read as above

2. Introduction
• Diabetes mellitus is a disorder in which blood
sugar (glucose) levels are abnormally high
because the body does not produce enough
insulin to meet its needs.
• Insulin , a hormone released from the pancreas,
controls the amount of glucose in the blood.
• Glucose in the bloodstream stimulates the
pancreas to produce insulin .
• Insulin helps glucose to move from the blood
into the cells.
• Once inside the cells, glucose is converted to
energy, which is used immediately, or the
glucose is stored as fat or glycogen until it is
needed

3. Types of Diabetes
• Type 1 diabetes (formerly called insulin -dependent diabetes)
– The body's immune system attacks the insulin -producing
cells of the pancreas, and more than 90% of them are
permanently destroyed.
– The pancreas, therefore, produces little or no insulin .
– Only about 10% of all people with diabetes have type 1
disease
– Most people who have Type1 DM develop the disease before
age 30, although it can develop later in life.
• Causes : Environmental factors , eg: viral infection or a
nutritional factor during childhood or early adulthood—causes
the immune system to destroy the insulin -producing cells of the
pancreas.
• A genetic predisposition may make some people more
susceptible to the environmental factor.

4. Types of Diabetes
• Type 2 diabetes(formerly called non– insulin -
dependent diabetes or adult-onset diabetes)
• The pancreas continues to produce insulin , sometimes
even at higher-than-normal levels. However, the body
develops resistance to the effects of insulin , so there is
not enough insulin to meet the body’s needs
• It usually begins in people older than 30 and becomes
progressively more common with age.
• About 27% of people older than 65 have type 2 diabetes
• Type 2 diabetes also tends to run in families

5. Causes of type 2 DM
• Obesity is the chief risk factor and 80 to 90% of people
with this disorder are overweight or obese, because
obesity causes insulin resistance, obese people need
very large amounts of insulin to maintain normal
blood glucose levels.
• Certain disorders and drugs can affect the way the
body uses insulin and can lead to diabetes.
• Steroid use and pregnancy ( gestational diabetes) are
the most common causes of impaired insulin use.
• Diabetes also may occur in people with excess
production of growth hormone (acromegaly) and in
people with certain hormone-secreting tumors.
• Severe or recurring pancreatitis and other disorders
that directly damage the pancreas can lead to
diabetes

6. Mechanism

7. Symptoms

8. Emergencies in diabetes are ?
Diabetic ketoacidosis (DKA) and Nonketotic
hyperglycemic-hyperosmolar syndrome(HHS) :
- triggered by infection and dehydration

9. Treatment of DKA/HHS
• Do not rush to correct high blood sugar in such
patient, correct triggers
• Rush and give fluids 1st before you give insulin at-
least 3litters in 2hrs @litre in half an hour (0.9%NS)
• Correct electrolytes 1st even before insulin as insulin
drops down potassium levels from blood.
• Than give insulin by infusion or intramuscular (not
subcutaneously) unless RBG is above 14mmol/l
• Stop insulin if RBG 14mmol/l and start d5% to avoid
brain edema as low glucose in blood and high in
brain cell will pull water in the braincells hence
edema and brain death.

11. Screening for diabetes
• It should be a routine physical examination
and annually.
• Important to screen people :
– Over 45 yr old
– Overweight
– Have high BP and/high cholesterol
– Have a family history of diabetes
– Have had diabetes during pregnancy or had
a baby who weighed over 4kg at birth
– Are of African American, Hispanic, Asian
American, or American Indian ethnicity

12. Diabetes treatment goals
• Experts recommend that people keep their blood
glucose levels
– Between 70 and 130 mg/dL fasting (before meals)
– Less than 180 mg/dL 2 hours after meals
– Hemoglobin A1c levels should be less than 7%.
• Avoid hypoglycaemia RBG of less than 4.5 mmol/l
(< 50mg/dl)
*Note : converting Mmol/l to mg/dl multiply by 18

13. Treatment
• Control Diet
• Do Exercise
• Have Education on diabetes
• In type 1 diabetes, insulin injections
• In type 2 diabetes, often drugs by mouth
and sometimes insulin injections

14. Diet

15. Insulin dosage : 0.5 to 1 IU/kg/day
Divided in 2/ 3am and 1/3pm dosages
Than
Divided into soluble(short acting) (color: ya maji) and lante
(intermediate acting)(color: yamaziwa) at a ratio of 1: 1
respetively
e.g: 40IU 2/3rd = 26IU 13IU soluble
13IU lante
1/3rd = 14 IU 7IU soluble
7IU lante

16. Oral hypoglycemic agents (OHA)
There are several groups of drugs BUT
1st line :METFORMIN (because : it sensitizes insulin
release from muscle cell without causing
hypoglycemia) : 500mg to 2gm per day in divided
doses.
2nd line : GLIBENCLAMIDE 5-10mg/day or
GLIMIPIRIDE 1-2mg/day (it sensitizes insulin
release from pancreas but causes hypoglycemia)
Note : if single drug cannot control blood sugar in
maximum dosage than combination can be given.

17. Complications of diabetes
• Diabetes damages blood vessels, causing them to
narrow and therefore restricting blood flow, because
blood vessels throughout the body are affected, people
may have many complications of diabetes. Many
organs can be affected, particularly the following:
– Brain: causing stroke
– Eyes : diabetic retinopathy and blindness
– Heart: causing heart attack(myocardial infraction)
– Kidneys: diabetic nephropathy and causing
kidney failure
– Nerves: diabetic neuropathy and causing
decreased sensation in feet, easy cut/damage,
gangrene and finally amputaion
– Penis : erectile dysfunction

18. Compilations