Diabetes mellitus

Made by: Mohammed Mehjez

Younes Ferwanan
Definition
• In Simple terms, Diabetes Mellitus is a disease marked by
high levels of sugar in the blood. Mellitus is Latin for “sweet
as honey”.

• , “Diabetes is not a single disease rather it is a

heterogeneous group of Syndromes characterized by
elevation of blood glucose caused by a relative or absolute
deficiency of Insulin.”

Diabetes Mellitus
 History

Diabetes Mellitus
Diabetes Mellitus
Incidence of Diabetes
• There are currently over 2 million people diagnosed with
diabetes in the UK and there are up to another 1 million
people with diabetes who have the condition and don’t know
it!

• The global incidence of diabetes is rising and the number of

people affected is projected to exceed 300 million by the
year 2025.
(www.diabetes.org.uk)

Diabetes Mellitus
Incidence of Diabetes
• Estimated 245 million people globally
• 20% of adult population
• 5% of all deaths each year
• 80% of people with diabetes live in low and middle income
countries

Diabetes Mellitus
Biostatical Analysis

Diabetes Mellitus
Diabetes Mellitus
Epidemiology in Palestine

• In 2013, the total number of new

reported cases of Diabetes mellitus in
West Bank was (4,816) with incidence
rate (178.4) per 100,000 of population.
• in 2012 was (222.2) per 100,000 of
population.

Diabetes Mellitus
Epidemiology in Palestine

• Types of Diabetes Mellitus according to

patient visits:
(4.4%) of patients with type one of
diabetes.
 (95.3%) with type two diabetes.
(0.2%) gestational diabetes mellitus.
(0.1%) of patients in impaired glucose
tolerance.

Diabetes Mellitus
Epidemiology in Palestine

• Treatment of type II of Diabetes Mellitus:

 Only (0.5%) of diabetic patients on diet.
(11.3%) of patients on compound treatment
(tablets and Insulin).
(21.3%) of patient on Insulin treatment.
(66.9) of type II diabetic patients are on oral
hypoglycemic drugs.

Diabetes Mellitus
Epidemiology in Palestine

• Mortality rate of diabetes in West Bank

is (6.1%)

Diabetes Mellitus
Epidemiology in Palestine

Diabetes Mellitus
Epidemiology in Palestine

Diabetes Mellitus
Epidemiology in Palestine

Diabetes Mellitus
Risk Factor which predispose to
Diabetes
• A parent, brother, or sister with diabetes
• Obesity
• Age greater than 45 years
• Some ethnic groups
• Gestational diabetes or delivering a baby weighing more
than 9 pounds
• High blood pressure
• High blood cholesterol level
• Not getting enough exercise

Diabetes Mellitus
Classification of Diabetes

1. Type 1 DM
• It is due to insulin deficiency and is formerly known as.
• Type I
• Insulin Dependent DM (IDDM)
• Juvenile onset DM

2. Type 2 DM
• It is a combined insulin resistance and relative deficiency
in insulin secretion and is frequently known as.
• Type II
• Noninsulin Dependent DM (NIDDM)
• Adult onset DM

Diabetes Mellitus
Classification of Diabetes

3. Gestational Diabetes Mellitus (GDM):

 developing during some cases of pregnancy but
usually disappears after pregnancy.
 After pregnancy, 5% to 10% of women with gestational
diabetes are found to have type 2 diabetes.
 Women who have had gestational diabetes have a 20%
to 50% chance of developing diabetes in the next 5-10
years
4. Other types:
 Secondary DM

Diabetes Mellitus
Type 1 Diabetes

Diabetes Mellitus
 Type 1 Diabetes
• Insulin not produced due to non
fuctional beta-cell  Hence no
maintainance of basal secretion level of
Insuline and no response to variations
in circulating fuels.
• No insulin to ‘unlock’ the receptors 
• Glucose cannot enter the cell 
• Glucose re-enters the blood stream 
• Extent of glycemic control  related to
metabolic complications

Diabetes Mellitus
Type 1 Diabetes

Diabetes Mellitus
Symptoms of type 1 Diabetes
• Polyuria
• Polydipsia
• Weight loss in spite of polyphagia
• Fatigue
• Nausea
• Vomiting
• Coma
• Patients with type 1 diabetes usually develop symptoms
over a short period of time, and the condition is often
diagnosed in an emergency setting.

Diabetes Mellitus
Morbidity/Complications
Complications of diabetes can be divided into three
categories
•Metabolic complications of low blood glucose levels
(hypoglycaemia) and of high blood glucose levels
(hyperglycaemia) e.g. Diabetic coma.
•Damage to small blood vessels (microvascular) leading in
turn to damage of:
 retina (retinopathy)
 kidney (nephropathy)
 nerves (neuropathy)

Diabetes Mellitus
Morbidity/Complications

• Damage to the larger arteries (macrovascular) leading to

damage of:
 brain (leading to stroke)
 heart (leading to coronary heart disease)
 legs and feet (leading to peripheral vascular disease)

Diabetes Mellitus
Treatment

• The choice of therapy is simple:

All patients need Insulin

Diabetes Mellitus
 • Associated with aging, obesity, Peripheral Insuline
resistance rather than by auto-immune processes or
viruses.
• Metabolic alterations are less (Non-ketotic)
• Occurs mostly in people over 40
• Type 2 diabetes is the most common of the two main
types and accounts for between 85 - 95% of all people
with diabetes.

Diabetes Mellitus
 Pancreas retain some beta-cell function
but variable insuline production is
insufficient and there is a decrease in the
number of receptors (insulin resistance)

Lack of sensitivity of target organs to

either endogenous or exogenous insuline


Glucose does not enter the cell

effectively Glucose re-enters the blood
stream 
Blood glucose levels rise.

Diabetes Mellitus
Symptoms of Type 2 Diabetes
• Slower onset
• Polydipsia
• Polyuria
• Polyphagia
• Fatigue
• Blurred vision
• Slow-healing infections
• Impotence in men

Diabetes Mellitus
Complications of Diabetes
• Hyperglycemia
• Diabetic Ketoacidosis / DKA
• Microvascular complications
• Macrovascular complications

Diabetes Mellitus
 Symptoms of DKA
• Polyuria
• Polydipsia
• Fatigue
• Nausea and vomiting
• Muscular stiffness or aching
• Mental stupor/ decreased consciousness may progress to
coma
• Rapid breathing
• Fruity breath (pear drops / nail varnish smell)
• Headache
• Low blood pressure
• Decreased appetite
• Abdominal pain

Diabetes Mellitus
 Microvascular Complications

Diabetes Mellitus
Microvascular Complications

Diabetes Mellitus
 Macrovascular Complications

Diabetes Mellitus
 Laboratory Tests

1. Glucosuria:
To detect glucose in urine by a paper strip.
2. Ketonuria:

To detect keton bodies in urine by a paper strip.

3. Fasting blood glucose

Glucose blood concentration in samples obtained after

at least 8 hours of the last meal.

Diabetes Mellitus
 Laboratory Tests

4. Random Blood glucose

Glucose blood concentration in samples obtained at
any time regardless the time of the last meal.
5. Glucose tolerance test

75 gm of glucose are given to the patient with 300 ml

of water after an overnight fast
6. Glycosylated hemoglobin (HbA1C)

HbA1C reflects the glycemic state during the preceding

8-12 weeks.

Diabetes Mellitus
 Management of DM

• The major components of the treatment of

diabetes are:

Diabetes Mellitus
Treatment: Dugs Classification

Diabetes Mellitus
Administration

Because insuline is a polypeptide, it is degraded in the

gastrointestinal tract if taken orally. Therefore it is generally
administered by subcutaneous injection. During
Hyperglycemic emergency, it is injected Intravenously.

Diabetes Mellitus
Standard and Intensive Therapy
• S.t therapy involves twice injections daily
• Int.t therapy involves three or more times injection daily
• Frequency of hypogylcemic episodes, coma and seizures
are higher in Int.t than st.t therapy due to insulin
excessiveness
• Patient with Int.t therapy has significant reduction in
nephropathy, neuropathy and retinopathy

Diabetes Mellitus
Insuline Preparations

Diabetes Mellitus
Plasma Insuline Levels/Hours

Diabetes Mellitus
Prevention of DM2
•  lifestyles changes, one can help to decrease the risk of
developing type 2 diabetes.
• Exercise.
• Diet
• Losing weight in obeys patient.
• Decease high cholesterol/triglyceride levels and 
high blood pressure.

Diabetes Mellitus
 Thank you for your patience


Diabetes Mellitus
4th Clinico-Pharmacological Conference
Frontier Medical College