Dr. Nathasha Luke

 Define the term glucose homeostasis  Describe how blood glucose levels are maintained in the fasting state and fed state  Describe the patho physiology of diabetes mellitus and how the regulation of blood glucose is affected in diabetes

 Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.  The effects of diabetes mellitus include long– term damageof various organs.

 by the year 2025, the number of people affected will reach 333 million  In most Western societies, the overall prevalence has reached 4-6%, and in Asia as 10-12%.

 Type 1 Diabetes Mellitus  Type 2 Diabetes Mellitus  Gestational Diabetes  Other types:  LADA  MODY ( maturity-onset diabetes of youth)  Secondry DM

 Type 1 diabetes develops when the immune system destroys pancreatic beta cells, the cells secreting insulin that regulates blood glucose.  usually strikes children and young adults.  Type 1 - 5% to 10% of diabetes.  Risk factors for type 1 diabetes Autoimmune Genetic environmental factors.

 T2 DM-90% - 95% of diabetes.  It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.  Type 2 diabetes is associated with  older age  obesity  family history  physical inactivity  race/ethnicity.  Type 2 diabetes is increasingly being diagnosed in children and adolescents.

 Usually insulin is secreted when blood glucose is high and it stimulates uptake of glucose by adipose tissue and liver.  This brings blood glucose levels to normal  In DM due to low insulin or insulin resistance, uptake of glucose by liver and other tissues are reduced and blood glucose levels remain high  Also there is increased breakdown of lipids and glycogen stores de to the absence of insulin

 A form of glucose intolerance during pregnancy.  gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant.  After pregnancy, 40% of women with gestational diabetes later develop type 2 diabetes..

 Acromegaly,  Cushing syndrome,  Thyrotoxicosis,  Pheochromocytoma  Chronic pancreatitis,  Cancer  Drug induced hyperglycemia:

 Prediabetes is a term used to distinguish people who are at increased risk of developing diabetes.  IFG is a condition in which the fasting blood sugar level is elevated (100 to 125 mg/dl) after an overnight fast but is not high enough to be classified as diabetes.  IGT is a condition in which the blood sugar level is elevated (140 to 199 mg/dL after a 2- hour oral glucose tolerance test), but is not high enough to be classified as diabetes.

 weight loss and increased physical activity among people with prediabetes prevent or delay diabetes  People with prediabetes are already at increased risk for other adverse health outcomes such as heart disease and stroke.

characteristic symptoms  Thirst  Polyuria  blurring of vision  weight loss. Emergencies -ketoacidosis -non–ketotic hyperosmolar state  Often symptoms are absent

 Type 1 DM present with symptoms early due to insulin absence/being v low presentations  symptoms  Emergencies-DKA Why???

Low insulin--- high BS---glucose leaks in urine----due to osmotic effect urine volume high--- polyuria---polydipsia Low insulin--- body ‘thinks’ it is fasting--- polyphagia/break down of stores---wt loss

 Type 2 DM are asymptomatic until later stages!!!

Non diabeticdiabetic impaired fasting glucose mg/dl <100 >126 Fasting blood glucose

Non diabeticdiabetic mg/dl <140 >200 Post prandial blood glucose

 100g of glucose is given orally after fasting  Blood sugar level measured in 2hrs  >200-DM  <140-non DM  OGTT is the investigation of choice to detect DM in pregnancy

 Criteria -FBS> 126mg/dl in a symptomatic pt Or -2 FBS >126mg/dl in asymptomatic Or PPBS >200 mg/dl

 HbA 1 C levels(glycocylated Hb) Good to assess the glycemic control of long term in DM patients In diabetics the Hb of blood gets glycocylated Since the life time of RBC is 120 days HbAic represents glycemic control of about 6 weeks A hemoglobin of 6% indicates good control and level >8% indicates action is needed.

 Renal functions  ECG  Lipid profile  Eye assessment  Foot examination Should be done routinely in diabetics

Management of Diabetes Mellitus

 The major components of the treatment of diabetes are: Diet and Exercise Oral hypoglycaemic therapy Insulin Therapy Regular follow up/education

 Diet is a basic part of management in every case.  should aim at: ◦ weight control ◦ providing nutritional requirements ◦ allowing good glycaemic control ◦ correcting blood lipid abnormalities

 Carbohydrate ◦ 60-70% calories from carbohydrates  Protein ◦ 10-20% total calories

 Fat ◦ <10% calories from saturated fat ◦ 10% calories from PUFA ◦ <300 mg cholesterol  Fiber ◦ grams/day

 Physical activity promotes weight reduction and improves insulin sensitivity, thus lowering blood glucose levels.

 There are currently four classes of oral anti- diabetic agents: i. Biguanides ii. Sulphonylureas iii. Insulin Secretagogues iv. α-glucosidase inhibitors v. Thiazolidinediones

Short-term use:  Acute illness, surgery, stress and emergencies  Pregnancy Long-term use:  If poor control  Type 1 DM

◦ Blood glucose monitoring ◦ Body weight monitoring ◦ Foot-care ◦ Personal hygiene ◦ Healthy lifestyle/diet or physical activity ◦ Identify targets for control ◦ Stopping smoking

Thank You