Diabetes Mellitus

By Taha Basit
Mariam Imran
Universal Symbol for Diabetes
By International Diabetes Federation

The colour blue reflects

the sky that unites all
nations and is the colour
of the United Nations flag
What is Diabetes?
 Diabetes mellitus (DM) is a group of diseases characterized by high levels of
blood glucose resulting from defects in insulin production, insulin action, or
both.

 The term diabetes mellitus describes a metabolic disorder of multiple

aetiology characterized by chronic hyperglycaemia with disturbances of
carbohydrate, fat and protein metabolism resulting from defects in insulin
secretion, insulin action, or both.

 The effects of diabetes mellitus include long–term damage, dysfunction and

failure of various organs.
Diabetes Long-term Effects
 The long–term effects of diabetes mellitus include progressive
development of the specific complications of retinopathy with
potential blindness, nephropathy that may lead to renal failure,
and/or neuropathy with risk of foot ulcers, amputation, Charcot
joints, and features of autonomic dysfunction, including sexual
dysfunction.

 People with diabetes are at increased risk of cardiovascular,

peripheral vascular and cerebrovascular disease.
• 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
Normal Function of Insulin
• Insulin is an essential anabolic hormone that exerts multiple effects on
glucose, lipid, protein, and mineral metabolism, as well as growth.
Importantly, insulin allows glucose to enter muscle and adipose cells,
stimulates the liver to store glucose as glycogen and synthesize fatty
acids, stimulates the uptake of amino acids, inhibits the breakdown of
fat in adipose tissue, and stimulates the uptake of potassium into cells.
•Types of Diabetes
There are three main types of diabetes mellitus:
• Type 1 DM
• Type 2 DM
• Gestational Diabetes
• Other types:
Secondary Diabetes Mellitus
Type 1 DM (Insulin-dependent DM)
 Was previously called insulin-dependent diabetes mellitus (IDDM)
or juvenile-onset diabetes.
 Type 1 diabetes develops when the body’s immune system destroys
pancreatic beta cells, the only cells in the body that make the
hormone insulin that regulates blood glucose.
 This form of diabetes usually strikes children and young adults,
although disease onset can occur at any age.
 Type 1 diabetes may account for 5% to 10% of all diagnosed cases
of diabetes.
Pathophysiology of T1DM
Diagnosis for T1DM

• Glycated hemoglobin (A1C) test. This blood test indicates your average blood
sugar level for the past two to three months. It measures the percentage of blood
sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin).
The higher your blood sugar levels, the more hemoglobin you'll have with sugar
attached. An A1C level of 6.5 percent or higher on two separate tests indicates
diabetes.
• If HbA1C is not available then
• Random blood sugar test. A blood sample will be taken at a random
time and may be confirmed by repeat testing. Blood sugar values are
expressed in milligrams per deciliter (mg/dL) or millimoles per liter
(mmol/L). Regardless of when you last ate, a random blood sugar
level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes,
especially when coupled with any of the signs and symptoms of
diabetes, such as frequent urination and extreme thirst.
• 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.
Treatment for T1DM
Treatment for type 1 diabetes includes:
• Taking insulin
• Frequent blood sugar monitoring
• Eating healthy foods
• Exercising regularly and maintaining a healthy weight
• Insulin and other medications
• Anyone who has type 1 diabetes needs lifelong insulin therapy.
• Types of insulin are many and include:
• Short-acting (regular) insulin- (Humulin R and Novolin R)
• Rapid-acting insulin- insulin lispro (Humalog) and insulin aspart
(Novolog)
• Intermediate-acting (NPH) insulin- insulin NPH (Novolin N, Humulin N).
• Long-acting insulin- insulin glargine (Lantus, Toujeo Solostar)
Insulin regimens
The majority of patients will require more than one daily injection if good glycaemic
control is to be achieved. However, a once-daily injection of an intermediate acting
preparation may be effectively used in some patients.

Twice-daily mixtures of short- and intermediate-acting insulin is a commonly used

regimen.

 In some cases, a mixture of short- and intermediate-acting insulin may be given in

the morning. Further doses of short-acting insulin are given before lunch and the
evening meal and an evening dose of intermediate-acting insulin is given at bedtime.

Other regimens based on the same principles may be used.

A regimen of multiple injections of short-acting insulin before the main meals, with an
appropriate dose of an intermediate-acting insulin given at bedtime, may be used,
• Insulin administration
• Insulin can't be taken orally to lower blood sugar because stomach
enzymes will break down the insulin, preventing its action. You'll need to
receive it either through injections or an insulin pump.
• Injections. You can use a fine needle and syringe or an insulin pen to
inject insulin under your skin.
• If you choose injections, you'll likely need a mixture of insulin types to
use throughout the day and night. Multiple daily injections that include a
combination of a long-acting insulin combined with a rapid-acting insulin
more closely mimic the body's normal use of insulin than do older insulin
regimens that only required one or two shots a day. A regimen of three
or more insulin injections a day has been shown to improve blood sugar
levels.
• Other medications
• Additional medications also may be prescribed for people with type 1
diabetes, such as:
• High blood pressure medications. Your doctor may prescribe
angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor
blockers (ARBs) to help keep your kidneys healthy. These medications are
recommended for people with diabetes who have blood pressures above
140/90 millimeters of mercury (mm Hg).
• Aspirin. Your doctor may recommend you take baby or regular aspirin
daily to protect your heart if your doctor feels you have an increased risk
for a cardiovascular event, after discussing with you the potential risk of
bleeding.
• Cholesterol-lowering drugs. Cholesterol guidelines tend to be more
aggressive for people with diabetes because of the elevated risk of heart
disease.
• Healthy eating and monitoring carbohydrates
• Fruits
• Vegetables
• Whole grains

• Physical activity
• choose activities you enjoy, such as walking or swimming, and make them
part of your daily routine. Aim for at least 150 minutes of aerobic exercise
a week, with no more than two days without any exercise. The goal for
children is at least an hour of activity a day.
Potential future treatments

• Pancreas transplant. With a successful pancreas transplant, you

would no longer need insulin. But pancreas transplants aren't always
successful — and the procedure poses serious risks. Because these
risks can be more dangerous than the diabetes itself, pancreas
transplants are generally reserved for those with very difficult-to-
manage diabetes, or for people who also need a kidney transplant.
• Islet cell transplantation. Researchers are experimenting with islet
cell transplantation, which provides new insulin-producing cells from a
donor pancreas. Although this experimental procedure had some
problems in the past, new techniques and better drugs to prevent islet
cell rejection may improve its future chances of becoming a successful
treatment.
Type 2 diabetes
 Was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-
onset diabetes.
 Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes.
 It usually begins as insulin resistance, a disorder in which the cells do not use insulin
properly. As the need for insulin rises, the pancreas gradually loses its ability to
produce insulin.
 Type 2 diabetes is associated with older age, obesity, family history of diabetes,
history of gestational diabetes, impaired glucose metabolism, physical inactivity, and
race/ethnicity.
 African Americans, Hispanic/Latino Americans, American Indians, and some Asian
Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk
for type 2 diabetes.
 Diagnosis of Type 2 DM
• HbA1C
• Random blood Sugar test
• Fasting blood sugar test

• Oral glucose tolerance test. You'll need to fast overnight and then

drink a sugary liquid at the doctor's office. Blood sugar levels are tested
periodically for the next two hours. Results are interpreted as follows:
• Less than 140 mg/dL (7.8 mmol/L) is normal.
• 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) is diagnosed as
prediabetes.
• 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.
Treatment of Type 2 DM
1) Diabetes medications
• Metformin (Fortamet, Glumetza, others) is generally the first
medication prescribed for type 2 diabetes. It works primarily by
lowering glucose production in the liver and improving your body's
sensitivity to insulin so that your body uses insulin more effectively.
• Sulfonylureas help your body secrete more insulin. Examples
include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and
glimepiride (Amaryl)
• Thiazolidinediones make the body's tissues more sensitive to insulin
• DPP-4 inhibitors help reduce blood sugar levels but tend to have a
very modest effect. Examples include sitagliptin (Januvia)
2)Healthy eating
• Contrary to popular perception, there's no specific diabetes diet.
However, it's important to center your diet around:
• A regular schedule for meals and healthy snacks
• Smaller portion sizes
• More high-fiber foods, such as fruits, nonstarchy vegetables and whole
grains
• Fewer refined grains, starchy vegetables and sweets
• Modest servings of low-fat dairy, low-fat meats and fish
• Healthy cooking oils, such as olive oil or canola oil
• Fewer calories
3)Physical activity
• Such as Aerobic exercise, resistance exercise and limit inactivity

4) Weight loss
Weight loss results in better control of blood sugar levels, cholesterol,
triglycerides and blood pressure. If you're overweight, you may begin to see
improvements in these factors after losing as little as 5% of your body
weight. However, the more weight you lose, the greater the benefit to your
health and disease management.
Gestational diabetes
• Gestational diabetes is a type of diabetes that can develop
during pregnancy in women who don't already have
diabetes.
• Gestational diabetes goes away after you the patient gives birth. But
it can affect the baby’s health, and it raises the risk of mother
getting type 2 diabetes later in life
 Pathophysiology of Gestation DM
• During pregnancy, the placenta makes hormones that cause glucose
to build up in your blood. Usually, your pancreas can send out
enough insulin to handle it. But if your body can’t make enough
insulin or stops using insulin as it should, your blood sugar levels
rise, and the patient develops gestational diabetes
Complications of DM
Secondary DM
 Acromegaly,
 Cushing syndrome,
 Thyrotoxicosis,
 Pheochromocytoma
 Chronic pancreatitis,
 Cancer
THANK YOU