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Introduction • Diabetes mellitus is a disorder in which blood

sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs.

• Insulin , a hormone released from the pancreas, controls the amount of glucose in the blood.

• Glucose in the bloodstream stimulates the pancreas to produce insulin .

• Insulin helps glucose to move from the blood into the cells.

• Once inside the cells, glucose is converted to energy, which is used immediately, or the glucose is stored as fat or glycogen until it is needed

Types of Diabetes• Type 1 diabetes (formerly called insulin -dependent diabetes)

– The body's immune system attacks the insulin -producing cells of the pancreas, and more than 90% of them are permanently destroyed.

– The pancreas, therefore, produces little or no insulin . – Only about 10% of all people with diabetes have type 1

disease– Most people who have Type1 DM develop the disease before

age 30, although it can develop later in life.

• Causes : Environmental factors , eg: viral infection or a nutritional factor during childhood or early adulthood—causes the immune system to destroy the insulin -producing cells of the pancreas.

• A genetic predisposition may make some people more susceptible to the environmental factor.

Types of Diabetes• Type 2 diabetes(formerly called non– insulin -

dependent diabetes or adult-onset diabetes)

• The pancreas continues to produce insulin , sometimes even at higher-than-normal levels. However, the body develops resistance to the effects of insulin , so there is not enough insulin to meet the body’s needs

• It usually begins in people older than 30 and becomes progressively more common with age.

• About 27% of people older than 65 have type 2 diabetes

• Type 2 diabetes also tends to run in families

Causes of type 2 DM • Obesity is the chief risk factor and 80 to 90% of

people with this disorder are overweight or obese, because obesity causes insulin resistance, obese people need very large amounts of insulin to maintain normal blood glucose levels.

• Certain disorders and drugs can affect the way the body uses insulin and can lead to diabetes.

• Steroid use and pregnancy ( gestational diabetes) are the most common causes of impaired insulin use.

• Diabetes also may occur in people with excess production of growth hormone (acromegaly) and in people with certain hormone-secreting tumors.

• Severe or recurring pancreatitis and other disorders that directly damage the pancreas can lead to diabetes

Mechanism

Symptoms

Emergencies in diabetes are ? Diabetic ketoacidosis (DKA) and Nonketotic hyperglycemic-hyperosmolar syndrome(HHS) : - triggered by infection and dehydration

Treatment of DKA/HHS• Do not rush to correct high blood sugar in such

patient, correct triggers• Rush and give fluids 1st before you give insulin

at-least 3litters in 2hrs @litre in half an hour (0.9%NS)

• Correct electrolytes 1st even before insulin as insulin drops down potassium levels from blood.

• Than give insulin by infusion or intramuscular (not subcutaneously) unless RBG is above 14mmol/l

• Stop insulin if RBG 14mmol/l and start d5% to avoid brain edema as low glucose in blood and high in brain cell will pull water in the braincells hence edema and brain death.

Screening for diabetes• It should be a routine physical examination

and annually.• Important to screen people :–Over 45 yr old–Overweight–Have high BP and/high cholesterol–Have a family history of diabetes–Have had diabetes during pregnancy or

had a baby who weighed over 4kg at birth–Are of African American, Hispanic, Asian

American, or American Indian ethnicity

Diabetes treatment goals• Experts recommend that people keep their blood

glucose levels– Between 70 and 130 mg/dL fasting (before

meals)– Less than 180 mg/dL 2 hours after meals– Hemoglobin A1c levels should be less than 7%.

• Avoid hypoglycaemia RBG of less than 4.5 mmol/l (< 50mg/dl)

*Note : converting Mmol/l to mg/dl multiply by 18

Treatment

• Control Diet• Do Exercise• Have Education on diabetes• In type 1 diabetes, insulin injections• In type 2 diabetes, often drugs by

mouth and sometimes insulin injections

Diet

Insulin dosage : 0.5 to 1 IU/kg/dayDivided in 2/ 3am and 1/3pm dosages

Than Divided into soluble(short acting) (color: ya maji) and lante (intermediate acting)(color: yamaziwa) at a ratio of 1: 1 respetivelye.g: 40IU 2/3rd = 26IU 13IU soluble 13IU lante 1/3rd = 14 IU 7IU soluble 7IU lante

Oral hypoglycemic agents (OHA)

There are several groups of drugs BUT 1st line :METFORMIN (because : it sensitizes insulin

release from muscle cell without causing hypoglycemia) : 500mg to 2gm per day in divided doses.

2nd line : GLIBENCLAMIDE 5-10mg/day or GLIMIPIRIDE 1-2mg/day (it sensitizes insulin release from pancreas but causes hypoglycemia)

Note : if single drug cannot control blood sugar in maximum dosage than combination can be given.

Complications of diabetes• Diabetes damages blood vessels, causing them to

narrow and therefore restricting blood flow, because blood vessels throughout the body are affected, people may have many complications of diabetes. Many organs can be affected, particularly the following:– Brain: causing stroke– Eyes : diabetic retinopathy and blindness– Heart: causing heart attack(myocardial

infraction)– Kidneys: diabetic nephropathy and causing

kidney failure– Nerves: diabetic neuropathy and causing

decreased sensation in feet, easy cut/damage, gangrene and finally amputaion

– Penis : erectile dysfunction

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