DIABETES MELLITUS

• Pancreas secretes 40-50

units of insulin daily in
two steps:
– Secreted at low levels during
fasting ( basal insulin
secretion)
– Increased levels after eating
(prandial)
– An early burst of insulin occurs
within 10 minutes of eating
– Then proceeds with increasing
release as long as
hyperglycemia is present
 Insulin
• Insulin allows glucose to move
into cells to make energy
• Inhibits glucagon activity
DIABETES MELLITUS
– is a chronic disorder of
carbohydrate, protein,
and fat metabolism
resulting from insulin
deficiency or abnormality
in the use of insulin
Types
1.Type I
formerly known as Insulin –
Dependent Diabetes Mellitus (IDDM)
Autoimmune (Islet cell antibodies)
• Early introduction of cow’s milk and
cereals
•Intake of medicine during
pregnancy
•Indoor smoking of family members
destruction of beta cells of the
pancreas 🡲 little or no
insulin production
requires daily insulin admin.
may occur at any age, usually appears
below age 15
2. Type II
 formerly known as Non Insulin–
Dependent Diabetes Mellitus (NIDDM)
 probably caused by:
 disturbance in insulin reception in
the
cells
 🢛 number of insulin receptors
 loss of beta cell
responsiveness to glucose leading
to slow or 🢛 insulin release by the
pancreas
 occurs over age 40 but can occur in
children
 common in overweight or obese
 w/ some circulating insulin
Pre-Diabetes
• Impaired fasting glucose (IFG)
– FPG- 100-125mg/dL
• Impaired glucose tolerance
(IGT)
– OGTT 140-199mg/dL
• HbA1c 5.7-6.4%
Who are at
risk?
?
Risk Factors
• Obesity
• Race
• History of CVD
• HTN
• Physical inactivity
• Familial history
• Polycystic Ovary Syndrome
• Gestational Diabetes

? ? ? ? ? ? ?
Clinical Manifestations ( Signs and Symptoms)

- Polyuria - weakness
- Polydipsia - fatigue
- Polyphagia - 🡱 blood sugar / glucose level
- weight loss - (+) glucose in urine (glycosuria)
- nausea / vomiting
- changes in LOC (severe hyperglycemia)
(sleepiness, drowsiness  coma)
- recurrent infection, prolonged wound healing
- altered immune and inflammatory response, prone to
infection (glucose inhibits the phagocytic action of WBC
🡲
🢛resistance)
- genital pruritus – (hyperglycemia and glycosuria favor fungal
growth : candidal infection – resulting in pruritus, common
presenting symptom in women)
Diagnostics
 DIAGNOSE TEST FOR
DIABETES
MELLITUS
● Tests for type 1 and type 2 diabetes

● 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 percent or higher on two separate tests indicates that you have diabetes. An
A1C between 5.7 and 6.4 percent indicates prediabetes (A condition in which blood sugar is
high but not high enough to be type 2 diabetes) 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're 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 random
blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimeters 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.
 TESTS FOR GESTATIONAL
DIABETES MELLITUS
Your doctor will likely evaluate your risk factors for gestational diabetes early in your
pregnancy:

● Initial glucose challenge test :- You'll begin the glucose challenge test by drinking a
syrupy glucose solution. One hour later, you'll have a blood test to measure your 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 your blood sugar level is higher than normal, it only means you have a higher risk of
gestational diabetes.

● Follow-up glucose tolerance testing:- For the follow-up test, you'll be asked to fast
overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet
solution — this one containing a higher concentration of glucose — and your 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.
Diagnostic Criteria
• Classic signs of
HYPERGLYSEMIA with
CPG ≥200mg/dL
• OGTT ≥200mg/dL
• FPG ≥126mg/dL
• A1C ≥ 6.5%
Interventions for Diabetes Mellitus
A.Dietary Management

1. Follow individualized meal plan and snacks as

scheduled
 Balanced diabetic diet –
 diet based on pts. size, wt., age, occupation and
activity
2. Pt. must have adequate CHO intake to correspond to
the time when insulin is most effective
3. Routine blood glucose testing before each meal and at
bedtime is necessary during initial control, during
illness and in unstable pts.
4. Do not skip meals
5. Measure foods accurately, do not estimate
6. Less added fat, fewer fatty foods and low-cholesterol
Interventions for Diabetes Mellitus
A.Dietary Management

7. Advise use of complex carbohydrates to help

stabilize blood sugar. Meal should include more
fiber and starch and fewer simple or refined
sugars.
8. Avoid concentrated sweets, high in sugar
(jellies, jams, cakes, ice cream)
9. If taking insulin, eat extra food before periods of
vigorous exercise
10.Avoid periods of fasting and feasting
11.Keep weight at normal level, obese diabetics
should be on a strict weight control program
and should lose weight.
B. Teach pt. on correct administration of insulin
and other hypoglycemic agents.
1. insulin in current use may be stored at room
temp., all others in ref. or cool area
2. avoid injecting cold insulin 🡲 lead to tissue
reaction
3. roll insulin vial to mix, do not shake, remove
air bubbles from syringe
4. press (do not rub) the site after injection
(rubbing may alter the rate of absorption of
insulin)
5. avoid smoking for 30 mins. after injection
(cigarette smoking 🢛absorption)
6. Rotate sites
 Failure to rotate sites may lead to
Lipodystrophy
 Lipodystrophy – localized
disturbance of fat metabolism
 Ex. Lipohypertrophy – thickening of
subcutaneous tissue at injection site,
feel lumpy or hard, spongy
• 🡲 result to 🢛 absorption of
insulin  making it difficult to
control the pt.’s blood glucose
 Insulin
injection
sites
 INSULIN ROUTE

Ultra rapid acting IV/SC PRANDIAL/

Insulin analog/ Short- SUPPLEMENTA
Acting L
(Humalog)
Rapid acting: IV/SC PRANDIAL/
Regular SUPPLEMENTA
(Semilente) L
Intermediate: SC BASAL
NPH (Lente)

Long acting: SC BASAL

Protamine Zinc
(Ultralente)
SLIDING SCALE
Oral Antidiabetic Agents
Classification &
Examples
Sulfonylureas
-Tolbutamide (Orinase)
- Chlorpropamide (Diabinese)
- Glipizide (Glucatrol)
- Glimepiride (Amaryl)
- Glibenclamide
Biguanides
- Metformin (Glucophage)
Alpha-Glucosidase Inhibitors
- Acarbose (Precose)
- Miglitol (Glyset)
Thiazolidinediones
- Rosiglitazone (Avandia)
- Pioglitazone (Actos)
Mechanism of Action
stimulate beta cells of the pancreas
to secrete insulin
improve binding bet. insulin and
insulin receptors
 🡱 no. of insulin receptors
 🡱 body tissues’ sensitivity to insulin
🡲 🡱 glucose uptake
 inhibit glucose prod. by the liver
delay absorption of glucose in the
intestine
enhance insulin action at the
receptor sites