DIABETES MELLITUS

DEFINITION
Diabetes mellitus(DM),commonly referred to as diabetes, is a
type of metabolic disorder in which there are high blood sugar
levels over a prolonged period.
Diabetes is due to either the pancreas not producing enough
insulin or the cells of the body not responding properly to the
insulin produced.
TYPES OF DIABETES MELLITUS
Type 1 DM
Type2DM
Gestational DM
Acute complications:
 Ketoacidosis
 The hyperglycemic hyperosmolar nonketotic
syndrome
 Hypoglycemia
 DIABETIC KETOACIDOSIS (DKA)
 It occurs when ketone production by liver exceeds
the
cellular use and renal excretion.
 Most commonly occurs in a person with type 1 diabetes, in whom the lack of
insulin leads to mobilization of fatty acids from adipose tissue.
 DKA often is preceded by physical or emotional stress, such as infection, pregnancy,
or extreme anxiety.
 In clinical practice, ketoacidosis also occurs with
the omission or inadequate use of insulin.
HYPERGLYCEMIC HYPEROSMOLAR
NONKETOTIC SYNDROME
▶ Hyperglycemic hyperosmolar nonketotic syndrome is
characterised by hyperglycemia (blood glucose
>600mg/dl),hyperosmolarity(plasma osmolarity>310mOsm/l),absence
of ketoacidosis.

▶ It is usually a complication of type 2 DM.

▶ It causes severe dehydration from sustained hyperglycemic diuresis.
▶ The loss of glucose in urine is so intensed that the patient is unable
to drink sufficient water to maintain urinary fluid loss.
▶ Thrombotic complications are frequent due to high viscosity of
blood.
CLINICAL FEATURES
 Nausea
 Vomiting
 Deep and fast breathing
 Mental confusion
 Coma
 Excessive urination
 TREATMENT
 Fluid Replacement:
Provide fluids either by mouth or through
vein(intravenously) until you’re rehydrated and
it will helps in diluting the excess sugar in
blood.
 Electrolyte replacement:
Electrolytes includes sodium potassium and
chloride.
The absence of insulin lower the level of
several electrolytes in blood.
To compensate the lost electrolyte,
electrolyte replacement is necessary.
 Insulin therapy
 HYPOGLYCEMIA

▶ Hypoglycemia,also known as low blood sugar,

is when blood sugar decreases to below normal level.
▶ The most common cause include the medications
of diabetes mellitus such as insulin and sulfonylureas.
▶ Other causes may include kidney failure,
certain tumors such as insulinoma, liver disease,
starvation etc.
CLINICAL FEATURES

▶ Heart palpitations
▶ Fatigue
▶ Pale skin
▶ Shakiness
▶ Anxiety
▶ Sweating
▶ Hunger
 TREATMENT
 Dietary therapy:
Provide 15g of fast-acting carbohydrates
such as fruit juice,candy,glucose tablet etc..
 Intravenous glucose therapy
)
 MICROVASCULAR COMPLICATIONS.
Diabetic nephropathy:
It is a progressive kidney disease involving damage to the
capillaries in the kidney’s glomeruli because of long standing
diabetes mellitus.
SYMPTOMS
 Albumin or protein in urine
 Ankle and leg swelling, leg cramps
 Hypertension
 TREATMENT
Lower the blood pressure
o Angiotensin converting enzyme inhibitor
eg:captopril
o Angiotensin II receptor blocker
eg:telmisartan
Calcium channel blocker
eg: amlodipine,verapamil
Severe cases
o Dialysis
o Kidney transplantation
Diabetic neuropathy
Diabetic neuropathy is a type of peripheral nerve injury. High blood sugar
can injure nerve fibers throughout your body, but diabetic neuropathy
most often damages nerves in your legs and feet
SYMPTOMS
 Numbness or reduced ability to feel pain or temperature changes
 Tingling or burning sensation.
 Sharp pains and cramps

TREATMENT
Gabapentin

Amitriptyline
Diabetic retinopathy
Diabetic retinopathy is a complication that
affects eye. It is caused by damage to
the blood vessels of the retine
SYMPTOMS
 Spots or dark strings floating in your vision

 Blurred vision
 Vision loss
TREATMENT
 Laser treatment

 Eye injections
MACROVASCULAR COMPLICATIONS
These mainly includes
 CARDIO VASCULAR DISEASE
 Coronary heart disease
 Hypertension
 Angina pectoris
 Stroke
 PERIPHERAL VASCULAR DISEASE
 Atherosclerosis
STROKE
A sudden disabling attack or loss of consciousness
caused by an interruption in the flow of blood
to the brain
SYMPTOMS
▶ Weakness or numbness of the face arm or leg
on one side of the body
▶ Loss of vision
▶ Loss of speech
▶ Loss of balance
TREATMENT
▶ Aspirin
Intravenous injection of tissue
▶ THROMBOLYSIS :
plasminogen activator
▶ Carotid endarterectomy

▶ PHYSIOTHERARY AND REHABILITATION

CORONARY HEART DISEASE
Coronary heart disease is a disease in which a waxy substance called
plaque builds up inside the coronary arteries. These arteries supply oxygen
rich blood to heart muscle.
SYMPTOMS
o chest pain
o Heart burn
o Tachycardia
o Dyspnoea
o sweating
TREATMENT
 Aspirin or other anti platelets
 Coronary Angioplasty.
 Coronary Artery Bypass surgery
 Statins to help lower cholesterol level
FOOT ULCER
DM impairs the normal step in wound healing process. The
prolonged inflammatory phase is due to the delay in formation of
mature granulation tissue and a parallel reduction in wound tensile
strength.
PHYSICAL APPEARANCE
It looks like a red crater in the skin
mostly located in the side or bottom of foot
,or top or tip of a toe.
TREATMENT

▶ Antibiotic

▶ Antiplatelet
drug.
Which one of these is a microvascular complication of
Diabetes ?

1: Stroke

2 : Peripheral neuropathy

3: Myocardial infarction

4: Peripheral artery disease

WHICH ONE OF THESE IS AN ACUTE COMPLICATION OF
DIABETES MELLITUS ?
1: Diabetic ketoacidosis

2: Myocardial infarction

3: Diabetic retinopathy

4: Stroke
A PERSON PRESENTS WITH SUDDEN ONSET LEFT UPPER
LIMB AND LOWER LIMB WEAKNESS SINCE 2 HOURS.
WHAT IS THE BEST TREATMENT OPTION?

1: Antiplatelets

2: Statins

3: Physiotherapy

4: Thrombolysis
THANK YOU……