DIABETIS by DIABETIS by ashwathy ashwathy.ppt

DIABETIS by ashwathyDIABETIS by ashwathy

1. DIABETIS MELLITUS

2. INTRODUCTION
Diabetes mellitus is now seen as a heterogeneous group
of diseases.
It is a long term diseasewith variable clinical
manifestation and progression.
Characterised by a state of chronic hyperglycemia,
resulting from, environmental & genetic factors.
The main cause of diabetes is the defective production or
action of insulin.
Insulin is a hormone that controls glucose, fat & amino
acid metabolism in our body.
Insulin produced in small group of cells known as Islets of
Langerhanswt in the pancreas.
The earliest sign of diabetes is Poly urea.
Chronic hyperglycemia leads to a number of complications
such as cardiovascular, renal, neurological etc.

3. CLASSIFICATION
THE CLASSIFICATION ADOPTED BY W.H.O.
Diabetes mellitus [DM]
A.Insulin –dependent diabetes mellitus [IDDM
,Type 1]
B.Non insulin –dependent diabetes mellitus
[NIDDM ,Type 2]
C.Malnutrition -related diabetes mellitus [MRDM]
D.Other types [ secondary to pancreatic hormonal,
drug induced , genetic & other abnormalities]
Gestational diabetes mellitus [GDM]

4. Features Type 1 Type 2
Most severe form of the
disease
Much common than
IDDM
Age of onset Usually before 40yrsAfter 40yrs
Major cause Lack of insulin Lack of insulin receptor
Insulin deficiency Yes Partial
Immune destruction of
β-cells
Yes No
Hereditary cause YES May or may not be
Need of insulin Always Not in initial stage, may
require in later stage.
Insulin resistance No Yes
Symptoms appear Rapidly Slowly
Body wt. Usually thin Over wt.
Stress induced obesityNO Yes
Ketosis Yes May/may not be

5. SIGNS & SYMPTOMS
OF IDDM
1.Polyurea
2.Polydipsia
3.Polyphagia
4.Rapid weight loss
5.Nausea & vomiting
6.Blurred vision
7.Slowed growth

6. SIGNS & SYMTOMS OF NIDDM
1.It can creep along unnoticed for years.
2.Any of type -1 diabetes warning signs
3.Blurred vision
4.Tingling or numbness in legs , feet
,fingers
5.Frequent infections
6.Itching of skin
7.Slow healing of cuts & bruises
8.Drowsiness

7. SECONDARY DIABETES
A small number of people who develop
diabetes as a result of other diseases of
the pancreas.
Eg: Pancreatitis, hormonal diseases.
It can also be a result of damage to the
pancreas caused by over intake of alcohol.

8. EPIDEMIOLOGICAL FACTORS
1. Agent:
-Cause is mainly insulin deficiency.
-It absolute in IDDM &partial in NIDDM.
-This may due to ;
Pancreatic disorder
Defects in formation of insulin
Destruction of beta cells
Decreased insulin sensitivity
Genetic defects
Auto immunity

9. HOST FACTORS
1.Age :
it may occur at any age
NIDDM usually comes to in middle yrs of
life & there after begins to rise frequency.
Malnutrition related diabetes large no. of
young people.
Younger diabetes tend to develop
complication earlier than older diabetes.

10. 2 .Sex :
-In some countries overall male & female
ratio is equal
-in south east Asia an excess of male
diabetes has been observed.
3. Genetic factor :
-In genetic nature of diabetes is undisputed.
-Identical twins & family trees of patients
with diabetes have found that heredity is
an important factor in both kind of
diabetes.

11. 4.Immune mechanisms :
-some people appear to have defective
immunological mechanism & under the
influence of some environmental trigger
attack their own insulin producing cells.
5. Obesity:
-Obesity particularly central adiposity as a
risk factor for NIDDM .

12. 6. Maternal diabetes:
•Diabetes mellitus leads to serious
complication during pregnancy.
•It may be gestational or pre gestational.
•Offspring of diabetes pregnancies
including gestational diabetes are often
large & heavy at birth , tend to develop
obesity in childhood & are at high risk of
developing type 2 diabetes at an early
age.
•Those borne to mothers after they have
developed diabetes have 3 fold higher risk
of developing diabetes than those born
before.

13. Maternal Diabetes associated with:
1.Intra Uterine Death
2.Intra Uterine Growth Retardation
3.Low Birth Weight, when associated rapid
growth catch-up later on.
4.Pre-mature delivery
5.Hypoglycemia & Hyperglycemia
6.Trauma during death
7.Perinatal mortality is increased due to
placental insufficiency

14. ENVIRONMENTAL RISK FACTORS
1. Life style:
-It is an important risk factors of the
development of NIDDM.
-Lack of exercise may alter the interaction
between insulin & its receptors & leads to
NIDDM
2. Diet:
-High saturated fat intake has been
associated with a high risk of impaired
glucose tolerance & higher fasting glucose
& insulin levels

15. -By the replacement of saturated by unsaturated
fatty acids leads to improved glucose tolerance
& enhanced insulin sensitivity
3. Dietary Fibre:
-High intake of dietary fibre leads to reduced
blood glucose & insulin level. In people with
Type II diabetes & impaired glucose tolerance.
4. Malnutrition:
-Malnutrition in early infancy & childhood may
leads partial failure of beta cell function.
-Damage to beta cells may associated impaired
carbohydrate tolerance in Kwarshiorkor.

16. 5. Alcohol:
-Excessive intake of alcohol can increase the
risk of Diabetes by damaging the Pancreas
,Liver &prompting obesity.
6. Viral Infection:
-Viruses that have been implicated are Rubella,
Mumps.
-Viral infection may trigger in immunogenetically
susceptible people a sequence of events
resulting of beta cells.
7. Chemical agents:
-A no: of chemical agents are toxic to beta cells.
-A high risk of cyanide producing foods may also
have toxic to effects on beta cells.

17. 8. Stress :
-surgery, trauma, accidents , stress of
situations, internal or external may’ bring
out’ the disease.
9. Other factors:
-It include mainly social factors such as
occupation, marital status, religion ,
economic status , urbanization & changes
in life style etc.

18. SCREENING FOR DIABETES
1.Urine examination
-Semi quantitative test for glucose in urine sample for those
found to have glycosuria.
-This is done for early detection and effective control of
hyperglycemia in asymptomatic diabetes.
-All those with glycosuria are considered diabetic or it should
be proved by standard oral glucose tolerance test.
2.Blood sugar testing
•Mass screening of glucose measurements by fasting, post –
prandial or random blood sample.
•The measurement of glucose level in random blood sample
is not accurate.
•Fasting value alone is considered less reliable since true
fasting cannot be assured.
•Therefore for epidemiological purposes the 2 hour value
after 75 gm oral glucose may used either alone or with the
fasting value.

19. PREVENTION & CARE
A.Primary prevention.
i.Population strategy
•‘Primordial prevention’ :-The preventive
measures comprise maintenance of normal body
weight through adoption of healthy nutritional
habits & physical exercise.
ii.High risk strategy
•There is no special high risk strategy for IDDM
diabetes.
•NIDDM linked with sedentary lifestyle, over
nutrition and obesity.
•Correction of these may reduce risk of diabetes &
its complication by reducing the use of alcohol
and diabetogenic drugs etc. in day to day life.

20. B.Secondary prevention
-When diabetes is detected, it must be treated
in the aims of ;
To maintain blood glucose level
To maintain ideal body weight.
-Treatment is based on
a)Diet alone –small balanced meals more
frequently.
b)Diet and oral anti diabetic drugs.
c)Diet & insulin.
C.Tertiary prevention
a)Diabetes major cause of disability thorough its
complications. Eg. Blindness, kidney failure,
CHD etc.
b)The main objective of this prevention providing
diabetes specialized clinics.

21. Thank you