DIABETES MELLITUS FLOW OF PRESENTATION - PowerPoint Presentation

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DIABETES MELLITUS

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FLOW OF PRESENTATION

Introduction

Definition

Burden of Diabetes

Classification of Diabetes

Clinical Features

Diagnosis Criteria

Complication of Diabetes Mellitus

Management

Preventive Measures

Treatment

Summary

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Diabetes Mellitus

Diabetes –

Latin “to flow through”.

high urine output (polydipsia)

Mellitus-

Latin: “honeylike”

Glucose in urine (glucosurea)

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What Is Diabetes?

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Introduction

Diabetes means that blood glucose in the body (often called blood sugar) is too high

Glucose comes from the food we

eat

Glucose is transported by the

blood stream

to all the cells in the body.

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Introduction

Insulin helps the glucose

from food

get into your cells.

Insulin

is a chemical (a hormone) made in a part of the body called the pancreas.

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Introduction

If your body doesn't make enough insulin or if the insulin doesn't work the way it should, glucose can't get into cells.

Glucose stays in the blood

.

Blood glucose levels get too high, causing

diabetes.

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Burden of Diabetes

220 million worldwide have diabetes.

By the year 2025, the number of people affected will reach 333 million –90% of these people will have Type 2 diabetes.

80% of deaths from diabetes in low and middle-income countries.

Diabetes has significant financial impact.

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Classification: Diabetes mellitus

The ADA (American Diabetes Association) classification of diabetes mellitus includes 4 classes:

Type 1

diabetes

(IDDM)

Type 2

diabetes

(NIDDM)

Gestational diabetes

Secondary diabetes

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Type 1 Diabetes

Body does not make insulin

Usually develops in children or young adults

Normal Weight

Must take insulin daily to live

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Type 2 Diabetes

Cells do not use insulin properly

Not enough insulin being produced

Generally develops in adulthood

Becoming more common in children due to obesity

Common in persons who are overweight

Many different ways to treat, including diet and exercise, pills, or insulin

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Type 2

Diabetes - Key

Concepts

Obesity

Insulin Resistance

Elevated Insulin Levels

Reduced ability to make insulin

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V

V

Insulin

Insulin action on cells

Cell

Blood

G

L

U

T

G

L

U

T

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How Insulin Works

Insulin

Insulin Receptor

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How Insulin Works

Insulin is a hormone made in your pancrease

It works like a key to unlock cells so that blood sugar (glucose) can enter

Glucose is then used by the body as fuel

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V

V

Insulin

Insulin resistance

Cell

Blood

G

L

U

T

G

L

U

T

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What are the major

risk factors

for type 2 diabetes mellitus?

Age



45 years

Overweight (BMI



23 kg/m

2*

)

Family history of diabetes

Habitual physical inactivity

Previously identified IFG or IGT

History of diabetes mellitus during pregnancy

High blood pressure (



140/90 mmHg in adults)

HDL cholesterol



35 mg/dl and/or a triglyceride level



250 mg/dl

History of vascular disease

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Gestational Diabetes Mellitus

A form of glucose intolerance that is diagnosed in some women during pregnancy.

It is also more common among obese women and women with a family history of diabetes.

After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes.

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Secondary Causes of DM

Growth Hormone Dysfunction (Acromegaly) ,

Adrenal Gland Dysfunction (Cushing syndrome),

Thyroid gland dysfunction (Thyrotoxicosis),

Adrenal gland tumour (Pheochromocytoma),

Inflammation of Pancrease (Chronic pancreatitis) ,

Cancerous tumour

Drug induced hyperglycemia like atypical antipsychotics, beta blockers, CCBs, steroids.

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CLINICAL FEATURES

Asymptomatic

in its early stages.

Classical symptoms:

Excessive thirst (

polydipsia

)

Excessive frequency of urination (

polyuria

).

Increased appetite (

polyphagia

)

Other symptoms:

Weight loss

Fatigue

Delayed healing of wounds

Skin infections

Blurring of vision

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Diagnostic Criteria

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Diagnostic criteria

(Continue…)

Diabetes Care

2013;36(

suppl

1):S13.

HbA1C ≥6.5%

OR

Fasting plasma glucose (FPG)

≥126

mg/dL (7.0 mmol/L)

OR

2-h plasma glucose ≥200 mg/dL

(11.1 mmol/L) during an OGTT

OR

A random plasma glucose

≥200 mg/dL (11.1

mmol/L)

Diagnosis Criteria of Diabetes

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Not Good

Good Control

6

Know Your Number

A1c

13

12

7

5

8

11

Blood Sugar

9

120

180

210

270

300

360

90

150

14

330

10

240

Poor Control

Pretty Good

Monitoring Your Diabetes:

What does an

A

1c

mean

An

A1c

measures how much sugar has been sticking to red blood cells over a 3 month period of time.

An

A1c

is a measure of long-term diabetes control.

Goal is A1c <7

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Monitoring Your Diabetes:

What is an A

1c

Red

blood

cell

Normal Blood Glucose

Above-Normal Blood Glucose

Red blood cell

Glucose particles

The higher your blood sugar, the more sugar that sticks to your red cells and the higher your

A1c

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Complications of diabetes

Diabetes can cause increased risk of:

Heart Problems

Stroke

Eye sight problems

Kidney problems

Foot problems

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Treatment goals

Symptom free

Prevent short term complications

Prevent long term complications

Quality of life

= Lifestyle

focus

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Management of Diabetes Mellitus

Type 1 DM

Non Pharmacological Measures

Insulin

Type 2 DM

Non Pharmacological Measures

Pharmacological Measures

Drugs Therapy (Oral Antihyperglycaemic Drugs)

Insulin

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Non Pharmacological Measures

Weight

Reduction

Healthy

diet (Low Sugar Diet)

Increased activity

level

Management of Diabetes Mellitus (contd..)

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Smoking Cessation

Stop Alcohol Consumption

Management of Diabetes Mellitus (contd..)

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Cornerstones of treatment

Insulin/tablets

Physical activity

Diet

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Healthy eating

To help control blood glucose, blood fats and adequate body

weight.

Healthy Eating

Regular carbohydrate

High in fibre

Low in fat

(particularly saturated fat)

Low in added sugar

Adequate energy /protein/fluids/

vits

and mins

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Exercise / activity

30 minutes moderate intensity most days preferably all

Helps to:

Increased insulin sensitivity

Decreased insulin requirements

Weight reduction

Lipid control

Blood pressure control

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Physical Activity:

Types of Exercise

Aerobic exercise (with oxygen)

Includes endurance exerciseWalking, riding bikes, swimming

Improves heart fitness

Anaerobic exercise (without oxygen)

Lasts for short durations

Resistance training (lifting weights)

Flexibility training (stretching)Improves muscle strength

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Insulin

-

Short acting Human

Regular insulin

-

Rapid

acting analogues

(

lispro

,

aspart

,

glulisine

)

- Intermediate acting insulin (NPH)

-

Long acting

analogues (

glargine

,

detemir

)

Management of Diabetes Mellitus (contd..)

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Injection

Sites of Insulin

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Oral Anti-hyperglycemic therapy

Therapeutic options:

Metformin :

Tells the liver to stop sending out sugar.

Sulfonylureas

:

P

ancreas to make more insulin

Thiazolidinediones

:

Tells the liver to stop sending out sugar

Meglitinides

:

T

ell the pancreas to make more insulin

a

-

glucosidase

inhibitors :

slow down the absorption of sugar from the gut after eating

Management of Diabetes Mellitus (contd..)

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Foot Care

Keep your blood sugars in good control

Check your feet every day

Look for cuts, blisters, red spots, swelling

Use a mirror to check the bottoms of your feet or ask someone to help

Wash your feet every day in warm (not hot) water

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Foot Care

Keep your feet soft and

smooth

Trim toe nails

weekly if you can reach

them.

Protect your feet from hot and cold water or surface.

Elevate feet when you are sitting and avoid crossing legs

Stop smoking to improve blood flow to your feet

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Foot Care

Wear Shoes and Socks at All times

Never walk barefoot

Wear comfortable shoes that protect feet

Feel inside of your shoes before putting them on to make sure lining is smooth and no objects are inside

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Salient features of Diabetes Mellitus

Diabetes Mellitus is chronic metabolic Disorder.

It is characterized by hyperglycemia either due to absolute or relative deficiency of Insulin in body.

Patients having clinical symptoms like

polyphagia

,

polyuria

, and

polydypsia.Mainly two types of DM : Type 1 and Type 2.

Untreated diabetes of longer duration leads to short term and long term complications development in body.

Diabetes Mellitus is managed by non pharmacological and pharmacological measures.

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THANK YOU