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BIOCHEMICAL
 PROFILE OF
  DIABETES
  MELLITUS




  DR MUSTANSAR
In 1500 BC
 Diabetes First Described In
 Writing
• Hindu healers wrote that flies and ants were attracted
  to urine of people with a mysterious disease that
  caused intense thirst, enormous urine output, and
  wasting away of the body



                      © 2004, John Walsh, P.A., C.D.E.
• 250 BC
  The Word Diabetes First Used
Apollonius of Memphis coined the name
"diabetes” meaning "to go through" or siphon.
He understood that the disease drained more
fluid than a person could consume.
Gradually the Latin word for honey, "mellitus,"
was added to diabetes because it made the
urine sweet.
Definition:-
• Diabetes mellitus is a chronic systemic disease
  characterized by either a deficiency of insulin or a
  decrease ability of the body to use insulin.
What is Diabetes Mellitus?

      A chronic syndrome of
•              impaired
    carbohydrate, protein, an
     d fat metabolism owing
     to insufficient secretion
       of insulin or to target
            tissue insulin
    resistance, characterized
      by polydipsia, polyuria
         and polyphagia.
A glucose (C6H12O6).
Classification of
Diabetes.Mellitus.:-
Type-I Diabetes mellitus:-
• In this form of diabetes mellitus the Beta cells of
  pancreas that normally produce insulin which are
  destroy by an auto-immune response.

• As a result insulin injection are needed to control the
  elevated blood sugar level.
Before Insulin


                                 JL on 12/15/22 and 2 mos later


Before insulin was discovered in 1921,
  everyone with type 1 diabetes died
  within weeks to years of its onset

                   © 2004, John Walsh, P.A., C.D.E.
CLASSIFICATION


                         Type 1 diabetes mellitus is
                    characterized by loss of the insulin-
                     producing beta cells of the islets of
                   Langerhans in the pancreas leading to
                              insulin deficiency.
                   Type 1 diabetes can affect children or
                     adults but was traditionally termed
                            "juvenile diabetes"
                   because it represents a majority of the
                    diabetes cases in children.


• TYPE1 DIABETES
Causes:-
• 1) Genetic factors.(HLA)
• 2) Immunological factors.

• 3) Environmental factors.
Type-2 Diabetes mellitus:-
• It refers from decreased sensitivity to insulin
  or decrease production of insulin.

• This type of patient firstly treated by diet and
  exercise and secondary by oral hypoglycemic
  drug.
TYPE 2 DIABETES



             Type 2 diabetes mellitus is
        characterized by insulin resistance
      which may be combined with relatively
             reduced insulin secretion.
        At this stage hyperglycemia can be
       reversed by a variety of measures &
         medications that improve insulin
     sensitivity or reduce glucose production
                     by the liver.
Causes:-
• 1) Age- > 40yrs.

• 2) Obesity

• 3) Family history.
Gestational D.M. :-
                • Onset is during pregnancy
                  usually 2nd & 3rd trimester.
                • It may be due to hormonal
                  secretion by the placenta
                  which inhibit the action of
                  insulin.
GESTATIONAL DIABETES



      Gestational diabetes mellitus (GDM) resembles type 2
     diabetes in several respects, involving a combination of
            relatively inadequate insulin secretion and
         responsiveness. It occurs in about 2%–5% of all
        pregnancies and may improve or disappear after
       delivery. This is particularly problematic as diabetes
    raises the risk of complications during pregnancy, as well
     as increasing the potential that the children           of
     diabetic mothers will also become diabetic in the future.
Clinical Manifestation:-
                •   Polydypsia.
                •   Polyphasia.
                •   Polyuria.
                •   Hyperglycemia.
                •   Blurred vision.
                •   Diabetic ketosis.
                •   Diabetic ketoacidosis.
                •   Dry skin.
                •   Slow healing wound.
                •   Weakness.
DIAGNOSIS
       Diabetes mellitus is characterized by recurrent or persistent
hyperglycemia, and is diagnosed by demonstrating any one of the following
                                           –
          * Fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dL).
  * Plasma glucose ≥ 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral
              glucose load as in a glucose tolerance test.
  * Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/L
                             (200 mg/dL)
               * Glycated hemoglobin (Hb A1C) ≥ 6.5%.
Investigations:-   • 1) Fasting blood glucose.
                   • 2) Random blood glucose.
                   • 3) Postprandial blood glucose
                     level.
                   • 4) Oral glucose tolerance test.
                   • 5) Urine test for ketonuria.
                   • 6) Urine test for proteinuria.
DIABETES MELLITUS
Glycemic Control

         A1C%      Mean Plasma Glucose (mg/dl)

           6                   135


           7                   170


           8                   205


           9                   240


          10                   275


          11                   310
Glycemic Control
•   HgA1C < 6% - normal.
•   HgA1C < 7% - goal.
•   HgA1C 7.0 - 7.5% - good control.
•   HgA1C > 7.5% - additional therapy
•   Pre-prandial glucose 90-130 mg/dl
•   Peak postprandial glucose < 180 mg/dl

• HgA1C every 3 months unless at goal then every 6
  months.
Management:-
• The main management or goal is to normalise insulin
  activity and blood glucose level to reduce the
  vascular and nephropathic complications.
5
FIVE
main         components      of
management of diabetes mellitus
patient’s are:-
Cont..

• 1) Diet

• 2) Exercise

• 3) Monitoring

• 4) Education

• 5) Medication
MEDICATION
              Medication may be 2 types



•




    Insulin                          Oral medications
CONCLUSION
• FOODS TO BE TAKEN      FOODS NOT TOBE
                         TAKEN


 •Fruits & veg                    •High in fat



                                 •High in sugar
 •Garlic, ginger


     •Radish                       •High in salt




    •Spinach                      •Low starchy
                                  carbohydrate
                                  foods
BIOCHEMICAL PROFILE OF DIABETES MELLITUS   by  DR MUSTANSAR  FJMC LAHORE
BIOCHEMICAL PROFILE OF DIABETES MELLITUS   by  DR MUSTANSAR  FJMC LAHORE
BIOCHEMICAL PROFILE OF DIABETES MELLITUS   by  DR MUSTANSAR  FJMC LAHORE

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BIOCHEMICAL PROFILE OF DIABETES MELLITUS by DR MUSTANSAR FJMC LAHORE

  • 1.
  • 2. BIOCHEMICAL PROFILE OF DIABETES MELLITUS DR MUSTANSAR
  • 3. In 1500 BC Diabetes First Described In Writing • Hindu healers wrote that flies and ants were attracted to urine of people with a mysterious disease that caused intense thirst, enormous urine output, and wasting away of the body © 2004, John Walsh, P.A., C.D.E.
  • 4. • 250 BC The Word Diabetes First Used Apollonius of Memphis coined the name "diabetes” meaning "to go through" or siphon. He understood that the disease drained more fluid than a person could consume. Gradually the Latin word for honey, "mellitus," was added to diabetes because it made the urine sweet.
  • 5. Definition:- • Diabetes mellitus is a chronic systemic disease characterized by either a deficiency of insulin or a decrease ability of the body to use insulin.
  • 6. What is Diabetes Mellitus? A chronic syndrome of • impaired carbohydrate, protein, an d fat metabolism owing to insufficient secretion of insulin or to target tissue insulin resistance, characterized by polydipsia, polyuria and polyphagia.
  • 9. Type-I Diabetes mellitus:- • In this form of diabetes mellitus the Beta cells of pancreas that normally produce insulin which are destroy by an auto-immune response. • As a result insulin injection are needed to control the elevated blood sugar level.
  • 10. Before Insulin JL on 12/15/22 and 2 mos later Before insulin was discovered in 1921, everyone with type 1 diabetes died within weeks to years of its onset © 2004, John Walsh, P.A., C.D.E.
  • 11. CLASSIFICATION Type 1 diabetes mellitus is characterized by loss of the insulin- producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children. • TYPE1 DIABETES
  • 12. Causes:- • 1) Genetic factors.(HLA) • 2) Immunological factors. • 3) Environmental factors.
  • 13. Type-2 Diabetes mellitus:- • It refers from decreased sensitivity to insulin or decrease production of insulin. • This type of patient firstly treated by diet and exercise and secondary by oral hypoglycemic drug.
  • 14. TYPE 2 DIABETES Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. At this stage hyperglycemia can be reversed by a variety of measures & medications that improve insulin sensitivity or reduce glucose production by the liver.
  • 15. Causes:- • 1) Age- > 40yrs. • 2) Obesity • 3) Family history.
  • 16. Gestational D.M. :- • Onset is during pregnancy usually 2nd & 3rd trimester. • It may be due to hormonal secretion by the placenta which inhibit the action of insulin.
  • 17. GESTATIONAL DIABETES Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. Clinical Manifestation:- • Polydypsia. • Polyphasia. • Polyuria. • Hyperglycemia. • Blurred vision. • Diabetic ketosis. • Diabetic ketoacidosis. • Dry skin. • Slow healing wound. • Weakness.
  • 23.
  • 24. DIAGNOSIS Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following – * Fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dL). * Plasma glucose ≥ 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test. * Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/L (200 mg/dL) * Glycated hemoglobin (Hb A1C) ≥ 6.5%.
  • 25. Investigations:- • 1) Fasting blood glucose. • 2) Random blood glucose. • 3) Postprandial blood glucose level. • 4) Oral glucose tolerance test. • 5) Urine test for ketonuria. • 6) Urine test for proteinuria.
  • 26.
  • 28. Glycemic Control A1C% Mean Plasma Glucose (mg/dl) 6 135 7 170 8 205 9 240 10 275 11 310
  • 29. Glycemic Control • HgA1C < 6% - normal. • HgA1C < 7% - goal. • HgA1C 7.0 - 7.5% - good control. • HgA1C > 7.5% - additional therapy • Pre-prandial glucose 90-130 mg/dl • Peak postprandial glucose < 180 mg/dl • HgA1C every 3 months unless at goal then every 6 months.
  • 30. Management:- • The main management or goal is to normalise insulin activity and blood glucose level to reduce the vascular and nephropathic complications.
  • 31. 5 FIVE main components of management of diabetes mellitus patient’s are:-
  • 32. Cont.. • 1) Diet • 2) Exercise • 3) Monitoring • 4) Education • 5) Medication
  • 33. MEDICATION Medication may be 2 types • Insulin Oral medications
  • 34. CONCLUSION • FOODS TO BE TAKEN FOODS NOT TOBE TAKEN •Fruits & veg •High in fat •High in sugar •Garlic, ginger •Radish •High in salt •Spinach •Low starchy carbohydrate foods