Diabetes mellitus

Pathophysiology of Diabetes

1. Hina ishtiaq 1

2. DIABETES MELLITUS “Metabolic disorder of multiple etiology characterized by chronic hyperglycaemia c aused by deficient production or action of insulin” 2

3. epidemiology Diabetes affects 25.8 million children and adults in the United States The development of diabetes is projected to reach pandemic proportions over the next 10-20 years . International Diabetes Federation (IDF) data indicate that by the year 2025, the number of people affected will reach 333 million – 90 % of these people will have Type 2 diabetes . 3

4. Genetic Poor diet & inadequate exercise Overweight High cholesterol Family history of diabetes etiology 4

5. NORMAL PHYSIOLOGY 5

6. Continue….. 6

7. 7

8. CLASSIFICATION: Type I – IDDM (20%) Type II – NIDDM (80-90%) Gestational Diabetes Other types: LADA ( Latent Autoimmune Diabetes in Adults) MODY (Maturity- Onset Diabetes Of Youth) Secondary Diabetes Mellitus 8

9. Hereditary Usually diagnosed in childhood Frequently called the ‘ insulin-needed ’ group Patients with type 1 diabetes need insulin daily to survive Pathogenesis: Production of autoantibodies against b cells of pancreas No insulin production Hyperglycemia Type- I diabetes 9

10. CLINICAL FEATURES: Polyuria Polydipsia Polyphagia Ketoacidosis Metabolic derangements Glucose, fat and protein metabolism Glycosuria Osmotic diuresis 10

11. CONTINUE…. Proteolysis Weightloss Muscle weakness Ketonemia Ketonuria 11

12. Usually occurs in adulthood Rates rising due to increased obesity and failure to exercise and eat healthy diet Pathogenesis: Cells involved in glucose metabolism become desensitized Do not respond to insulin Hyperglycemia TYPE-II DIABETES 12

13. Clinical features Polyuria Polydipsia Obesity Weakness Weight loss N on- ketotic coma Dehydration Osmotic diuresis Urinary fliud loss 13

14. B lood sugar levels are high during pregnancy in women Women who give birth to children over 9 lbs . High risk of type 2 diabetes and cardiovascular disease T reatment to normalize maternal blood glucose levels to avoid complications in the infant. GESTATIONAL DIABETES 14

15. Impaired glucose tolerance and impaired fasting glucose Above average blood glucose levels N ot high enough to be classified under type 1 or type 2 diabetes Long-term damage to body Starts with unhealthy eating habits & inadequate exercise PRE-DIABETES 15

16. symptoms 16

17. DIABETES COMPLICATIONS Multifactorial but main cause is hyperglycemia and glucose toxicity 17

18. LONG TERM DIABETES COMPLICATIONS Diabetic nephropathy Retinopathy Hypertension Peripheral neuropathy Microangiopathy Macrovascular disease Myocardial infarction 18

19. Short term complications Ketoacidosis Diabetic coma Hyperosmolar non-ketotic coma Weakness 19

20. Laboratory diagnosis 20

21. LABORATORY DIAGNOSIS Normal glucose level= 70-120mg/dl Random glucose level >200 or =200mg/dl Fasting glucose level >126 or =126mg/dl 21

22. FPG (Fasting Plasma Glucose Test) 22

23. D etermine the amount of sugar or glucose in the blood This is measured in mg/dl Blood glucose range for pre-diabetics will be in the 100-125 mg/dl range. Type 2 diabetes will have blood sugar results in the range of 126 mg/dl and above These levels can increase the risk of heart disease and stroke FPG (Fasting Plasma Glucose Test) 23

24. OGTT (Oral Glucose Tolerance Test 24

25. OGTT (Oral Glucose Tolerance Test Blood glucose levels are measured to see how the body reacted Blood glucose range for pre-diabetics will be between 140-199 mg/dl. For those with type 2 diabetes, the range will start at 200 mg/dl and continue to peak 25

26. Glycosylated Haemoglobin (HbA1c) HbA1c is a test that measures the amount of glycated haemoglobin in your blood. Glycated haemoglobin is a substance in red blood cells that is formed when blood sugar (glucose) attaches to haemoglobin.

27. (HbA1c)

28. Management of Diabetes Mellitus 28

29. management Self-care of diabetics Medical nutrition therapy Oral hypoglycemic therapy Insulin therapy 29

30. B e physical active…. E at a healthy diet A bcs (know and control) , blood pressure, cholesterol, and smoking T ake your medication B.E.A.T. DIABETES 30

31. Self-care of diabetics Blood glucose monitoring Body weight monitoring Personal hygiene Healthy lifestyle Reducing excessive salt intake 31

32. Medical nutrition therapy First line of defense for type-2 diabetics Adequate diet – low cholesterol intake Exercise Weight reduction Improves insulin sensitivity Lower blood glucose level 32

33. Oral hypoglycemic agents Metformin Type-2 diabetes Reduce hepatic glucose production Sulphonylureas Tolbutamide  Glimepiride Type-2 diabetes Increase insulin release Pramlintide Type-1 diabetes 33

34. Type-1 diabetes main treatment Type-2 diabetic patients with insulinopenia Portable pen injectors Subcutaneous Insulin glargine…….. Insulin therapy 34

35. Insulin injection sites 35

36. Methods of insulin administration Insulin syringes and needles Insulin pen injector devices Inhaled insulin-A novel method for delivering a powdered form of insulin by inhalation has been approved by the FDA. 36

37. Unfortunately, there is not yet a cure for diabetes BUT DON ’ T GIVE UP HOPE! Doctors are providing treatment that can lower symptoms of diabetes of all types, which can reduce pain. By following a good diet and exercise plan, body may be able to use insulin minimally, or none at all in cases besides type 1 There is also research being done on “ islet ” transplantation Can diabetes be cured? 37

38. Islet transplantation 38

39. Internet sites that might be helpful in learning more about diabetes! Http://www.Diabetes.Org/ Http://diabetes.Niddk.Nih.Gov/ Brochures These are often given/found at the doctors office Books to help deal with diabetes Http://www.Amazon.Com/best-guide-managing-diabetes-pre-diabetes/dp/1416588388 Learn benefits of good health, diet and exercise Join a support group How can I educate myself on diabetes? 39

40. references Robin’s pathology http:// s3.amazonaws.com/ppt-download/diabetesppt-120326200000-phpapp02.pptx?response-content-disposition=attachment&Signature=gaFU8RP2HdD%2FIicZN2cbsdixYAc%3D&Expires=1431767006&AWSAccessKeyId=AKIAIA7QTBOH2LDUZRTQ http://www.pitt.edu/~ super4/36011-37001/36831.ppt https:// www.google.com.pk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=management%20of%20diabetes%20mellitus%20ppt https:// www.google.com.pk/search?q=management+of+diabetes+mellitus&espv=2&biw=1366&bih=659&source=lnms&tbm=isch&sa=X&ei=EF5XVY6PKOefyAOwv4DABw&ved=0CAYQ_AUoAQ http ://www.diabetes.org/diabetes-basics/diabetes-statistics/? utm_source=WWW. http :// www.heart.org/HEARTORG/Conditions/Diabetes/SymptomsDiagnosisMonitoringofDiabetes/Symptoms-Diagnosis-Monitoring-of-Diabetes_UCM_002035_Article.jsp. 40

41. REMEMBER….TAKE CONTROL OF YOUR LIFE! DON ’ T LET DIABETES CONTROL YOU ! ANY QUESTION?? THANK YOU.. 41