1. Diabetes Mellitus
Diabetes Mellitus is a group of metabolic diseases characterized by elevated levels of glucose in blood (hyperglycemia)
Diabetes Mellitus results from defects in :
insulin secretion
insulin action
or both of them

2. Diabetes Mellitus Normally a certain amount of glucose circulates
in the blood
The major sources of this glucose are :
absorption of ingested food in the (GI) tract
formation of glucose by the liver from food
substances

3. Diabetes Mellitus
Insulin a hormone produced by the pancreas , controls the level of glucose in the blood by regulating the production and storage of glucose
In the diabetic state ,the cells may stop responding to insulin, or the pancreas may stop producing insulin entirely

4. Diabetes mellitus
This leads to hyperglycemia, which may result in acute metabolic complications such as :
Diabetic Ketoacidosis (DKA)
Hyperglycemic Hyperosmolar Nonketotic
Syndrome (HHNS)

5. Diabetes Mellitus Diabetic Ketoacidosis (DKA) :
a metabolic derangement in type 1 diabetes that results from a deficiency of insulin
highly acidic ketone bodies are formed, resulting in acidosis, usually requires hospitalization for treatment, and is usually caused by non adherence to insulin therapy, concurrent illness, or infection

6. Diabetes Mellitus
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) :
a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an intercurrent illness that raises the demand for insulin ; associated with polyuria and dehydration

7. Diabetes Mellitus Long-term effects of hyperglycemia contribute to:
macrovascular complications such as: (coronary artery disease, cerebrovascular disease, and peripheral vascular disease )
chronic microvascular complications such as : (nephropathy in the kidney, retinopathy in the eye )
Neuropathic complications (diseases in the nerves)

8. Diabetes Mellitus Risk factors for diabetes mellitus :
family history for diabetes
obesity
age >45 years
hypertension
HDL cholesterol level <35mg/dl
glyceride level >250mg/dl

9. Diabetes Mellitus Classification of diabetes:
Type 1 (insulin-dependent diabetes mellitus)
Type 2 (non-insulin-dependent diabetes
mellitus)
Gestational diabetes mellitus

10. Diabetes mellitus Type 1 diabetes (IDDM) :
A metabolic disorder characterized by an absence
of insulin production and secretion from
autoimmune destruction of the beta cells of the
islets of langerhans in the pancreas

11. Diabetes Mellitus Type 2 diabetes (NIDDM) :
a metabolic disorder characterized by the relative
deficiency of insulin production and a decreased
insulin action and increased insulin resistance

12. Diabetes Mellitus Gestational diabetes :
Gestational diabetes is any degree of glucose intolerance with its onset during pregnancy
Hyperglycemia develops during pregnancy because of the secretion of placental hormones which causes insulin resistance
Gestational diabetes occurs in up to 14%of pregnant women and increases their risk for hypertensive disorders during pregnancy

13. Diabetes Mellitus
Initial management includes dietary modification and blood glucose monitoring
If hyperglycemia persists, insulin is prescribed
Oral antidiabetic agents should not be used during pregnancy

14. Diabetes Mellitus Physiology/Pathophysiology :
All of the following result in hyperglycemia :
Impaired insulin secretion from (pancreas)
Increased basal hepatic glucose production from (liver)
Decreased insulin-stimulated glucose uptake(muscle)
Gastrointestinal absorption of glucose (GIT)

15. Diabetes Mellitus Clinical Manifestation of (DM) :
Three (Ps): (1)Polyuria (increased urination)
(2)Polydipsia (increased thirst)
(3)Polyphagia (increased appetite)
Fatigue and weakness
Sudden vision changes
Tingling and numbness in hands or feet
Dry skin
Slow wound healing
Weight loss, nausea and vomiting

16. Diabetes Mellitus Assessment and Diagnostic findings :
Fasting plasma glucose (FPG) >126mg/dl
Random plasma glucose >200mg/dl
Oral glucose tolerance test
Intravenous glucose tolerance test

17. Diabetes Mellitus Laboratory Examination : Hgb(A1C)
Fasting lipid profile
Test for microalbuminuria
Serum creatinine level
Urine analysis
electrocardiogram

18. Diabetes Mellitus There are five components of diabetes management :
(1)Nutritional management
(2)Exercise
(3)Monitoring glucose levels and ketones
(4)Pharmacologic therapy
(5)Education

19. Diabetes Mellitus
(1)Nutritional management of the diabetic patient includes the following goals :
Providing all the essential food constituents(eg, vitamins, minerals) necessary for optimal nutrition
Meeting energy needs
Maintaining reasonable weight
Decreasing serum lipid levels
Preventing wide daily fluctuations in blood glucose level

20. Diabetes Mellitus (2) Exercise :
Exercise is extremely important in managing diabetes because of its effects on lowering blood glucose and reducing cardiovascular risk factors
Exercise lowers the blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization

21. Diabetes Mellitus (3)Monitoring glucose levels and ketones :
Blood glucose monitoring is a cornerstone of diabetes management, and self –monitoring of blood glucose (SMBG) levels by patients has altered diabetes care
Frequent (SMBG) enables people with diabetes to adjust the treatment regimen to obtain optimal blood glucose control

22. Diabetes Mellitus (4)Pharmacologic therapy : Insulin therapy
Insulin preparations :
(1) human insulin preparation
(2)animal insulin preparation

23. Diabetes Mellitus Complications of insulin therapy :
Local allergic reactions
Systemic allergic reactions
Insulin lipodystrophy
Insulin resistance
Morning hyperglycemia

24. Diabetes Mellitus Alternative methods of insulin delivery :
Insulin pens
Jet injectors
Insulin pumps : for continuous subcutaneous insulin infusion
Implantable and inhalant insulin delivery
Transplantation of pancreatic cells

25. Diabetes Mellitus Oral anti diabetic agent :
Sulfonylureas (orinase, micronase )
Biguanides (glucovance)
Alpha glycosidase inhibitor (precose)
Meglitinides (prandin, starix)