1. Diabetes Mellitus: Prevention & Treatment Medical surgical in nursing www.gabric.com www.daneshnameh.com 1388/02/01

2. Diabetes Mellitus: Prevalence Outbreak rate in the world9%

3. Diabetes Mellitus: Definitions Comprises a group of disorders Characterised by raised levels of blood glucose Usually blood sugar level: 3.5 to 6.5 mmol/l High blood sugar because pancreas cannot produce enough insulin (type1) or is resistance to it (type2)

4. Diabetes Mellitus: Natural physiology Food enters digestive system Sugar absorbed through intestines into blood Blood carries sugar to cells Cells absorb sugar Sugar Converted into useful energy Pancreas Insulin

5. Diabetes Mellitus: Type 1 (IDDM) Insulin Dependent Diabetes Mellitus Used to be called juvenile onset diabetes Most commonly begins during childhood Cells that produce insulin in the pancreas Have been destroyed by the immune system Accounts for about 10- 15% of people with diabetes Need daily injections of insulin to survive

6. Diabetes Mellitus: Type 2 (NIDDM) Pancreas doesn't enough insulin or cells ignore it (insulin resistance) Most people with diabetes hare type 2 (90- 95%) Generally occurs in those over 40 years old Associated with obesity & runs in families to some extent 30% - 50% will require insulin injection Lifestyle issues prominent

7. Diabetes Mellitus: Other types Diabetes Mellitus associated with other condition or syndromes Gestational Diabetes Mellitus (G.D.M)

8. Diabetes Mellitus: Cause CauseType 1Type 2 Genetic30% risk in monozygots 100% risk in monozygots EnvironmentVirus, diets, stress Obesity, age, malnutrition in- utero Hypo thesisDestruction of Pancreatic cells Various

9. Diabetes Mellitus: Risk factors Family history of diabetes Race/ethnicity Obesity (BMI 27 kg/) Age 45 year Hypertension (BP 140/190 mmHg) Previously identified impaired fasting glucose or impaired glucose tolerance HDL cholesterol level35 mg/dl and or triglyceride level 250 mg/dl History of gestational diabetes or delivery of babies over 9 lbs

10. Diabetes Mellitus: Clinical manifestations Polyuria PolyPhagia Polydipsia

11. Clinical manifestations: Other symptoms Fatigue Weakness Sudden vision changes Tingling or numbness in hands or feet Dry skin Skin lesions or wounds that are slow to heal Recurrent infections

12. Diabetes Mellitus: Diagnostic findings Diagnostic findings symptoms of diabetes plus casual plasma glucose concentration 200 mg/dl Fasting plasma glucose 126 mg/dl 2-hour post load glucose 200 mg/dl

13. Acute side effects of diabetes Hypoglycemia Diabetic ketoacidosis (DKA) Hyperglycemia hyperosmolar nonketotic syndrome (HHNS)

14. Delayed side effects of diabetes Macro vascular diseases Micro vascular diseases Neuropathy

15. Delayed side effects of diabetes

16. Diabetes Mellitus “The Great Limiting Factor in Diabetes Mellitus”

17. The great limiting factor Control blood glucose

18. The Great Limiting Factor Healthy regimen

19. The Great Limiting Factor Keeping activity

20. The Great Limiting Factor Stress rein

21. The Great Limiting Factor Healthiness of heart

22. Diabetes Mellitus: Targets / Goals Control of blood sugar at the best way Prevention of sever Hypoglycemia and Hyperglycemia Prevention of neuropathy and skin lesion Familiarization with remedial and preventive actions Lack of adverse effects

23. Diabetes Mellitus: Treatment "Major parts of diabetes Medical care and treatment"

24. Major parts of diabetes Medical care and treatment Education

25. Major parts of diabetes Medical care and treatment Nutritional management

26. Major parts of diabetes Medical care and treatment Exercise

27. Major parts of diabetes Medical care and treatment Pharmacologic therapy.oral antidiabetic agents.insulin

28. Oral Anti diabetic Agents Sulfonylureas Biguanides Alpha glucosidas inhibitors Thiazolidinediones Meglitinides

29. Insulin Rapid – acting (humalog) Short – acting (regular) Intermediate – acting (NPH) Long – acting (ultra lent)

30. Insulin “Methods of Insulin provision”

31. Methods of Insulin provision Insulin pens

32. Methods of Insulin provision Jet injection

33. Methods of Insulin provision Mini Med

34. Methods of Insulin provision Implantation or inhalation insulin

35. Methods of Insulin provision Graft.Islets gland graft.Basal cell graft.Pancreatic graft

36. Insulin injection points

37. Major parts of Diabetes Medical care and treatment Monitoring.Self monitoring of blood glucose (SMBG).Glycosylated hemoglobin (Hb AIC).Urine testing for glucose.Testing for ketones

38. Technology of blood sugar measurement Lancet Mini med gluco watch

39. The source of my highs and lows