cottonseed and canola oils

 Nuts and seeds, such as almonds, peanuts, flaxseed and pumpkin
seeds
 Fatty fish, such as salmon, mackerel, sardines, tuna and cod

Saturated fats, the "bad fats," are found in dairy products and meats.
These should be a small part of your diet. You can limit saturated fats by
eating low-fat dairy products and lean chicken and pork.

5. Skip fad diets and make healthier choices

Many fad diets — such as the glycemic index, paleo or keto diets —
may help you lose weight. There is little research, however, about the
long-term benefits of these diets or their benefit in preventing diabetes.

Your dietary goal should be to lose weight and then maintain a healthier
weight moving forward. Healthy dietary decisions, therefore, need to
include a strategy that you can maintain as a lifelong habit. Making
healthy decisions that reflect some of your own preferences for food and
traditions may be beneficial for you over time.

One simple strategy to help you make good food choices and eat
appropriate portions sizes is to divide up your plate. These three
divisions on your plate promote healthy eating:

 One-half: fruit and nonstarchy vegetables

 One-quarter: whole grains
 One-quarter: protein-rich foods, such as legumes, fish or lean
meats

When to see a doctor

The American Diabetes Association recommends routine screening with

diagnostic tests for type 2 diabetes for all adults age 45 or older and for
the following groups:

 People younger than 45 who are overweight or obese and have one
or more risk factors associated with diabetes
 Women who have had gestational diabetes
 People who have been diagnosed with prediabetes
 Children who are overweight or obese and who have a family
history of type 2 diabetes or other risk factors

`
 CASE STUDY

PATIENT PROFILE

Patient name:- Neha Singh

Husband name:- Rohan Singh
Gender:- female
Medical record no.:- (MR#): 6991/53579
Age:- 60 years
Room no.:- 3 Bed no.:- 5

PATIENT HISTORY

 Diabetes for 15 years.

 Diabetic foot.

 Cold clumpsy skin.

 Pulseless condition.
  Excess vomiting for last 1 year.

 On & off constipation & diarrhea.

 Insulin admin 2 months.

GENERAL PHYSICAL EXAMINATION

Temp- 98F BP- 100/70

Pulse rate- 71 beats/min

Respiration rate- 18breaths/min Anemia= -ve

Pallor= -ve Jaundice= -ve

Cyanosis= 0 Edema=0

SYSTEMATIC EXAMINATION

 CVS = S = S2 = 0
1

 CNS = intact
  GIT = soft doughy abdomen

 Chest = Clear

LAB DIAGNOSIS

TESTS RESULTS NORMAL

RANGE
 13.5 – 17.5
Haemoglobin 6.9 grams/dL
3.5 – 10.5 billion
WBC 13.83 cells/L
150 – 450
PLATELET COUNT 475 billion/L
4.32 – 5.72
RBC 4.07 million cells/mcL

BIOCHEMICAL & XHEMICAL PATHOLOGY

TEST

TESTS RESULTS UNITS NORMAL

RANGE
ALBUMIN 3.5 g/dl 3.4 – 4.0
BUN 14 mg/dl 5.0 – 18
CREATININE 0.9 Mg/dl 0.5 – 1.3
ALP 291 U/L 20 - 160
ALT <60 U/L 10 - 65
 AST 48 U/L 15 - 40
T BILRUBIN - mg/dl 0.0 – 1.0
D BILRUBIN - mg/dl 0.0 – 0.3
SODIUM 132 mmol/l 135 - 148
POTASSIUM 3.8 mmol/l 3.5 – 5.0
CALCIUM 10.9 mg/dl 3.8 –
10.5
GLUCOSE - mg/dl 65 - 170

MEDICATION OF THE PATIEN

PRESCRIB GENERIC PRESCRIBED STANDARD SIDE -
ED DRUGS NAME DOSE DOSE EFFECTS
Inj-Flagyl Metroni 1000cc*TID 500mg*TI Diarrhe
dazole D a,
nausea,
headac
he,
anorexi
a
Inj.Omepr Omepra 40mg*OD 10- Agitatio
azole zole 40mg*OD n, rash,
difficult
y
Inj.Insulin Insulin 10units/SC 2IU/Kg/da Weight
ySC* gain,Hy
pokale
mia
Inj.Benzyl Penicilli 1.2g*QID 0.6- 1.2 Hyperse
penicillia n-G g*OID nsitivity
reactio
n.
INTERACTION:
NO INTERACTION FOUND

MONITORING:
 Adequate hydration (CZ of antiprotozal).
 Check regularly the glycemic control.