The Disease Called

DIABETES
ROMEL Y. FELARCA,MD.
DIPLOMATE , PHILIPPINE ACADEMY
OF FAMILY PHYSICIAN
 TOP TEN CAUSES OF
MORTALITY IN THE PHILIPPINES
1. DISEASES OF THE HEART
2. DISEASES OF THE VASCULAR SYSTEM
3. MALIGNANT NEOPLASMS/ CANCERS
4. PNEUMONIA
5. ACCIDENTS
6. TUBERCULOSIS
7. COPD
8. Diabetes Mellitus
9. DISEASES OF THE RESP. SYSTEM
10. KIDNEY DISEASE
 DIABETES MELLITUS:
It is a metabolic disease of multiple
etiology.
Results from the inability of the body to
convert sugar, starches and other food
into energy due to insufficient amount
or ineffective hormone called INSULIN.
It is genetically inherited.
It is “triggered” by unhealthy lifestyle.
 Without insulin,
glucose cannot
get into the cells
of the body
where it is used
as fuel

Without insulin, your body can't use sugar and fat broken down from the food you
eat. When sugar can't get into your cells, your blood sugar rises and it's this high
blood sugar level that damages your body.
 Type 1 Diabetes
used to be called 'juvenile diabetes
insulin-dependent diabetes.
accounts for about 5 to 10 percent of
all diagnosed diabetes.
It's an autoimmune disease, which
means that your immune system (the
body's system for fighting infection) is
destroying the cells in your pancreas
that produce insulin
 Type 2 diabetes
called 'non-insulin-dependent diabetes
mellitus' or adult-onset diabetes.
most common type of diabetes,
accounting for 90 to 95 percent of all
diabetes.
Results from the combination of
decreased insulin action and decreased
insulin level.
 Gestational DM
Develops during pregnancy, disappear
after delivery.
about 3 to 5 percent of all pregnant
women, get this form of diabetes during
pregnancy.
almost 40 percent of women who have
gestational diabetes will go on to develop
type 2 diabetes
 Rise of Diabetes Mellitus
DM increases due to the following:
– Population Growth
– Aging
– Urbanization
– Increasing prevalence of obesity
– Increasing prevalence of physical inactivity
Between 2000 and 2025 diabetics will
more than double from 171 to 380
million.
 Table 1. The American Diabetes Association
guidelines for the evaluation of glucose level
(1,1a)
 Glucose Level  ADAEvaluation
  Normal  Fasting plasma glucose (FPG) <100 mg/dL
(5.6 mmol/L)

 Impaired Glucose Tolerance (IGT)  Fasting plasma glucose (FPG) ³ 100

(5.6 mmol/L) but <126 mg/dL (7.0 mmol/L) or
two-hour plasma glucose level of ³ 140 mg/dl
(7.8 mmol/L) but <200 mg/dl (11.1 mmol/L)

 Diabetes mellitus  FPG =126 mg/dL (7.0 mmol/L) or

randomly (or 2 hr PPBS value) = 200 mg/dL
(11.1 mmol/L).
Signs and Symptoms of DM:
Classic symptoms of DM:
– Polyuria
– Polydipsia
– Polyphagia
– Unexplained wt. loss
Minor Signs and Symptoms of DM:
– Body weakness, dizziness, blurring of vision
– Drying of lip and buccal cavity, numbness
on extremities, dry skin, non healing wound
 (S.W.E.E.T)
1.Sugar Control
2.Watch your weight
– Body Mass Index (BMI)
(18.5 to 24.4kg/m2)
– Waist to Hip Ratio (WHR)
– 80% to 90% of T2DM
patients are obese
 (S.W.E.E.T)
3.Exercise regularly
– Brisk Walking: 30 mins or more at least
4x/wk.
– Nature of Activity
 Preventing the Onset of DM
(S.W.E.E.T)
4.Eat right diet(Fruits and
Vegetables)
– High fiber diet
– Polyunsaturated fat (omega-3 fatty
acids)
– Monounsaturated fat
 Preventing the Onset of DM
(S.W.E.E.T)
5.Take your medications regularly
– Metformin: can be given to delay onset
of DM
: lesser hypoglycemia
: contributes to wt. loss
: improves cardiovascular
risk
 Obesity:
Central Obesity
 Diet:
Diet plays a major role in prevention
of Diabetes Mellitus.
 Smoking:
Vices should be avoided!
 Alcohol:
Vices should be avoided!
Complications of Diabetes Mellitus:
1.Cardiovascular Disease
– 20% of patients with CVD are Diabetics.
– 75% of these patients died due to CVD
Complications of Diabetes Mellitus:
2.Nephropathy
– Usually begins as recurrent UTI
– Urinalysis: presence of rbc, protein,
sugar.
Complications of Diabetes Mellitus:
3.Retinopathy
– Usually there is blurry vision
 RETINOPATHY
Retinopathy may lead to permanent
blindness.
RETINOPATHY
Complications of Diabetes Mellitus:
4.Neuropathy
– Usually there is numbness on
extremities
– Occasionally there is “tingling sensation”
– Worse is loss of sensation
Complications of Diabetes Mellitus:
5.Skin
Infections
– There is
itchiness
– There is drying
of skin
– Recurrent
wounds/
non healing
wounds
Non healing wound/diabetic
ulcer
Ulcers with gangrene
Before amputation of the leg
Both legs were amputated
With artificial leg
 Treatment
There is no cure for Diabetes.
Treatment involves medicines, diet,
and exercise to control blood sugar
and prevent symptoms and
complications.
 TABLE 4. ORAL ANTIDIABETICS
Sulfonylurea
 First Generation
– Tolbutamide (Orinase)
–  Chlorpropamide (Diabinese)
– Tolazamide (Tolinase)
– Acetoheximide (Dymelor) Glimiperide (Amaryl)
Second generation
– Glipizide (Glucotrol)
– Glipizide-gits (Glucotrol-XL)
– Glyburide (Diabeta, Micronase)
– Glyburide micronized (Glynase)
  
Mechanism of Action
– Stimulate first-phase insulin secretion by blocking K+ channel
in ß-cells.
– Stimulate the release of insulin from the beta cells.

Side Effects
• Late hyperinsulinemia and hypoglycemia
Weight gain
 ORAL ANTIDIABETICS
Meglitinides
   Repaglinide (Prandin)
   Nateglinide (Starlix)
Mechanism of action
– Stimulate first-phase insulin secretion by
blocking K+ channel in ß-cells.
– Stimulate the release of insulin from the beta
cells of the pancreas
Side effects
– Hypoglycemia
Weight gain
 ORAL ANTIDIABETICS
Biguanides
   Metformin (Glucophage, Riomet)
   Metformin-XR (Glucophage-XR)
Mechanism of action
– Decrease hepatic glucose production
Increase muscle glucose uptake and utilization
Side effects
– Nausea
Diarrhea
Anorexia
Lactic acidosis
 ORAL ANTIDIABETICS
Thiazolidinediones
   Rosiglitazone (Avandia)
   Pioglitazone (Actos)
Mechanism of action
– Lower blood glucose by increasing the
sensitivity of muscle and fat tissue to
insulin,allowing more glucose to enter the
cells in the presence of insulin for
metabolism. Inhibit gluconeogenesis and
decrease hepatic glucose output.
Fluid retention and weight gain
 ORAL ANTIDIABETICS
a-Glucosidase Inhibitor
   Acarbose (Precose)
   Miglitol (Glyset)

• Mechanism of action
• Inhibits pancreatic alpha amylase and
gastrointestinal alpha glucoside hydrolase enzymes
used in the digestion of sugars.
• Delays glucose absorption and lowering post prandial
hyperglycemia .

Side effects
• Flatulence
Abdominal bloating
 Criteria considered in choosing insulin
are :
Onset
– time required for the medication to have an
initial effect or action.
– how soon it starts working
Peak
– Is when the agent will have the maximum
effect.
– when it works the hardest
Duration
– Length of time that the agent remains active
in the body.
– how long it lasts in the body
 Types of Insulin
Rapid acting insulin
– Novolog(aspart)
– Humalog(lispro)
– Apidra(glulisine)

– They should be injected under the skin within 15

minutes before you eat.
– You have to remember to eat within 15 minutes after
you take a shot.
– These insulins start working in five to 15 minutes
and lower your blood sugar most in 45 to 90
minutes.
– It finishes working in three to four hours. With
regular insulin you have to wait 30 to 45 minutes
before eating. Many people like using lispro because
it's easier to coordinate eating with this type of
insulin.
 Types of Insulin

Short acting insulin

– Humulin R(human)
– Novolin R(human)

– Also called regular insulin.

– It lowers blood sugar most in 2 to 5 hours
and finishes its work in 5 to 8 hours.
 Types of Insulin
Intermediate - Acting Insulin
– NPH (N) or Lente (L) insulin starts
working in one to three hours
– lowers your blood sugar most in six to
12 hours
– finishes working in 20 to 24 hours.
 Types of Insulin
Intermediate acting insulin
– Isophane Insulin Suspension(NPH)
Humulin N(human)
Novolin N(human)
– Isophane Insulin Suspension and insulin
injection
Humulin 50/50(human)
Humulin 70/30(human)
Novolin 70/30(human)
 Types of Insulin
Intermediate acting insulin
– Lispro Protamine Suspension and Lispro
injection
Humalog Mix 75/25
Novolog Mix 70/30
– Insulin Zinc Suspension
Lente Iletin
Novolin L (human)
 Types of Insulin
Long- Acting Insulin
– Lantus (glargine)
– Levemir(detemir
Where should you inject?
 How to store it
If you use a whole bottle of insulin within 30 days, keep
that bottle of insulin at room temperature. On the label
write the date that is 30 days away. That date is when
you should throw out the bottle with any insulin left in
it.

If you don't use a whole bottle within thirty days then

you should store it in the refrigerator all of the time.

If insulin gets too hot or too cold, it doesn't work right.

So, don't keep insulin in the freezer or in the glove
compartment of your car during warm weather.

Keep at least one extra bottle of insulin around your

house. Store extra insulin in the refrigerator.
 Reality About Diabetes Mellitus
Today
World prevalence of DM is rapidly increasing.
245M approximately DM worldwide today
– 1/5 will be from developed country
– 4/5 will be from developing country and the rest of
the world.
Global prevalence rises from 2.8% to 4.4%
By year 2025 approximately there are 380M
diabetics worldwide.
DM is considered the “hidden epidemic of the
21st century.
 Diabetes Mellitus

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