GuideSrilakshmi M. Pharm

Presented by

A.Srikanth reddy

07FM1R0013

•DIABETES( From a Greek word meaning “ siphon “, referring to the increased output of urine)

MELLITUS(From a Latin word meaning

“sweet“

Diabetes mellitus (DM) is a set of related diseases in which the body Cannot regulate specifically sugar( glucose) in the blood. known also as glycosuria (glucose in urine)

• Figures for the year 2007 show that the 5 countries with the largest amount of people diagnosed with diabetes were

• India (40.9 million),• China (38.9 million), • US (19.2 million),• Russia (9.6 million), and• Germany (7.4 million).• Currently, India is the diabetes capital of the world.

• Glucose in the blood gives you energy to perform normal glucose level• daily activities, run for a bus, (100mg/dl)ride your bike, take an aerobic exercise class, glucose is produced in liver.

• Gluconeogenesis & glycogenesis

Insulin is produced by beta cells of langerhans of pancreas

In a healthy person, the blood glucose level is regulated by several hormones, including insulin.

Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel

insulin

• Type 1 diabetes

• Type 2 diabetes

• Gestational

• Pre-diabetes

Type 1 diabetes:

•Type 1 diabetes comprises about 10% of total cases of diabetes.

The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss due to T-cell mediated autoimmune attack. There is no known preventive measure against type 1 diabetes

•Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin•.•People with type 1 diabetes require daily insulin treatment to sustain life

• At least 90% of patients

with diabetes have type 2 diabetes.

• The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance.

• The body tries to overcome

this resistance by secreting more and more insulin (hyper inslunemia)

• It causes Dystocia It is abnormal or difficult child birth.

• The Gestational diabetes occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery

• Untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight),

• Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy

• About 20%–50% of affected women develop type 2 diabetes later in life

• Pre-diabetes is a common condition related to diabetes. In people with pre-diabetes, the blood sugar level is higher than normal but not high enough to be considered diabetic.

• Polydipsia• • Polyuria

• Weight loss

• Polyphagia • Poor wound healing: High blood sugar levels prevent white blood cells, which

are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function

properly, wounds take much longer to heal and become infected more frequently

• Diabetic retinopathy• Diabetic Neuropathy• Diabetic ketoacidosis• Hyper osmolar hyperglycemic non ketonic syndrome• Foot problems• Hypoglycemia • Diabetic nephropathy • Atherosclerosis• Infection

• Common complication of diabetes affecting the blood vessels in the retina (the thin light-sensitive membrane that covers the back of the eye). If untreated, it may lead to blindness

• Non proliferative: retinopathy is the earlier stage. (bleeding) in the retina with leakage of blood causing a "wet retina" or protein deposits

• Proliferative retinopathy is the second stage. New abnormal vessels develop in the retina and grow towards the center of the eye.

• It is the disorder related to nerves Types• Peripheral: causes pain or loss of feeling in the toes, feet, legs, hands • Autonomic: Autonomic neuropathy causes changes in digestion, bowel and

bladder function, sexual response, and perspiration (sweating)

• Proximal neuropathy :causes pain in the thighs, hips, or buttocks and

leads to weakness in the legs

• With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly (dysesthesia).

• Normal sweat secretion and oil production that lubricates the skin of the foot is impaired leads to formation of foot ulcers

• Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wound

• Amputation of leg is the only treatment

• Hypoglycemia (low blood sugar) is a commonly perceived problem Generally, hypoglycemia is defined as a serum glucose level (the amount of sugar orglucose in your blood) below 70 mg/dL, (normal-100mg/dl)

Sypmtoms

• Difficult in speech or slurred speech

• Confusion, dizziness, Dysphoria, anxiety, moodiness, depression, Fatigue, weakness, apathy, lethargy.

• Diabetic nephropathy typically affects the network of tiny blood vessels (the microvasculature) inthe glomerulus, a key structure in the kidney composed of capillary blood vessels.

• The glomerulus is critically necessary for the filtration of the blood. Features of diabetic nephropathy include the nephrotic syndrome with excessive filtration of protein into the urine (proteinuria

• The levels of glucose causes the accumulation of fat in blood vessels leading to the hardening of the walls of the vessels which leads diminished blood supply cause the atherosclerosis further leads to heart attacks

• in diabetic keto acidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs

• These fatty acids are converted to ketones by a process called oxidation.

The body consumes its own muscle, fat, and liver cells symptoms

Excessive thirst Frequent urination, Dehydration, Vomiting Loss of appetite, Confusion, Abdominal pain,

• As the body contains high amount of glucose in blood it encourages the growth of bacteria, fungus in infections as we know that glucose serves as the source of energy for microbes

• It is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, and even death

• Finger stick glucose test

• Fasting plasma glucose

• Glycosylated hemoglobin

• The test involves sticking the

patient's finger for a blood sample

which is then placed on a strip. The

strip goes into a machine

that reads the blood sugar level. 

• Finger stick blood glucose values

may be inaccurate at very high or very

low levels, so this test is

only a preliminary screening study

• The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL without eating anything, they probably have diabetes.

• This test is a measurement of how high blood sugar levels have been over about the last 120 days (the average life-span of the red blood cells on which the test is based).

• Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell.

• The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood

• Diet• Exercise• Medications• Alcohol use• Quit smoking• Self monitored glucose

• A healthy diet is key to controlling blood sugar levels

and preventing diabetes complications.

• If the patient is obese and has had difficulty losing weight on their own, talk to a healthcare

provider. He or she can recommend a dietitian

• Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity canalso reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers

• As little as 20 minutes of walking three times

a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise

• Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or

high blood sugar levels, increase in triglycerides, which is a type of fat in our blood.

• Chronic alcohol causes pancreatitis &damage to beta cells of langerhans

• Smoking: If the patient has diabetes, and you smoke cigarettes , they are raising the risks markedly for nearly all of the complications of diabetes.

• Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If someone needs

help quitting, talk to a healthcare provider.

•  Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook.

• Sulfonylureas: These drugs stimulate the pancreas to make more insulin.Ex. Glipizide (Glucotrol) glyburide

• Insulin

• Biguanides: These agents decrease the amount of glucose produced by the liver. Ex- Metformin, phenformin,butformin

• Alpha- glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.

Ex- Miglitol(Glyset), Acarbose(Glucobay)

• Meglitinides: These agents stimulate the pancreas to make more insulin.Ex- Repaglinide(Prandin)

Nateglinde(Starlix)