2. DIABETES
Diabetes is a condition that impairs the body’s abiliy to process blood glucose.
“It is a chronic metabolic disorder which is characterized by chronic
hyperglycemia(increase glucose level in blood ),glycosuria, hyperlipemia, and negative
nitrogen balance, and altered metabolism of carbohydrate, lipids, and proines, and
increase the risk of vascular complications.”
 Acute complications of diabetes are :
I. Hypoglycemia.
II. Hyperglycemic
III. Ingections
 Chronic complications of diabetes are :
I. Microvascular disease:Retinopathy;nephropathy;
neuphropathy.
II. Diabetic foot

3. Etiopathogenesis of diabetes :
1) Type 1 diabetes :-
-B cell destruction, usually leading to absolute insulin deficiency.
 Immune-mediated
 Idiopathic
2) Type 2 diabetes :-
 may range from predominantly insulin resistance with relative
insulin deficiency
 to a predominantly secretory defect with insulin resistance
3) Other specific types :-
 Genetic defects of B cell function –
 Genetic defects in insulin action –
 Diseases of the exocrine pancreas
 Endocrinopathies
 Drug- or chemical-induced
 Infections
 Uncommon forms of immune-mediated diabetes
 Other genetic syndromes sometimes associated with diabetes.

4.  Polydipsia (excessive thirst),
 Polyphagia (increased food intake),
 Polyuria (excessive urine production),
 Rapid weight loss,
 Hyperventilation
 Mental confusion.
 Tiredness.
 Weakness.
 Generalised pruritus.
 Delayed healing of wounds.
Symptoms :-

5. Management of diabetes mellitus:-
• Relief from diabetes symptoms.
• Improvement in quality of life.
• Glycemic control.
• Prevention of acute complications.
• Prevention of infections.
• Identification and management of comorbid
conditions like obesity,hypertension and
dyslipidaemia.
• Prevention of microvascular complications such as
retinopathy.
• Prevention of macrovascular camplications such as
cardiovascular,cerebrovascular disease.

7. Prevention of diabetes
I. Primordial prevention : is to reduce risk factors for
diabetes, e.g, reducing or preventing obesity
II. Primary prevention : targets people having prediabets
to prevent the onset of diabetes. It includes a healthy
diet, weight controland use of metforming if required.
III. Secondary prevention : prevent the onset of
complications in patients with diabetes.
IV. Tertiary prevention: of diabetes control physical
disability and rehabitation measures in patient with
diabetes.

8. Management of Type 1 DM
• Strict meal plan.
• Physical exercise
• Only Insulin
Management of Type 2 DM
• Strict meal plan.
• Physical exercise.
• Oral hypoglycaemic agents.
• Insulin.

9. Non-Pharmacological Management of Diabetes :-
 Take high proteinous diet and high fat and carbohydrate
diet.
 Do not eat sweet food like jam,chocolate,cake,sweets cream
etc. Thay raise the levels of triglycerides in body.
 Boiled or steam food to be eaten. Do not use excess oil for
cooking.
 Avoide alcohol intake.
 Use of oils and colors to be avoided for making sweets.
 Weight control.
 Ample amount of water should be taken daily.
 Exercise should be done regularly.

10. Pharmacological management :-
 Oral hypoglycemic drugs : tolbutamide,chloropropamide,Glipizide.
 Herbal drugs : Guargum,stevia,paneer booti
 Surgery : surgery is done rarely. In this there is transplantation of β-cell of
pancreas, weight loss surgery and kidney transplantation.

12. 1. Insulin is a hormone that occurs naturally in the body
2. carbohydrates are broken down into blood glucose,
3. Which is where the body gets most of its energy
4. The pancreas makes and releases insulin to help the body use or
store that glucose and reduce the blood glucose level

13. Types of insulin
1. Rapid acting insulin: starts its action with in 5 minutes and peaks at
one hour.
E.g. actrapid
2. Short acting insulin: starts its action with in 30 minutes can be
taken before meals.
E.g. regular (Humulin R)
3. Intermediate acting: often used with rapid or short acting to take
care of insulin needs over long period usually half a day.
E.g. NPH Insulin
4. Long acting insulin: Its usually taken in the morning and balance
blood glucose level for a full day, used with rapid or short acting
insulin.
E.g. lantus
5. Pre-mixed insulin: mixes short acting and intermediate acting
insulin and is usually taken twice a day, just before meals and used
mainly for people who have difficulty mixing there own insulin.
E.g. human mixtard

14. THYROID DISORDERS
Definition :
Thyroid disorders are linked to a condition in which
the thyroid gland, a butterfly. shaped gland, stops
working properly
Various metabolic functions of our body are
regulated through thyroid glands The thyroid gland is
responsible for the production of two important
thyroid hormones: triedothyronine (T3) and thyroxine
(T4)

17. 1. Hypothyroidism: Any state in which a person's thyroid
hormone production is below normal is known as hypothyroidism
(underactive thyroid).
2. Hyperthyroidism: Hyperthyroidism (excessive thyroid
hormone) is a condition in which there is an excessive amount of
thyroid hormones

18. Etiopathogenesis :
Etiopathogenesis
Hypothirodism : depending on causes, hypothyroidism is two types:primary
hypothyirodism and secondary hypothyirodism.
Causes of primary hypothirodism:
Autoimmune disorder
Iatrogenic hypothyroidism due to iodine 131.
Iodine deficiency
Thyroid hypoplasia
Causes of secondary hypothyroidism:
Pituitary disease
Hypothylamic disease

19. Risk factors:
Are a woman.
Have a family history of thyroid disease.
Have an autoimmune disease, such as type 1 diabetes or
celiac disease.
Have received treatment for hyperthyroidism.
Received radiation to your neck or upper chest.
Have had thyroid surgery.

20. • fatigue.
• weight gain.
• Trouble tolerating cold.
• joint and muscle pain.
• dry skin or dry, thinning hair.
• heavy or irregular menstrual periods or fertility
problems.
• slowed heart rate.
• depression.
• Puffy face,hands,and feet
• Constipation
• Bradycardia.
Symptom of hypothyroidism :

21. Symptoms of hyperthyroidism:
Anxiety.
Difficulty concentrating.
Fatigue.
 Frequent bowel movements.
Goiter (visibly enlarged thyroid gland) or
thyroid nodules.
Hair loss.
Hand tremor.
Heat intolerance.

22. Diagnosis and investigation of thyroid disorders :-
1. Thyroid-stimulating harmone test: Increased TSH level
indicates hypothyroidism and decreased TSH level
indicates hyperthyroidism.
2. T4: Thyroxine test: Low T4 indicates
hypothyroidism,wheres high T4 levels indicate
hyperthyroidism.
3. FT4: Free T4 or Free thyroxine tests
4. T3: Triiodothyronine tests.
5. FT3: Free T3 or Free triiodothyrinine.
6. Antithyroid peroxidase anti detection in autoimmune
hypothyroidism.

23.  Non-Pharmacological Management:
1. Non-pharmacological management of Myxoedema Coma involve
use of warm blanket and mechanical ventilation for respiratory
failure.
2.Non-pharmacological management of Graves' Orbitopathy
 Maintain euthyroid state (The state of having normal
thyroid gland function)
 Stop smoking (Smoking increases risk for Graves'
orbitopathy)
 Avoid: Bright light, dust.
 Sleep with head elevated.
 Apply artificial tears and simple eye ointment at night.

25.  Patients with recurrent thyrotoxicosis following surgery or when
surgery is refused or contraindicated.
 Toxic multinodular goitre
Radioactive Iodine (RAI) Therapy:
Radioactive iodine therapy is used to treat thyrotoxicosis (hyperthyroidism). This
treatment damages the cells of thyroid gland, preventing it from making high
levels of thyroid hormones.
Patients with contraindications to antithyroid agents.
 Patients who failed to achieve normal thyroid hormone
levels with antithyroid agent
Patients with comorbidities increasing surgical risk.
Females planning pregnancy in the future

This therapy is contraindicated in pregnant and
breastfeeding women.

26. Surgery (Thyroidectomy) :
Thyroidectomy is the surgical removal of the hypersecreting thyroid gland.
This will stop synthesis and release of thyroid hormones permanently. This
will make it necessary to take thyroid replacement hormones lifelong.
 A large thyroid gland (> 80 g)
 Severe ophthalmopathy
 Patients who failed to achieve normal thyroid hormone levels with
antithyroid agent

27.  Pharmacological Management:
To restore normal thyroid hormone concentrations in tissue.
To provide symptomatic relief.
To prevent neurologic deficits in newborns and children,
and
 To reverse biochemical abnormalities of hypothyroidism.
Levothyroxine Regimen:
Tab.L- thyroxine-start with 50-100 mcg/day
 Adjust by 12.5 or 25 mcg increments if TSH is high; decrement of the
same if TSH is low
 During pregnancy, dose of L-thyroxine should be increased by 50%
and return to previous level after delivery.
 Adjust dose based on TSH levels.
 • L-thyroxine should be taken as a single daily dose, at least 30
minutes before
morning breakfast.

28. The overall therapeutic objectives are:
Pharmacotherapy of Hyperthyroidism:
To eliminate the excess thyroid hormone.
To minimize the symptoms and
To minimize long-term consequences of hyperthyroidism
Type and severity of hyperthyroidism:
 Patient age and gender.
 Existence of nonthyroidal conditions, and
 Response to previous therapy.