Diabetes Mellitus : Circumstances & Solution - PowerPoint Presentation

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Diabetes Mellitus :Circumstances & Solution

Dr.

Badrudduja

Khan

Deptt

. of

Moalejat

, AK. Tibbiya College, AMU, Aligarh

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As of 2000 it was estimated that 171 million people globally suffered from diabetes or 2.8% of the population. Type-2 diabetes is the most common type worldwide.

Diabetes in India

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Figures for the year 2007 show that the 5 countries with the largest amount of people diagnosed with diabetes were India (40.9 million), China (38.9 million), US (19.2 million), Russia (9.6 million), and Germany (7.4 million).

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Currently, India is the diabetes capital of the world. It is estimated that over 40 million of those with diabetes are currently in India and that by 2025 that number will grow to 70 million. In other words, 1 in every 5 diabetics in the world will live in India. Diabetes is the number one cause of kidney failure, is responsible for 5% of blindness in adults and 1 million limb amputations

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Stress also seems to be a greater risk factor in India for diabetes. It is important to de-stress according to each one's disposition - for example spending quality time with friends and family, Yoga, breathing exercises, walking, meditation, aerobics and other fitness regimen can ward off diabetes.Preliminary findings of a recent study in India among school children in the higher socio-economic group in Chennai showed child obesity is growing higher and girls were found to be disproportionately "heavier" than boys

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Diabetes Overview

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.

Glucose in the blood gives you energy to perform daily activities, walk briskly, run for a bus, ride your bike, take an

aerobic exercise class

, and perform your day-to-day chores.

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From the foods you eat, glucose in the blood is produced by the liver (an organ on the right side of the abdomen near your stomach).

In a healthy person, the blood glucose level is regulated by several hormones, including insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas secretes other important enzymes that help to digest food.

Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel.

People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).

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Type 1 diabetes

: The body stops producing insulin or produces too little insulin to regulate blood glucose level.

Type 1 diabetes comprises about 10% of total cases of diabetes in the United States.

Type 1 diabetes is typically recognized in childhood or adolescence. It used to be known as juvenile-onset diabetes or insulin-dependent diabetes mellitus.

Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin.

People with type 1 diabetes require daily insulin treatment to sustain life.

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Type 2 diabetes

:

The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands.

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At least 90% of patients with diabetes have type 2 diabetes.

Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.

Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. More than half of all people with type 2 diabetes require insulin to c ontrol their blood sugar levels at some point in the course of their illness.

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Gestational diabetes:

It

is a form of diabetes that occurs during the second half of pregnancy.

Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life.

Women with gestational diabetes are more likely to have large babies

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Metabolic Syndrome

(also referred to as syndrome X) is a set of abnormalities in which insulin-resistant diabetes (type 2 diabetes) is almost always present along with hypertension, high fat levels in the blood (increased serum lipids, predominant elevation of LDL cholesterol, decreased HDL cholesterol, and elevated triglycerides), central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome

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Causes, Incidence, and Risk Factors:

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.

An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

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Symptomatology

High blood levels of glucose can cause several problems, including:

Blurry vision

Excessive thirst

Fatigue

Frequent urination

Hunger

Weight loss

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Symptoms of type 1 diabetes

:

Fatigue

Increased thirst

Increased urination

Nausea

Vomiting

Weight loss in spite of increased appetite

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Symptoms of type 2 diabetes: Blurred vision Fatigue

Increased appetite

Increased thirst

Increased urination

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Signs and Tests A

urine analysis

may be used to look for glucose and

ketones

from the breakdown of fat. However, a urine test alone does not diagnose diabetes.

The following blood tests are used to diagnose diabetes:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/

dL

on two occasions. Levels between 100 and 126 mg/

dL

are referred to as impaired fasting glucose or

prediabetes

. These levels are considered to be risk factors for type 2 diabetes and its complications.

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Hemoglobin A1c test -- this test has been used in the past to help patients monitor how well they are controlling their blood glucose levels. In 2010, the American Diabetes Association recommended that the test be used as another option for diagnosing diabetes and identifying pre-diabetes. Levels indicate

:

Normal: Less than 5.7%

Pre-diabetes: Between 5.7% - 6.4%

Diabetes: 6.5% or higher

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Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)

Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/

dL

and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)

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Persons with diabetes need to have their hemoglobin A1c (HbA1c) level checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to determine how well treatment is working.

Have your cholesterol and triglyceride levels checked each year (aim for LDL levels below 100 mg/

dL

).

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Treatment

The immediate goals are to treat diabetic

ketoacidosis

and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.

The long-term goals of treatment are to:

Prolong life

Reduce symptoms

Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs.

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These goals are accomplished through:Blood pressure and cholesterol controlCareful self testing of blood glucose levels

Education

Exercise

Foot care

Meal planning and weight control

Medication or insulin use

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EXERCISE Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

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Here are some exercise considerations:Always check with your doctor before starting a new exercise program.Ask your doctor or nurse if you have the right footwear.

Choose an enjoyable physical activity that is appropriate for your current fitness level.

Exercise every day, and at the same time of day, if possible.

Monitor blood glucose levels before and after exercise.

Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.

Carry a diabetes identification card and a cell phone in case of emergency.

Drink extra fluids that do not contain sugar before, during, and after exercise.

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ComplicationsEmergency complications include:Diabetic hyperglycemic

hyperosmolar

coma

Diabetic

ketoacidosis

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Long-term Complications Include:AtherosclerosisCoronary artery disease

Diabetic nephropathy

Diabetic neuropathy

Diabetic retinopathy

Erection problems

Hyperlipidemia

Hypertension

Infections of the skin, female urinary tract, and urinary tract

Peripheral vascular disease

Stroke

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Drugs of Interest/ Options

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Insulin Injection Insulin injection is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is too high because the body does not produce or use insulin normally) that cannot be controlled with oral medications alone. Insulin injection is in a class of medications called hormones.

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Insulin injection is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. All of the types of insulin that are available work in this way. The types of insulin differ only in how quickly they begin to work and how long they continue to control blood sugar.

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Oral Drugs(1) Metformin

Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood).

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(2) Rosiglitazone

Rosiglitazone

is used along with a diet and exercise program and sometimes with one or more other medications to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood).

Rosiglitazone

is in a class of medications called

thiazolidinediones

. It works by increasing the body's sensitivity to insulin, a natural substance that helps control blood sugar levels.

Rosiglitazone

is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic

ketoacidosis

(a serious condition that may occur if high blood sugar is not treated).

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(3) Pioglitazone Pioglitazone is used with a diet and exercise program and sometimes with other medications, to treat type 2 diabetes (condition in which the body does not use insulin normally and therefore cannot control the amount of sugar in the blood). Pioglitazone is in a class of medications called

thiazolidinediones

. It works by increasing the body's sensitivity to insulin, a natural substance that helps control blood sugar levels. Pioglitazone is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic

ketoacidosis

(a serious condition that may develop if high blood sugar is not treated).

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Latest Updates

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Insulin Glargine (

rDNA

origin) Injection

Insulin

glargine

is used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). It is also used to treat people with type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood) who need long-acting insulin to control their diabetes. Insulin

glargine

is a long-acting, man-made version of human insulin. Insulin is a hormone made in the pancreas. Insulin helps move sugar from the blood into other body tissues where it is used for energy.

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It also helps the body break down carbohydrates, fats, and proteins from the diet. In a person with diabetes, the pancreas does not produce enough insulin for the body's needs, so additional insulin is required. People with diabetes may gradually develop serious nerve, blood vessel, kidney, and eye problems if the diabetes is not controlled properly. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information

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Thanks