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An endocrine disorder in which there is
insufficient amount or lack of insulin
secretion to metabolize carbohydrates.
It is characterized by hyperglycemia,
glycosuria and ketonuria.
Diabetes mellitus is a group of
metabolic diseases characterized by
elevated levels of glucose in the blood
(hyperglycemia) resulting from defects in
insulin secretion, insulin action, or both
Insulin, a hormone produced by thepancreas, controls the level of glucose inthe blood by regulating the production andstorage of glucose. In the diabetic state, thecells may stop responding to insulin or thepancreas may stop producing insulin entirely.This leads to hyperglycemia, which mayresult in acute metabolic complications suchas diabetic ketoacidosis (DKA) andhyperglycemic hyperosmolar nonketoticsyndrome (HHNS).
Risk of diabetes typically increase when you are: Older age (45 years or older) Less active (sedentary life) Overweight or obeseFamily history of diabetesPre-diabetesHigh blood pressureHigh lipids (triglycerides and low
HDL)Diabetes during pregnancy or baby
>9 lbs.
Type 1 - IDDM
• little to no insulin
produced
• 20-30% hereditary
• Ketoacidosis
Gestational
• overweight; risk for
Type 2
Type 2 - NIDDM
• some insulin produced
• 90% hereditary
Other types include Secondary
Diabetes :
• Genetic defect beta cell or insulin
• Disease of exocrine pancreas
• Drug or chemical induced
• Infections-pancreatitits
• Others-steroids,
Type 1 diabetes is a chronic (lifelong)
disease that occurs when the pancreas
produces too little or no insulin to regulate
blood sugar levels appropriately.
Causes :-
Viral infection
Genetics
Not caused by life style.
Type 2 diabetes also called NIDDM is
a chronic, life-long disease that
results when the body's insulin does
not work effectively.
Causes and risk factors
Genetics
low activity level
poor diet
excess body weight (especially around the
waist)
Race/ethnicity;
History
Blood tests
• Fasting blood glucose test: two tests > 126 mg/dL
• Oral glucose tolerance test: blood glucose > 200
mg/dL at 120 minutes
• Glycosylated hemoglobin (Glycohemoglobin test)
assays
• Glucosylated serum proteins and albumin
FSBS – (finger stick) monitoring blood sugar
ORAL ANTI-DIABETIC DRUGS:-
Oral sulfonylureas (like glimepiride,
glyburide, and tolazamide) trigger the
pancreas to make more insulin.
Biguanides (Metformin) tell the liver to
decrease its production of glucose, which
increases glucose levels in the blood
stream.
Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Patients with Type 1 diabetes mellitus depend on external insulin (most commonly injected subcutaneously)
The commonly used types of insulin are:
Rapid-acting insulin These begin to work within 5 to 15 minutes and are active for 3 to 4 hours.
Short-acting, such as regular insulin – starts working within 30 minutes and is active about 5 to 8 hours.
Intermediate-acting,– starts working in 1 to
3 hours and is active 16 to 24 hours.
Long-acting, insulin – starts working in 4 to
6 hours, and is active well beyond 32
hours.
Diabetes Diet: A healthy diet is
key to controlling blood sugar
levels and preventing diabetes
complications.
Eat a consistent, well-balanced
diet that is high in fiber, low in
saturated fat, and low in
concentrated sweets.
Purpose - controls
blood glucose and
lowers blood glucose
Purpose - reduce the
amount of insulin
needed
Diabetic ketoacidosis
Hyperglycemic-hyperosmolar-
nonketotic syndrome
Hypoglycemia from too much insulin or
too little glucose
Physical General signs
Ill appearance
Dry skin
Dry mucous membranes
Decreased skin turgor
Vital signs
Tachycardia
Hypotension
Tachypnea
Hypothermia
Fever, if infection
Specific signs
Ketotic breath (fruity, with acetone smell)
Confusion
Coma
Abdominal tenderness
1. Fluids
- If in shock, initial resuscitation with normal saline. Dehydration
should then be corrected gradually over 48 to 72 hour
using 0.45% Saline
- Monitor :
- Fluid input and output
- Electrolytes, creatinine and acid-base status regularly
- Neurological states
2. Insulin- insulin infusion is started, titrating the dose according to the
blood glucose. Monitor blood glucose regularly.
- aim for gradual reduction of blood glucose .
Cardiovascular disease
Cerebrovascular disease
Retinopathy (vision) problems
Diabetic neuropathy
Diabetic nephropathy
Male erectile dysfunction
Uncontrolled diabetes
can lead to…
Kidney failure
Amputations
Loss of Sensations
Heart disease
and strokes
Blindness
Death