Diabetes Mellitus

short desription

1. General understanding of
Diabetes Mellitus

2. •Disease in which the body doesn’t
produce or properly use insulin, leading
to hyperglycemia.
•DM comprises of group of common
metabolic disorders, that share the
phenotype of hyperglycemia. Several
distinct type of DM exists and are caused
by complex interaction of genetics and
environmental factors
Diabetes Mellitus

3. •Depending on the etiology of DM,
factors contributing to
hyperglycemia include
–Reduced insulin secretion
–Decreased glucose utilization
–And increased glucose production

4. Epidemiology
•The world wide prevalence of DM has raise
dramatically over the past two decade from
an estimated 30 million cases in 1985 to 177
million in 2000
•Based on current trends more than 360
million individuals will have diabetes by the
year 2030.
•Prevalence of type II DM is increasing world
wide much more rapidly because of Obesity
and reduced activity.
•Six of the top 10 countries with the highest
rates are in Asia.

5. Classification
•Type I Diabetes (Insulin dependent
diabetes mellitus)
–Immune mediated
–idiopathic
•Type II Diabetes (NIDDM)
•Gestational Diabetes Mellitus (GDM)

6. •Others
–Genetic defect of ß-cell function characterized by
mutation
–Genetic defect in insulin action
–Diseases of exocrine pancrease eg. Pancreatitis
–Endocrinopathies eg. Acromegaly
–Drugs or chemical induced eg. Thyroid hormone,
thiazide, phenytoin etc.
–Infections eg congenital rubella, CMV
–Uncommon forms of immune mediated diabetes
eg. “Stiffperson syndrome”

7. What goes wrong in diabetes?
•Multitude of mechanisms
–Insulin
•Regulation
•Secretion
•Uptake or breakdown
–Beta cells
•damage

8. Type I Diabetes
•Low or absent endogenous insulin
•Dependent on exogenous insulin for life
•Onset generally < 30 years
•5-10% of cases of diabetes
•Onset sudden
–Symptoms: 3 P’s: polyuria, polydypsia,
polyphagia
•Genetic component to disease

9. Type II Diabetes
•Insulin levels may be normal, elevated or
depressed
–Characterized by insulin resistance,
–diminished tissue sensitivity to insulin,
–and impaired beta cell function (delayed or
inadequate insulin release)
•Often occurs >40 years

10. Risk factors Type II DM
•Family history
•Sedentary lifestyle,
•Obesity (BMI > or = 25 kg/m2 and aging
•Hypertension
•HDL cholesterol level < 35mg/dl
•PCOS

12. Characteristics IDDM NIDDM
Age of onset Less than 40 yrsMore than 50 yrs
Duration of symptoms Weeks Month to years
Body weight Normal or LowObese
Ketonuria Yes No
Rapid death without
treatment with insulin
Yes No
Autoantibodies Yes No
Diabetic complication at
diagnosis
No 10-20%
Family history of DiabetesNo Yes
Other autoimmune diseaseYes No
Comparative clinical features of IDDM and NIDDM

13. Criteria for diagnosis of DM
symptoms of diabetes plus random
blood glucose concentration greater
than 11.1mmol/lit (200mg/dl)
or
fasting plasma glucose greater than or
equal to 7mmol/lit (126mg/dl)
or
two hour plasma glucose greater than
or equal to 11.1mmol/lit (200mg/dl)
during an oral glucose tolerance test.
(American Diabetes Association)

14. Laboratory investigation in diabetes
Oral glucose tolerance test
Glycosylated haemoglobin
Micro albumin
Urine protein / creatine ratio
Serum creatinine
Insulin level
C-peptide
Insulin antibody test
GAD 65 antibody

15. Complication of DM
•Acute complications
•Diabetic Keto-acidosis
•Hyperglycemic Hyper-osmolar state
•Chronic complications
•Diabetic neuropathy
•Diabetic retinopathy
•Diabetic nephropathy
•Diabetic hepato-pathy
•Diabetic encephalopathy

16. Management of Diabetes Mellitus
•Nutrition
•Blood glucose
•Medications
•Physical activity/exercise
•Behavior modification

17. Medical Nutrition Therapy
•Primary Goal – improve
metabolic control
•Blood glucose
•Lipid (cholesterol) levels

18. Medical Nutrition Therapy
•Maintain short and long term body
weight
•Reach and maintain normal growth and
development
•Prevent or treat complications
•Improve and maintain nutritional status
•Provide optimal nutrition for pregnancy

19. Nutritional Management for Type I
Diabetes
•Consistency and timing of meals
•Timing of insulin
•Monitor blood glucose regularly

20. Nutritional Management for Type
II Diabetes
•Weight loss
•Smaller meals and snacks
•Physical activity
•Monitor blood glucose and
medications

21. Nutrition Recommendations
•Carbohydrate
–60-70% calories from
carbohydrates and
monounsaturated fats
•Protein
–10-20% total calories

22. Nutrition Recommendations
•Fat
–<10% calories from saturated fat
–10% calories from PUFA
–<300 mg cholesterol
•Fiber
–20-35 grams/day
•Alcohol
–Type I – limit to 2 drinks/day, with meals
–Type II – substitute for fat calories

23. Total calories requirements in DM
(Kcal/kg body weight)
Nutritional statusSedentary Light work Heavy work
Obese 25 30 35
Normal 30 35 40
Lean 35 40 45

24. Research Articles

25. Herbal supplements for type 2 Diabetes
Mellitus: A systematic review of clinical results
Razif bin Abas1,2, Srijit Das1, Zar Chi Thent1,*
•Journal of Experimental and Applied Animal Sciences Volume 1, Number 3, pp. 341-354, 2015 Print ISSN
2314-5684 | Online ISSN 2314-5692
Conclusion-
•It is concluded that treatment with single natural
product or herbal supplement is effective for the
treatment of type 2 DM. The advantages of using
herbal medicine include its cost-effectiveness, patient
compliance and easy availability. Proper calculation of
appropriate dose and toxicity level is mandatory be-
fore commercialization of the drug. Knowledge of
herbal products used in the treatment for DM may
help clinicians and other medical personnel.
Alternative medicine treatment may be effective in a
primary health care set up.

26. •Diabetes Mellitus and its Herbal Treatment
Pallab Das Gupta and Amartya De* BCDA College of Pharmacy and Technology, 78 Jessore road (south), Hridaypur,
Barasat, Kolkata, west Bengal, India.
•International Journal of Research in Pharmaceutical and
Biomedical Sciences ISSN: 2229-3701
•CONCLUSION Diabetes mellitus is the most common endocrine
disorder, affecting more than 300 million people worldwide. For
this, therapies developed along the principles of western
medicine (allopathic) are often limited in efficacy, carry the risk
of adverse effects & are often too costly, especially for the
developing world. Therefore, treating diabetes mellitus with
plant derived compounds which are accessible & do not require
laborious pharmaceutical synthesis seems highly attractive.
has been made to focus on hypoglycemic plants & maybe useful to
the health professionals, scientists and scholars working in the
field of pharmacology & therapeutics to develop evidence based
alternative medicine to cure different kinds of diabetes in man &
animals. Isolation & identification of active constituents from
these plants, preparation of standardized dose & dosage
regimen can play a significant role in improving the hypoglycemic
action. REFERENCES 1. Medscape.com. Type 2 Diabetes Mellitus
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27. •All the herbal drugs discussed in the review exhibit significant
clinical & pharmacological activity. The potency of herbal
drugs is significant & they have negligible side effects than the
synthetic anti diabetic drugs. In this review article an attempt
has been made to focus on hypoglycemic plants & maybe
useful to the health professionals, scientists and scholars
working in the field of pharmacology & therapeutics to
develop evidence based alternative medicine to cure different
kinds of diabetes in man & animals. Isolation & identification
of active constituents from these plants, preparation of
standardized dose & dosage regimen can play a significant role
in improving the hypoglycemic action.