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DM For MRT
DM For MRT
• Objectives
• Definition of Diabetes mellitus
• Etiological classification
• Diagnostic criteria
• Pathogenesis of type 1 DM
• Pathogenesis of type 2 DM
• Clinical presentations
• Management of diabetes mellitus
Objectives
Main objective
OR
OR
• A1C 5.7–6.4
When do you say that an individual has
“Normal Blood Glucose” value ?
Normal Blood Glucose values
development of T2DM
2. Insulin resistance
Genetic considerations
T2DM has a strong genetic component
If both parents have Type 2 Dm, the risk approaches 40%
The disease is polygenic and multifactorial
obesity,
nutrition and
physical activity modulate the disease process
Clinical Features of Diabetes Mellitus
• Polydypsia, polyphagia and Polyuria
• Other features of DM
• blurred vision,
diabetes mellitus
Management of DM
• Approach to the management of diabetes mellitus
History
details related to DM and its complications
Prior diabetes therapy, follow up
Weight , family history
Risk factors
Symptoms of hyperglycemia and hypoglycemia
History of chronic complications of Dm
Symptoms of infection
Physical examination
Complete physical examination
BMI
Examine : the B/P, the eyes , Peripheral nerves , cardiovascular system,
peripheral arterial disease
Laboratory evaluation
determine the FBS,RBS,HbA1C,LFT,RFT,LIPIDS
ECG, measurement of Iselet cell antibodies
Insulin
Insulin initiation dose to type 1 dm is 0.4-0.5 unit/kg Sc, 2/3 am, 1/3
pm
(If available, 1/3 of the total dose should be regular insulin
• Pregnancy
• Initial therapy for patients presenting with fasting blood glucose >250 mg/dl ,
random glucose consistently >300 mg/dl, or ketonuria
38
Outline of presentation
• Objectives
• Summary
39
Objectives
After completing the session :
40
Case 1. Discuss the case in group of 4 members
A 32 yrs, old Diabetes patient for 3 yrs. who has been taking
Insulated insulin 22 U, am and 12 U,pm, SC.
He developed cough , chest pain and fever of four days
duration, these symptoms were accompanied with
polyurea , polydypsia , vomiting and abdominal pain of two
days duration.
On Physical Examination: Young patient with deep breathing,
confused, B/P, : 70/50mmHg, pulse 120/minute, Temp. 38,6
0
c., sunken eyes , Bronchial breathing sound in Left lower
posterior lung field.
Questions
What are the Diagnosis of the patient? 41
Case 1. Answers.
42
Acute complication of DM
• Hypoglycaemia
43
Diabetic Ketoacidosis (DKA)
1. hyperglycemia,
3. ketonemia.
• Metabolic acidosis is often the major finding.
46
DKA risk factors
• T1DM
• 1st presentation
• Acute-illness
• Insulin omission (inappropriate sick-day management,
noncompliance, Eating Disorders)
DKA: Precipitating Factors
Acute illness
(MI, GIB, trauma,
10-20% pancreatitis)
20-38%
New-onset DM
33%
Infections
DKA: Diagnosis
• Fatigue
• Laboratory:
• pH < 7.3, serum HCO3 < 15 mEq/L, AG > 14 mM
Alteration in
sensoria or mental Alert Alert/drowsy Stupor/coma Stupor/coma
obtundation
50
Management of DKA
51
Management of DKA cont.
52
Management of DKA cont.
53
Hyperglycaemic Hyperosmolar State (HHS)
status
54
Management
• Management is the same as Mg. of DKA, except increase fluid
administration upto 8-10 lt.
• HHS is often precipitated by a serious, concurrent illness such as
1. myocardial infarction
2. stroke
3. Sepsis, pneumonia, and other serious infections
4. a debilitating condition (prior stroke or dementia) or
5. social situation that compromises water intake usually contributes
to the development of the disorder
Laboratory values in DKA and HHS
57
Laboratory values in DKA and HHS cont.
58
Hypoglycaemia
• occurs in most patients with type 1 diabetes and type 2
diabetes mellitus
59
Clinical presentation and diagnosis of
hypoglycaemia
• adrenergic manifestations are
palpitation
sweating
hunger pain
weakness.
60
• Neuroglycopenic manifestations include
headache
drowsiness
62
Treatment of Hypoglycemia
63
Treatment of Hypoglycemia
64
Case 2. Discuss the case in group of 4 members
Questions
Specify the diagnoses of the patient?
How do you confirm the diagnosis?
65
Case 2. Ans.
66
Chronic complications of DM
• Affects many organ systems
67
Classification of Chronic complication of
DM
• Diabetes-related complications can be divided into
1. vascular and
2. nonvascular complications
68
The vascular complications of DM are further subdivided into
1. gastroparesis,
2. infections,
4. hearing loss
Pathogenesis of Chronic complications
71
Pathogenetic mechanisms
• Four prominent theories, have been proposed how hyperglycemia might
lead to chronic complications
74
Diabetic Nephropathy
• Is the leading cause of ESRD
75
Diagnostic test
Microalbuminuria test,
U/A,
RFT,
U/S
76
treatment of diabetic nephropathy
Intensive control of blood sugar and blood pressure
Chronic Dialysis
Renal Transplantation
Diabetic Neuropathy cont.
• Physical exam : reveals sensory loss, loss of ankle reflex, loss of
vibration and position sense
78
Autonomic neuropathy
79
• Hyperhidrosis of the upper extremities and
83
CVD cont.
• Silent ischemia
86
Hypertension
• Hypertension accelerates complications of DM
particularly cardiovascular diseases and
nephropathy
87
Lower extremity complications
88
treatment
• Glycemic control
• Infections –
1. Pneumonia, UTI, TB
2. rhinocerebral mucormycosis,