REVIEW OF ANATOMY AND PHYSIOLOGY

PANCREAS
HORMONES:

INSULIN BY BETA CELL

GLUCAGON BY ALPHA CELLS

 PANCREAS
• SECRETES 40-50 UNITS OF INSULIN DAILY IN TWO STEPS:
• SECRETED AT LOW LEVELS DURING FASTING(BASAL INSULIN
SECRETION)
• INCREASED LEVELS AFTER EATING (PRANDIAL)
• AN EARLY BURST OF INSULIN OCCURS WITHIN 10 MINUTES OF EATING
• THEN PROCEEDS WITH INCREASING RELEASE AS LONG AS
HYPERGLYCEMIA IS PRESENT.
 INSULIN

• INSULIN IS A HORMONE SECRETED BY BETA CELL WHICH ARE

ALLOWS GLUCOSE TO MOVE INTO CELLS TO MAKE ENERGY.
• INHIBITS GLUCAGON ACTIVITY.
 DIABETES MELLITUS

DEFINITION
• DIABETES IS A GROUP OF METABOLIC DISEASES CHARACTERIZED
BY INCREASED LEVELS OF GLUCOSE IN THE
BLOOD(HYPERGLYCEMIA). RESULTING FROM DEFECTS IN INSULIN
SECRETIONS ARE BOTH
• CARE OF THE PATIENT WITH DIABETES WITH FORMERLY KNOWN AS
DIABETES MELLITUS.
 TYPES OF DIABETES

I. TYPE I
II. TYPE II
III. GESTATIONAL DIABETES
IV. LATENT AUTOIMMUNE DIABETES OF ADULTS
 TYPE 1

• A METABOLIC DISORDER CHARACTERIZED BY AN ABSENCE OF

INSULIN PRODUCTION AND SECRETIONS FROM AUTOIMMUNE
DESTRUCTION BETA CELL OF THE ISLETS OF LANGERHANS IN
THE PANCREAS
• FORMERLY CALLED INSULIN DEPENDENT DIABETES OR
JUVENILE DIABETES
PATHOPHYSIOLOGY OF TYPE 1
DIABETIES
VIRAL INFECTION

AUTO IMMUNE RESPONSE

DESTRUCTION OF BETA CELL

INSULIN DEFICIENCY

TYPE 1 DIABETES MELLITUS

 TYPE 2
A METABOLIC DISORDER CHARACTERIZED BY THE RELATIVE
DEFICIENCY OF INSULIN PRODUCTION AND A DECREASED INSULIN
ACTION AND INCREASE INSULIN RESISTANCE FORMERLY CALLED
NON INSULIN DEPENDENT DIABETES OR , ADULT ONSET DIABETES.
PATHOPHYSIOLOGY OF TYPE 2 DIABETES MELLITUS

Impaired
insulin
secretion in
Leads to
pancreas
receptor and
post receptor
defects

Increased
glucose Increased
Insulin resistance
production glucose
in peripheral
in liver
tissues

Type 2 diabetes
mellitus
 GESTATIONAL DIABETES

• GESTATIONAL DIABETES IS ANY DEGREE OF GLUCOSE

INTOLERANCE WITH ITS ONSET DURING PREGNANCY ,
• HYPERGLYCEMIA DEVELOPS DURING PREGNANCY BECAUSE
OF THE SECRETION OF PLACENTAL HORMONES WHICH
CAUSES INSULIN RESISTANCE
• GESTATIONAL DIABETES OCCURS IN AS MANY AS18% OF
PREGNANT WOMEN AND INCREASES THEIR RISK FOR
HYPERTENSIVE DISORDERS DURING PREGNANCY.
LATENT AUTOIMMUNE DIABETES OF ADULTS

• IN ADULTS LADA SUB TYPE OF DIABETES IN WHICH THE

PROGRESSION OF AUTO IMMUNE BETA CELL DESTRUCTION IN
THE PANCREAS IS SLOWER THAN IN TYPE 1 AND 2 DIABETES
• PATIENT WITH LADA ARE NOT INSULIN DEPENDENT IN THE
INITIAL SIX MONTH OF DISEASE ONSET.
 EPIDEMIOLOGY
• IT IS ESTIMATED THAT 29.1 MILLION PEOPLE IN THE UNITED
STATE HAVE DIABETES , ALTHOUGH ALMOST 1/3 RD OF THESE
CASES ARE UNDIAGNOSED ,
• THE NUMBER OF PEOPLE OLDER THAN 2O YEARS NEWLY
DIAGNOSED DIABETES INCREASES BY 1.7MILLION PER YEAR
OUT OF THE 422 MILLION PEOPLE EFFECTED BY DIABETES IN
THE WORLD
• IT IS PREDICTED THAT 2045 THIS WILL RAISE TO 134 MILLION
• MINORITY POPULATION ARE THIS PROPORTIONATELY
EFFECTED BY DIABETES
CONT..
• DIABETES IS INCREASING AMONG ALL GENDER AND RACIAL
GROUP
• DIABETES IS THE LEADING CAUSE OF NON TRAUMATIC
AMPUTATIONS
• BLINDNESS IN THE WORKING AGE ADULTS , AND END STAGE
KIDNEY DISEASE
• TYPE 2 DIABETES IS A 7TH LEADING CAUSE OF DEATH
• THE ECONOMICAL CAUSE OF DIABETES CONTINUE TO
INCREASE BECAUSE OF INCREASING HEALTH CARE COSTS
 RISK FACTORS

• Obesity
• Race
• Physical inactivity
• family history
• Gestational diabetes
• Age equal to or greater than 45 years
• Previously identified impaired fasting glucose or impaired glucose tolerance
• Hypertension(> 140/90 mm Hg)
• High density lipoprotein(HDL)cholesterol level <35mg/dl and triglyceride level >250mg/dl
• History of gestational diabetes or delivery of a baby over 4kg
 CLINICAL MANIFESTATIONS
• CLINICAL MANIFESTATION OF DIABETES INCLUDE THE THREE “Ps”
• - POLYURIA (INCREASE URINATION )
• - POLYDIPSIA (INCREASE THIRST)
• - POLYPHAGIA (INCREASED APPETITE)
• SUDDEN VISION CHANGES
• TINGLING OR NUMBNESS IN HANDS OR FEET
• DRY SKIN
• SKIN LESIONS OR WOUNDS THAT ARE SLOW TO HEAL
CONT…
• - WEIGHT LOSS
• - NAUSEA / VOMITING
• - WEAKNESS
• - FATIGUE
• - INCREASE BLOOD SUGAR / GLUCOSE LEVEL
• - (+) GLUCOSE IN URINE (GLYCOSURIA)
• - RECURRENT INFECTION, PROLONGED WOUND HEALING )
• - GENITAL PRURITUS - (HYPERGLYCEMIA AND GLYCOSURIA
FAVOR FUNGAL
• GROWTH : CANDIDAL INFECTION - RESULTING IN PRURITUS,
COMMON
• RESENTING SYMPTOM IN WOMEN)
 ASSESSMENT

HISTORY
• SYMPTOMS RELATED TO THE DIAGNOSIS OF DIABETES
• SYMPTOMS OF HYPERGLYCEMIA
• SYMPTOMS OF HYPOGLYCEMIA
• FREQUENCY TIMING SEVERITY ,AND RESOLUTION
• RESULT OF BLOOD GLUCOSE MONITRING
• STATUS ,SYMPTOMS ANDMANAGEMENT OF CHRONIC
COMPLICATION OF DIABETIES
• EYE,KIDNEY,NERVE,GENITOURINARY AND SEXUALAND
SEXUAL BLADDER,AND GESTROINTESTINAL,CARDIAC
,PERIPHERAL VASCULAR,
• FOOT COMPLICATION ASSOCIATED WITH DIABETES
• ADHERENCE TO ABILITY TO FOLLOW PRESCRIBED DIETRY
MANAGEMENT PLAN
• ADHERENCE TO PRESCRIBED EXERCISE REGIMEN
• ADHERENENCE TO ABILITY TO FOLLOW PRESCRIBED DIETRY
MANAGEMENT PLAN
• USE OF TOBACCO ,ALCOHOL,AND PRESCRIBED AND C OVER
THE COUNTER MEDICATION
• LIFESTYLE CULTURAL ,PSYCHOSOCIAL,AND ECONOMIC
FACTOR THAT MAY AFFECT DIABETIES TREATMENT
• EFFECTS OF DIABETES OR ITS COMPLICATIONS ON
FUNCTIONAL STATUS eg MOBILITY , VISION
 PHYSICAL EXAMINATION

• BLOOD PRESSURE SITTING AND STANDING TO DETECT

ORTHOSTATIC CHANGES
• BODY MASS INDEX HEIGHT AND WEIGHT
• FUNDOSCOPIC EXAMINATION AND VISUAL ACUITY
• FOOT EXAMINATION SIGN LESION,AND SIGN OF INFECTION
,PULSES
• SKIN EXAMINATION LESIONS,AND INSULINE INJECTION SITES
• NEUROLOGICAL EXAMINATION
• VIBRATORY AND SENSORY EXAMINATION DEEP TENDON
REFLEXES
• ORAL EXAMINATION
 LABORATORY EXAMINATION

• HBA,C
• FASTING LIPID PROFILE
• TEST FOR MICROALBUMINURIA
• SERUM CREATININE LEVEL
• URINALYSIS
• ELETROCARDIOGRAM
 NEED FOR REFERRALS

• OPTHALMOLOGIST
• PEDIATRIST
• DIETITIAN
• DIABETES EDUCATOR
• OTHERS IF INDICATERD