Diabetes Mellitus

Diabetes Mellitus for nursing students

1. Diabetes Mellitus By Lorita Furtado

2. Diabetes Mellitus Diabetes mellitus  ( DM ), commonly known as  diabetes , is a group of metabolic disorders  characterized by a  high blood sugar   Diabetes is due to either the  pancreas  not producing enough insulin, or the cells of the body not responding properly to the insulin produced .

3. Types and Causes of Diabetes Mellitus Type 1 Diabetes / insulin-dependent diabetes mellitus (IDDM)/ juvenile diabetes R esults from the pancreas's failure to produce enough insulin Causes Is partly inherited with multiple genes, including certain HLA genotypes known to influence the risk of diabetes. In genetically susceptible people, the onset can be triggered by one or more  environmental factors such as a viral infection  or diet. Among dietary factors, gliadin  (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood. Type 1 diabetes can occur at any age, and a significant proportion is diagnosed during early adulthood.  Latent autoimmune diabetes of adults  (LADA) is the diagnostic term applied when type 1 diabetes develops in adults; it has a slower onset than the same condition in children.

4. Types and Causes of Diabetes Mellitus ii. Type 2 Diabetes/ non insulin-dependent diabetes mellitus(NIDDM) /adult-onset diabetes   Results due to failure of cells to respond to insulin adequately(  insulin resistance ) Causes is primarily due to lifestyle factors like obesity, high   waist-hip ratio, lack of physical activity, poor diet,   stress, and  urbanization etc. Dietary factors such as  consumption of sugar -sweetened drinks, lots of  white rice diet with  saturated fat  and  trans fats is associated with an increased risk.  Adverse childhood experiences  (ACEs), including abuse, neglect, and household difficulties, increase the likelihood of type 2 diabetes later in life. G enetics .

5. Types and Causes of Diabetes Mellitus iii. Gestational Diabetes(GDM) occurs when  pregnant woman  without a previous history of diabetes develop high blood sugar levels

6. Pathophysiology-Insulin Secretion

7. Pathophysiology-Normal Insulin secretion During digestion, food is broken down into basic components. Carbohydrates are broken down into simple sugars, primarily glucose which is an important source of energy for the body's cells. To provide energy to the cells, glucose needs to leave the blood and get inside the cells . Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone produced by the pancreas. When levels of glucose in the blood rise, like following a meal, the pancreas normally produces more insulin.

8. Pathophysiology

9. In case of DM 1 Immune system attacks the beta cells (Reason is unknown, it can be due to genetic predisposition to the disease or environmental factors such as particular viral infection or the diet) Infiltration of Islets cells with lymphocytes Destruction of beta cells Deficiency of Insulin Secretion

10. Cascade of events leading to DM pathophysiology (common to all types)

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12. Complications Cardiovascular disease  and about 75% of deaths in people with diabetes are due to coronary artery diseases and other macro vascular diseases like stroke, peripheral artery disease. D amage in small blood vessels including those in the eyes leads to diabetic retinopathy which can result in gradual vision loss  and eventual blindness. Diabetes also increases the risk of having glaucoma, cataracts and other eye problems. It is recommended that people with diabetes visit an ophthalmologist  once a year.   Damage to the kidneys, known as  diabetic nephropathy , can lead to tissue scarring, proteinuria and eventually   chronic kidney disease , sometimes requiring  dialysis or kidney transplantation.

13. Complications Damage to the nerves of the body, known as  diabetic neuropathy , is the most common complication of diabetes . The symptoms can include  numbness ,  tingling , pain, and altered pain sensation, which can lead to damage to the skin.   Diabetes-related foot problems  (such as  diabetic foot ulcers ) may occur, and can be difficult to treat, occasionally requiring  amputation . Additionally,  proximal diabetic neuropathy  causes painful  muscle atrophy  and  weakness . Those with diabetes, have a greater rate of decline in  cognitive function . Having diabetes, especially when on insulin, increases the risk of falls in older people.

14. Diagnosis R ecurrent or persistent high blood sugar, and is diagnosed by demonstrating any one of the following : Diabetes mellitus Impaired Glucose Tolerance Fasting Plasma Glucose Level ≥ 126 mg/dL 110-125 mg/dL Plasma glucose two hours post 75g oral glucose load(OGTT) ≥ 200 mg/ dL 140 mg/dL-200 mg/ dL Random Plasma glucose ≥200 mg/ dL Glycated Hemoglobin (HbA1C) ≥ 6.5

15. Management Aim of the management=Keeping blood sugar levels as close to normal, without causing low blood sugar. Non Pharmacological = dietary changes, exercise , weight loss, and use of appropriate medications (insulin, oral medications). Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, high blood pressure, metabolic syndrome obesity, and lack of regular exercise . Specialized footwear may be used to reduce the risk of ulcers in at-risk diabetic feet Lifestyle

16. Medications Type  1 diabetes can only be treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs Type 2 diabetes Metformin is generally recommended as a first line treatment for type 2 diabetes. It works by decreasing the liver's production of glucose .  Several other groups of drugs that are also used in treatement in combination or single include Sulfonylureas - agents that increase insulin release Acarbose - agents that decrease absorption of sugar from the intestines Thiazolidinedione - agents that make the body more sensitive to insulin  SGLT2 inhibitors - agents that increase the excretion of glucose in the urine Type 2 diabetes may also be treated with i nsulin at later stages.  When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications .  Doses of insulin are then increased to glucose targets . Gestational Diabetes M etformin  and  Glibenclamide ( stimulates pancreas to produce more  insulin).

17. Management Surgery These measures are occassionally considered Weight loss surgery  in those with obesity. Pancreas Transplant for people with type 1 diabetes who have severe complications of their disease.

18. Types of Insulin

19. Commonly used Insulin examples

20. Prevention There is no known preventive measure for type 1 diabetes. However, Type2 DM can be prevented by:-

21. Thank You