Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose. It has many subclassifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycemia. This activity outlines the pathophysiology, evaluation, and management of DM and highlights the role of the interprofessional team in managing patients with this condition. Objectives: Describe the pathophysiology of diabetes mellitus. Outline the epidemiology and risk factors of diabetes mellitus. Review the treatment considerations and common complications of diabetes mellitus. Identify the importance of improving collaboration and care coordination amongst the interprofessional team to enhance the delivery of care for patients affected by diabetes mellitus. Access free multiple choice questions on this topic. Go to: Introduction Diabetes mellitus is taken from the Greek word diabetes, meaning siphon - to pass through and the Latin word mellitus meaning sweet. A review of the history shows that the term "diabetes" was first used by Apollonius of Memphis around 250 to 300 BC. Ancient Greek, Indian, and Egyptian civilizations discovered the sweet nature of urine in this condition, and hence the propagation of the word Diabetes Mellitus came into being. Mering and Minkowski, in 1889, discovered the role of the pancreas in the pathogenesis of diabetes. In 1922 Banting, Best, and Collip purified the hormone insulin from the pancreas of cows at the University of Toronto, leading to the availability of an effective treatment for diabetes in 1922. Over the years, exceptional work has taken place, and multiple discoveries, as well as management strategies, have been created to tackle this growing problem. Unfortunately, even today, diabetes is one of the most common chronic diseases in the country and worldwide. In the US, it remains as the seventh leading cause of death. Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. DM has several categories, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and secondary causes due to endocrinopathies, steroid use, etc. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM). T1DM presents in children or adolescents, while T2DM is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to poor lifestyle and dietary choices. The pathogenesis for T1DM and T2DM is drastically different, and therefore each type has various etiologies, presentations, and treatments.

1. Diabetes mellitus and its
management

2.  Introduction
 What is diabetes
 Pathology
 Physiology
 Epidemiology
 Investigation
 significance in dentistry
 Management of hypoglycaemia
 Conclusion
 References

3.  According to world health organization
 Diabetes is a chronic , metabolic disease characterized by elevated levels
of blood glucose or (blood sugar), which leads over time to serious
damage to the heart , blood vessels , eyes , kidneys and nerves .

14.  Aetio-pathology of diabetes It is now generally agreed that the
underlying characteristic common to all forms of diabetes is the
dysfunction or destruction of pancreatic β-cells
 Many mechanisms can lead to a decline in function or the
complete destruction of β-cells (these cells are not replaced, as
the human pancreas seems incapable of renewing β-cells after the
age of 30 years
 .These mechanisms include genetic predisposition and
abnormalities, epigenetic processes, insulin resistance, auto-
immunity, concurrent illnesses, inflammation, and environmental
factors. Differentiating β-cell dysfunction and decreased β-cell
mass could have important implications for therapeutic
approaches to maintaining or improving glucose tolerance .

15. Types of dm
Type 1
Gestational
diabetes
Neonatal
Type 2
MODY

17.  Previously known as juvenile diabetes
 As it usually develops in teenagers, and in children
 The body's immune system attacks the insulin –producing islet cells in
the pancreas.
 The attack on the body's own cells is known as autoimmune diseases.
 Once insulin producing cells are destroyed , a person can no longer
produce their own insulin .

20.  Is slowly progressive t cell mediated
autoimmune disease.

33.  The current diagnostic criteria used for the
diagnosis of diabetes and intermediate
hyperglycaemia have been in place globally
for almost a decade and are widely accepted.
However, in 2003 the ADA modified its
recommendations resulting in discrepancies
between its recommendations and those of
theWHO.

34. These include:
fasting plasma glucose value used to
define IFG
inclusion of 2–h plasma glucose
value in defining IFG
requirement for fasting plasma
glucose level in defining IGT

35.  Aetio-pathology of diabetes It is now generally agreed that the
underlying characteristic common to all forms of diabetes is the
dysfunction or destruction of pancreatic β-cells (9–12). Many
mechanisms can lead to a decline in function or the complete
destruction of β-cells (these cells are not replaced, as the human
pancreas seems incapable of renewing β-cells after the age of 30
years (13)).These mechanisms include genetic predisposition and
abnormalities, epigenetic processes, insulin resistance, auto-
immunity, concurrent illnesses, inflammation, and environmental
factors. Differentiating β-cell dysfunction and decreased β-cell
mass could have important implications for therapeutic
approaches to maintaining or improving glucose tolerance (11).
Understanding β-cell status can help define subtypes of diabetes,
and guide

36.  Oral complications
Gingivitis and
periodontitis
Salivary glands
dysfunction
Delayed wound
healing {degradation
of newly formed
collagen )
Candidiasis
Burning mouth
syndrome

38.  Approx 5% of patients require emergency
procedures in their lifetime
 Extraction , abcess drainage ,ulcer care

41. • Compatible with most of the
drug
• Hypoglycaemc effect on
higher dose of aspirin
Insulin
• Hypoglycaemic effect with
NSAIDS n aspirin
• Ketonacozole can also induce
hypoglycaemic effect
Metformin

42.  Chest radiograph- posterior anterior view
 Electrocardiogram
 Blood investigations :
 Blood sugar fasting an postprandial
 Glucose tolerance test
 Renal profile : blood urea nitrogen , serum ,
creatinine, serumelectrolytes.

43.  He must be shifted to insulin on the day of
surgery
 He general principle of management of he
patient under general anasthesia is to provide
at least 200g of carbohydrates with adequate
insulin to cover the need.

44.  Check the patients blood and urine sugar
levels on the morning of surgery, with he help
of hemoglucose strips and urostrips or
glucometer

45. Apprehensive
Agitated
Tachycardia
Restless
Skin is moist and pale
Signs of
hypoglaycaemia

46.  In conscious patient
 Oral carbohydrates are given to correct the
glucose levels .
 In unconscious patient
 Iv administration of 50% glucose solution
restores consciousness in 10-15 minutes or IM
glucagon restores in 15 minutes.

47.  Vomiting
 Tachypnea
 Kussmaul
 Deep breathings
 Dehydration
 Circulatory collapse

48.  Administration of insulin to normalize body
metabolism
 Restortion of body fluids
 Shift the pt into earliest oral feeds

58.  The main goal of diabetic managemen and
control is as far as possible , to restore
carbohydrate metabolism to normal state
 there are importantly two types of dm
 Hypoglycaemic and hpyerglyacemic stage
 Drug interaction between insulin is safe
 Insulin replacement therapy is given via
injections


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in 2002. Diabetes Care. 2003; 26: 917-932.
 3.World Health Organization: Definition, Diagnosis andClassification of
Diabetes Mellitus and its Complications: Report of aWHO Consultation.
Part 1: Diagnosis and Classification of Diabetes Mellitus.Geneva,World
Health Org., 1999
 . 4.The Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Follow-up Report on the Diagnosis of Diabetes
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 5.World Health Organization: Diabetes Mellitus: Report of aWHO Expert
Committee. Geneva,World Health Org., 1965 (Tech. Rep. Ser., no. 310).
6.World Health Organization: Expert Committee on Diabetes Mellitus.
Geneva,World Health Org., 1980 (Tech. Rep. Ser., no. 646)
 7.World Health Organization: Diabetes Mellitus: Report of aWHO Study
Group. Geneva,World Health Org., 1985 (Tech. Rep. Ser., no. 727).

61.  Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus Report of
the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus. Diabetes
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