Diabetes is a disease where blood glucose levels are too high due to the body not producing enough insulin or not properly using the insulin it does produce. There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where the body does not properly use insulin; and gestational diabetes which occurs during pregnancy. Diabetes is diagnosed through blood tests and managed through lifestyle changes like diet and exercise as well as medication like insulin. Treatment aims to control blood sugar levels to prevent complications.

1. DIABETES
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high.
Blood glucose is your main source of energy and comes from the food you eat. Insulin, a
hormone made by the pancreas, helps glucose from food get into your cells to be used for
energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin
well. Glucose then stays in your blood and doesn’t reach your cells.
Types of diabetes:
The most common types of diabetes are type 1, type 2, and gestational diabetes.
Type 1 diabetes
If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and
destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in
children and young adults, although it can appear at any age. People with type 1 diabetes need to
take insulin every day to stay alive.
Type 2 diabetes
If you have type 2 diabetes, your body does not make or use insulin well. You can develop type
2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in
middle-aged and older people. Type 2 is the most common type of diabetes.
Gestational diabetes
Gestational diabetes develops in some women when they are pregnant. Most of the time, this
type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes,
you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes
diagnosed during pregnancy is actually type 2 diabetes.
Other types of diabetes
Less common types include monogenic diabetes, which is an inherited form of diabetes, and
cystic fibrosis-related diabetes.
Etiology
Both genetic and environmental factors are relevant in the development of type 1 diabetes, but
the exact relationship between the two is unknown. There is a strong immunological component

2. to type 1 and a clear association with many organ-specific autoimmune diseases. Circulating islet
call antibodies (ICAs) are present in more than 70% of those with type 1 at the time of diagnosis.
Family studies have shown that the appearance of ICAs often precedes the onset of clinical
diabetes by as much as 3 years. Type 1 has been widely believed to be a disease of clinically
rapid onset, but the development is related to a slow process of progressive immunological
damage. However, it is not currently possible to use screening methods to reliably identify
patients who will develop diabetes in the future. The final event that precipitates clinical diabetes
may be caused by sudden stress such as an infection when the mass of beta-cells in the pancreas
falls below 5-10%.
Risk factors
Risk factors for Type 1diabetes include:
 Having a family history (parent or sibling) of Type 1 diabetes.
 Injury to the pancreas (such as by infection, tumor, surgery or accident).
 Presence of autoantibodies (antibodies that mistakenly attack your own body’s tissues or
organs).
 Physical stress (such as surgery or illness).
 Exposure to illnesses caused by viruses.
Risk factors for prediabetes and Type 2 diabetes include:
 Family history (parent or sibling) of prediabetes or Type 2 diabetes.
 Being African-American, Hispanic, Native American, Asian-American race or Pacific
Islander.
 Being overweight.
 Having high blood pressure.
 Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.
 Being physically inactive.
 Being age 45 or older.
 Having gestational diabetes or giving birth to a baby weighing more than 9 pounds.
 Having polycystic ovary syndrome.
 Having a history of heart disease or stroke.
 Being a smoker.
Risk factors for gestational diabetes include:
 Family history (parent or sibling) of prediabetes or Type 2 diabetes.
 Being African-American, Hispanic, Native American or Asian-American.
 Being overweight before your pregnancy.

3.  Being over 25 years of age.
Pathophysiology
The pathophysiology of diabetes is related to the levels of insulin within the body, and the
body’s ability to utilize insulin. There is a total lack of insulin in type 1 diabetes, while in type 2
diabetes, the peripheral tissues resist the effects of insulin. Normally, the pancreatic beta cells
release insulin due to increased blood glucose concentrations. The brain in order for normal
functions to occur continually requires glucose. Hypoglycemia, or low plasma glucose levels, is
usually caused by drugs used in the treatment of diabetes, including insulin and oral
antihyperglycemics. The pathophysiology of diabetes involves plasm concentrations of glucose
signaling the central nervous system to mobilize energy reserves. It is based on cerebral blood
flow and tissue integrity, arterial plasma glucose, the speed that plasma glucose concentrations
fall, and other available metabolic fuels. Low plasma glucose causes a surge in autonomic
activity. Diagnosis of hypoglycemia requires verification of low plasma glucose levels.
Immediate treatment is the intake of glucose. The responses to hypoglycemia include decreased
insulin secretion, increased secretion of glucose counter-regulatory hormones such as glucagon
and epinephrine, a greater sympathoadrenal response, related symptoms, and finally, cognitive
dysfunction, seizures, or coma. Late hypoglycemia of occult diabetes may develop in some
patients with impaired glucose tolerance, or early type 1 or type 2 diabetes. After a high-
carbohydrate meal, the patient experiences hypoglycemia.
Signs and symptoms
 Frequent urination
 Increased thirst
 Fatigue
 Blurred vision
 Increased hunger
 Unexplained weight loss
 Slow healing cuts and wounds.
 Tingling or numbness in the hands or feet.
Symptoms of Type 1 Diabetes
You might notice:
Unplanned weight loss. If your body can’t get energy from your food, it will start burning muscle
and fat for energy instead. You may lose weight even though you haven’t changed how you eat.
See which foods are high in trans fatty acids.
Nausea and vomiting. When your body resorts to burning fat, it makes ketones. These can build
up in your blood to dangerous levels, a possibly life-threatening condition called diabetic
ketoacidosis. Ketones can make you feel sick to your stomach.
Symptoms of Type 2 Diabetes

4. These tend to show up after your glucose has been high for a long time.
Yeast infections. Both men and women with diabetes can get these. Yeast feeds on glucose, so
having plenty around makes it thrive. Infections can grow in any warm, moist fold of skin,
including:
Between fingers and toes
Under breasts
In or around sex organs
Slow-healing sores or cuts. Over time, high blood sugar can affect your blood flow and cause
nerve damage that makes it hard for your body to heal wounds.
Pain or numbness in your feet or legs. This is another result of nerve damage.
Symptoms of Gestational Diabetes
High blood sugar during pregnancy usually has no symptoms. You might feel a little thirstier
than normal or have to pee more often.
Symptoms of high blood sugar (HYPERGLYCEMIA)
 Need for frequent urination
 Drowsiness
 Nausea
 Extreme hunger and/or thirst
 Blurring of the vision
Symptoms of low blood sugar (HYPOGLYCEMIA)
 Shaking
 Fast heartbeat
 Sweating
 Anxiety
 Dizziness
 Extreme hunger
 Weakness and tiredness
 Irritability
Diagnosis
In June 2000, the UK formally adopted the world health organization criteria for diagnosing
diabetes mellitus that was initially published in 1999. It has since been updated and the
diagnostic criteria have been reiterated (world health organization, 2006).
1. Diabetes symptoms
 a fasting serum glucose concentration > 7.0 mmoI/L

5.  or serum glucose concentration >11.1 mmoI/L 2h after 75g anhydrous glucose in an
oral glucose tolerance test.
2. With no symptoms, diagnosis should not be based on a single glucose determination but
requires confirmatory serum venous determination. At least one additional glucose test
result, on another day with the value in the diabetic range, is essential, either fasting or
from the 2-h post glucose load. If the fasting value is not diagnostic, the 2-h value should
be used.
Glucose tolerance test
The patient should not be taking any drugs which interfere with glucose handing. A normal diet
with at least 150 g of carbohydrate per day should be consumed for the 3 days before the test, but
the patient Should be fasted from 8 pm on the day before the test. The test should commence at
around 9 am with a Venous serum glucose test, followed by the administration of 75 g of glucose
by mouth over a 5 min period. This is often given in the form of 394ml of Lucozade original.
The second venous serum glucose sample is then taken 2h after the drink. The patient should be
seated and is not permitted to smoke, eat or drink anything other than water until the test is
complete. As there is a risk of later-onset hypoglycemia in some individuals, it is advisable to
suggest that the patient has something to eat immediately upon completion of the test, especially
if he/she is planning to drive.
Treatment
Treatment for people with diabetes includes advice on nutrition, physical activity, weight loss
and smoking cessation if appropriate. Drug therapy is prescribed where necessary.
Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make
a diabetes treatment plan that is right for you – and that you can understand. You may also need
other health care professionals on your diabetes treatment team including a diabetes specialist.
Treatment for diabetes requires keeping close watch over your blood sugar levels with a
combination of medications, exercise, and diet. By paying close attention to what and when you
eat, you can minimize or avoid the seesaw effect of rapidly changing blood sugar levels, which
can require quick changes in medication dosages, especially insulin.
Patient counselling points
1. Diabetic Counseling Rph/ Sara Saber Clinical ph diploma Ain Shams university Counseling
Diabetic Patient Rph/ Sara Saber Clinical ph diploma Ain Shams university
2. • 1 in 11 adults has diabetes (425 million). • 1 in 2 adults with diabetes is undiagnosed (212
million). • 1 in 6 births is affected by hyperglycemia in pregnancy.
3. • Over 1 million children and adolescents have type 1 diabetes. • Three-quarters of people with
diabetes are of working age (327 million) • Two-thirds of people with diabetes live in urban
areas (279 million

6. 4. MIDDLE EAST AND NORTH AFRICA Prevalence Countries with highest age adjusted
comparative diabetes are Saudi Arabia (17.7%). Saudi Arabia is the highest number of people
with type 1 diabetes in children and adolescents(0-19 years) in 2017. The countries which
allocated the largest share to diabetes were Saudi Arabia(24%).
5. Role of pharmacists in diabetes management Due the significant gaps between reaching the
goal of “optimal medication therapy” and the current state of medication use. The pharmacist’s
role in caring for diabetic patients has expanded. Pharmacists utilize their clinical expertise in
monitoring and managing diabetes medication plans to positively impact health outcomes and
empower patients to actively manage their health. The pharmacist can educate the patients about
the proper use of medication to assure safe, appropriate, cost-effective diabetes medication use.
6. Essential components of diabetic counseling I. Counseling regarding the disease: The diabetic
patients should be explained that the disease is lifelong, progressive and needs necessary
modifications in the lifestyle pattern. Strict compliance with the prescribed medication.
7. Type 1 Diabetes • Body does not make insulin. • Usually develops in children or young adults.
• Normal Weight. • Must take insulin daily to live.
8. Why is Insulin so Important •If the sugar stays in your blood – it doesn’t do your cells (body)
any good. •The sugar has to get inside the cells for the body to use it. •Insulin is like a key that
opens up the door and allows the sugar to get out of the blood and inside the cell where the cell
can “burn” the fuel for energy!
9. Without insulin. With treatment of insulin.
10. Type 2 Diabetes • Cells do not use insulin properly. • Not enough insulin being produced.
•Becoming more common in children due to obesity. •Many people with type 2 diabetes may
remain unaware of their condition for years as the symptoms become over a period of time.
References
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