1. Diabetes Mellitus
By
Pete Kelly
Diabetes Specialist Nurse

2. Any burning ques9ons?

3. Defini9on
‘Diabetes Mellitus is a chronic disease caused by
deficiency in produc9on of insulin by the pancreas,
or by the ineffec9veness of the insulin produced’
World Health Organisation 2002

4. Defini9on
‘Diabetes Mellitus is a chronic disease caused by
deficiency in produc9on of insulin by the pancreas,
or by the ineffec9veness of the insulin produced’
World Health Organisation 2002
DIABETES = COMES FROM THE GREEK MEANING TO
PASS THROUGH OR SYPHON

5. Defini9on
‘Diabetes Mellitus is a chronic disease caused by
deficiency in produc9on of insulin by the pancreas,
or by the ineffec9veness of the insulin produced’
World Health Organisation 2002
DIABETES = COMES FROM THE GREEK MEANING TO
PASS THROUGH OR SYPHON

6. Defini9on
‘Diabetes Mellitus is a chronic disease caused by
deficiency in produc9on of insulin by the pancreas,
or by the ineffec9veness of the insulin produced’
World Health Organisation 2002
DIABETES = COMES FROM THE GREEK MEANING TO
PASS THROUGH OR SYPHON
MELLITUS = MEANS SUGAR, SWEET OR
HONEY

7. UK Prevalence
• Currently 2.8 million people are diagnosed with diabetes
• Further 850,000 who don’t know they have diabetes
• By 2010 it is an9cipated there will be 3 million diagnosed
Diabetes UK 2009
• Within EU ~ es9mated to be 25 million people with
diabetes and the same amount undiagnosed
• In Plymouth there at least 12,000 people diagnosed
Type 2 diabetes and a further 1,000 diagnosed

8. Diagnosis of Diabetes Mellitus.
 Diabetes symptoms (polyuria, polydipsia)
Random Laboratory venous plasma glucose > 11.1 mmol/l.
Random Laboratory fasting venous plasma glucose > 7.0 mmol/l.
Advisable to have two tests results to confirm diagnosis, or one oral
glucose tolerance test.
 Oral glucose tolerance test (OGTT). Patient takes 75g oral glucose
and two hours later has bloods taken, if venous plasma glucose
>11.1 mmol/l, Diabetes is diagnosed.
More recently the WHO have agreed to use the HbA1c
as a method of diagnosis

9. Types of diabetes
• Type One
• Type Two
• Mature onset of diabetes in young (MODY)
• Gesta9onal diabetes mellitus
• Secondary to gene9c condi9ons

10. The physiology of normal blood
• The pancreas controls blood glucose levels.
• It lies behind the stomach.
• The pancreas does two jobs:
1. Produces pancrea9c juices which aids food diges9on.
Alpha cells release Glucagons, which increases blood glucose
by prompting the release of glucose (from the Liver) into the
blood.
Beta cells release Insulin, a hormone which encourages
the absorption of glucose into muscle cells, fat cells, and
connective tissue cells etc, this reduces blood sugars.

23. Causes and Risk Factors
Type 1 Type 2

24. Causes and Risk Factors
Type 1 Type 2

25. Causes and Risk Factors
Type 1 Type 2
• Being overweight
•Close member of the family has type 2
diabetes
•Waist measurement
•Hypertension
•POS and being overweight
•Impaired glucose tolerance
•Gestational diabetes
•Mental health problems

26. Complications of all types

27. Complications of all types
Vascular disease
Ischaemic heart disease
Gangrene / amputations
Nerve Damage (Neuropathy)
Eye Disease (Retinopathy)
Cataracts
Blindness
Renal disease (Nephropathy)

28. Newly diagnosed
Type 1
Diet, exercise + Insulin
Type 2
Diet and exercise for 3 months
↓
Oral hyperglycaemic agent:
Sulphonylurea for those not overweight (eg. Gliclazide, Glibenclamide)
Biguanide for those overweight (eg. Metformin)
Can use together if not individually effective
↓
Newer agents – Glitazones, Gliptins and GLP-1
↓
Insulin Metformin can also be added if patient is overweight

31. Diabetes diet

32. Hypoglycaemia

33. Hypoglycaemia
Classed as a blood sugar below 4mmols/l.
Symptoms of a hypoglycaemic event.
 Swea9ng
 Shaking
 Drowsiness
 Vagueness
 Mood changes

34. Treatment of a Hypoglycaemic
Episode.

35. Treatment of a Hypoglycaemic
Episode.
• If the pa9ent is conscious provide 4 dextrose tablets or
20mls of polycal or 50mls of lucozade.
• If the pa9ent is conscious but confused or uncoopera9ve
treat with Glucogel (Hypostop).
• Provide a carbohydrate snack when the pa9ent is alert
again. (ie sandwiches, toast or bowl of cereal.
• Con9nue to test the blood sugar every 20 minutes un9l
stable.
• Expect higher blood sugars that day
• Remember do not omit the next insulin dose a
reduc9on may be required.