1. DIABETES MELLITUS DR. J. PRATHEEBA DEVI

2. Definition Definition Diabetes is a metabolic disorder characterized by raised levels of glucose in the blood.

3. Epedemiology  India has around 33 million people with Diabetis and 19% of the worlds diabetic population is from India.

4. ANATOMY

5. Anatomy

6. Insulin Action Insulin is required for glucose to enter the cells of the body where it is utilised it is as if insulin is a key which opens doors of the cells to allow glucose to enter. When insulin is absent or defective glucose cannot enter the cells and remains in blood in high amounts. Insulin is required for glucose to enter the cells of the body where it is utilised it is as if insulin is a key which opens doors of the cells to allow glucose to enter. When insulin is absent or defective glucose cannot enter the cells and remains in blood in high amounts. insulin is a key

7. Types of diabetes Type 1 (juvenile diabetes)  Pancreas does not produce insulin. Occurs in young adults and children Type 2 diabetes  Pancreas does not produce enough insulin or its action is prevented Gestational diabetes  Occurs during pregnancy

8. HyperglycemiaSymptoms  Frequent need to urinate  Extreme thirst  Dry skin or mouth  Hunger  Blurred vision  Drowsiness  Slow healing of wounds or infections

9. Risk factors  Obesity  Family history  Sedentary life style  Hypertension

10. Urine glucose test Urine glucose monitoring is a viable, cost- effective way of monitoring diabetes control, especially when the cost of blood glucose monitoring makes it inaccessible or when people do not wish to perform blood testing. Urine glucose monitoring is a viable, cost- effective way of monitoring diabetes control, especially when the cost of blood glucose monitoring makes it inaccessible or when people do not wish to perform blood testing.

11. Urine glucose strips

12. Blood sugar Fasting blood sugar (FBS) measures blood glucose after fasting for at least 8 hours.. Fasting blood sugar (FBS) measures blood glucose after fasting for at least 8 hours.. 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after meal. 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after meal. Random blood sugar (RBS) measures blood glucose regardless of when we eat. Random blood sugar (RBS) measures blood glucose regardless of when we eat.

13. Blood sugar monitoring

14. NORMAL VALUES Fasting -normal -70 -100 mgs% Fasting -normal -70 -100 mgs% -diabetic ->126 mgs % -diabetic ->126 mgs % Post prandial –normal-<140 mgs % Post prandial –normal-<140 mgs % diabetic >200 mgs % diabetic >200 mgs % Values between these normal values is said to be impaired diabetic

15. Oral glucose tolerance test The oral glucose tolerance test (OGTT) measures the body's ability to use glucose, that is the body's main source of energy. An OGTT can be used to diagnose prediabetes and diabetes. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes The oral glucose tolerance test (OGTT) measures the body's ability to use glucose, that is the body's main source of energy. An OGTT can be used to diagnose prediabetes and diabetes. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes prediabetesdiabetesgestational diabetes prediabetesdiabetesgestational diabetes

16. procedure Eat a balanced diet that contains at least 150 to 200 grams (g) of carbohydrate per day for 3 days before the test. Fruits, breads, cereals, grains, rice,, and starchy vegetables such as potatoes, beans, and corn are good sources of carbohydrate. Eat a balanced diet that contains at least 150 to 200 grams (g) of carbohydrate per day for 3 days before the test. Fruits, breads, cereals, grains, rice,, and starchy vegetables such as potatoes, beans, and corn are good sources of carbohydrate. 150 to 200 grams (g) of carbohydrate 150 to 200 grams (g) of carbohydrate Do not eat, drink, smoke, or exercise strenuously for at least 8 hours before your first blood sample is taken Do not eat, drink, smoke, or exercise strenuously for at least 8 hours before your first blood sample is taken

17. For the standard glucose tolerance test, you will drink 75 g to 100 g; pregnant women drink 100 g of glucose. For the standard glucose tolerance test, you will drink 75 g to 100 g; pregnant women drink 100 g of glucose. Blood samples will be collected at timed intervals of 1, 2, and 3 hours after you drink the glucose. Blood samples may also be taken as soon as 30 minutes to more than 3 hours after you drink the glucose. Blood samples will be collected at timed intervals of 1, 2, and 3 hours after you drink the glucose. Blood samples may also be taken as soon as 30 minutes to more than 3 hours after you drink the glucose.

18. Normal values Glucose tolerance diagnostic test (for gestational diabetes) 100 g of glucose Fasting:Less than 95 mg/dL or 5.2 mmol/L1- hour:Less than 180 mg/dL or 10.0 mmol/L2- hour:Less than 155 mg/dL or 8.6 mmol/L3- hour:Less than 140 mg/dL or 7.7 mmol/L Glucose tolerance diagnostic test (for gestational diabetes) 100 g of glucose Fasting:Less than 95 mg/dL or 5.2 mmol/L1- hour:Less than 180 mg/dL or 10.0 mmol/L2- hour:Less than 155 mg/dL or 8.6 mmol/L3- hour:Less than 140 mg/dL or 7.7 mmol/L Glucose tolerance screening test (75 g of glucose) 2-hour:Less than 140 mg/dL or 7.8 mmol/LHigh values Glucose tolerance screening test (75 g of glucose) 2-hour:Less than 140 mg/dL or 7.8 mmol/LHigh values

19. Glycosylated haemoglobin Clinically, hemoglobin A1c values are used most frequently to assess glucose control in insulin-dependent diabetics whose glucose levels are very labile and in whom single blood glucose measurements may not accurately reflect the level of control present over the preceding few weeks. Clinically, hemoglobin A1c values are used most frequently to assess glucose control in insulin-dependent diabetics whose glucose levels are very labile and in whom single blood glucose measurements may not accurately reflect the level of control present over the preceding few weeks. Normal (adult): 4.5% to 5.7%

20. Complications  Cardiovascular  Renal  Ocular  Neurological  Dental  Dermatological  Foot amputation

21. Diabetic retinopathy

22. Diabetic nephropathy In diabetics there is damage to the filters and there is proteinuria In diabetics there is damage to the filters and there is proteinuria

23. Diabetic foot

24. Diabetic neuropathy

25. Diabetic ketoacidosis

26. Management Diet Diet Exercise Exercise Drugs Drugs

27. Diabetic diet

28. Diet schedule

29. Walking

30. Oral Anti Diabetic Drugs  Insulin secretagogues sulfonyl ureas  Insulin sensitizers metformin  Inhibitors of GI absorption @_Glucosidaseinhibitors

31. INSULIN  Rapid acting_fast insulin -insulin aspart lispro  Short acting –actrapid  Intermediate acting-protophane,HUMULIN NPH  Mixed –novomix 30 mixtard 30/70

32. Methods of insulin injection

33. Novo pen

34. Complications of diabetis hypoglycemia Symptoms  Tiredness  Nervousness  Headache  Sweating  Tachycardia  Blurred vision

35. Hypoglycemia management If patient is conscious –oral glucose is preferred If patient is conscious –oral glucose is preferred If unconscious -50 ml of 25 % dextrose followed by a maintainence dose of 10%dextrose If unconscious -50 ml of 25 % dextrose followed by a maintainence dose of 10%dextrose