1. NON DRUG MANAGEMENT OF DIABETES A Dissertation submitted to THE JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY, ANANTAPUR In partial fulfillment for the award of degree of BACHELOR OF PHARMACY Reg.No: 07GT1R0010 Under the supervision of K.HARI KUMAR, M.Pharm, NOVEMBER 2010 DEPARTMENT OF PHARMACEUTICAL CHEMISTRY SRI VENKATESWARA COLLEGE OF PHARMACY R.V.S. NAGAR, CHITTOOR - 517127

2. INTRODUCTION Diabetes is a disorder of metabolism- the way in which our body converts the food in to energy. Most of the food eaten is break down by digestive juices in to chemicals, including a simple sugar called glucose. Glucose is body’s main source of energy. After digestion, glucose passes in to blood stream, where it is available for cells to take in and use or store for later use. In order for our cells to take in glucose, a hormone called insulin must be present in blood. Insulin acts as a “key” that unlocks “doors” on cell surfaces to allow glucose to enter the cells. Insulin is produced by special cells called islet cells in an organ called the pancreas, which is about 6 inches long and lies behind your stomach.

3. DEFINITION OF DIABETES ACCORDING TO WORLD HEALTH DIABETES Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels. TYPES OF DIABETES DIABETES INSIPIDUS (DI) Diabetes insipidus (DI) is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the latter. DIABETES MELLITUS Diabetes mellitus is a group of metabolic disease in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.

4. TYPES OF DIABETES MELLITUS DIABETES MELLITUS TYPE 1 Diabetes mellitus type 1 (Type 1 diabetes, IDDM, or juvenile diabetes) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose.

5. TYPE 2 DIABETES MELLITUS Diabetes mellitus type 2 – formerly non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes – is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.

6. GESTATIONAL DIABETES MELLITUS (GDM) Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. The lack of insulin causes the blood glucose (also called blood sugar) level to become higher than normal. Gestational diabetes affects between 3 and 5 percent of women during pregnancy.

13. Table 2:Blood pressure values Table 3:Normal total cholesterol values CATAGERY *SBP (mm hg) *DBP(mm hg) OPTIMAL <120 And <80 NORMAL <130 And <85 BORDERLINE 130 – 139 Or 85-89 HYPERTENSION STAGE 1 140 – 159 Or 90-99 STAGE 2 160 – 159 Or 100-109 STAGE 3 Or 110 NORMAL 200 mg/dI BORDERLINE 200 – 240 mg/dI HIGHER >240 mg/dI

14. Table 4:Normal lipid values Table 5: Normal urea / Creatinine values RISK LDL CHOLESTEROL (MG/dI) HDL CHOLESTEROL (MG/dI) TRIGLYCERIDES (MG/dI) HIGH ≥ 130 <35 ≥ 400 BORDERLINE 100 – 129 35 -45 200 - 399 LOW <100 >45 <200 Blood urea (mg/dI) Below 40 mg/dI Serum Creatinine (mg/dI) Below 1.4 mg/dI

24. CONCLUSION Diabetes is an iceberg disease. It is a major public health problem in the developed as well as developing countries. The number of people suffering from diabetes has soared to 282 million and disease knows kills more people than AIDS. The term diabetes mellitus is a metabolic disorder with multiple etiology characterized by chronic hyperglycemia with disturbances of carbohydrates, fats and protein metabolism resulting from defects in insulin secretion or insulin action or both. By maintaining proper life styles, diet and exercise may involve to control blood glucose levels. All these aspects are involved in insulin sensitization and regulating insulin levels in body. Finally nondrug management would involve to maintain diabetic condition and avoiding diabetic complications.