DIABETES

MELLITUS
By: Nurol Iman L. Cabugatan, MD
Medical Officer III-NCR
DIABETES
MELLITUS
 EPIDEMIOLOGY
 DEFINITION
 TYPES
 CAUSES
 SYMPTOMS
 COMPLICATION
 DIAGNOSIS
 RISK FACTORS
 MANAGEMENT
EPIDEMIOLOGY

According to a 2019 global survey, there are over 400 million people worldwide are diagnosed with diabetes
International Diabetes Federation (IDF),
As of May 2020, has reported that the total cases of diabetes in adults in the country are at 3.9 million.

Philippine Statistics Authority,

4th leading cause of death among Filipinos in 2020, accounting for 37,300 deaths.

1 out of 14 Filipino adults lives with diabetes

WHAT IS
DIABETES Diabetes mellitus (DM), is a group of metabolic diseases in which there are
high blood sugar levels over a prolonged period.
MELLITUS? Symptoms of high blood sugar include frequent urination, increased thirst,
and increased hunger.
WHAT IS DIABETES MELLITUS?
WHAT IS
INSULIN
• Insulin is the hormone produced by
the pancreas
• It has a functionto control the amount
of blood sugar
TYPES OF THERE ARE THREE
DIABETES TYPES OF DIABETES
MELLITUS MELLITUS
• DIABETES MELLITUS
TYPE 1
• DIABETES MELLITUS
TYPE 2
• GESTATIONAL DIABETES
Diabetes • Diabetes mellitus TYPE 1
Type 1 diabetes mellitus is characterized by:
Mellitus TYPE  Results from the pancreas failure to produce
enough insulin
1 This form was previously referred to as
“insulin dependent diabetes mellitus (DDM )
or juvenile diabetes.
Diabetes mellitus TYPE 1

• Type 1 diabetes can occur at any age,

• But it is most often diagnosed in children, teens, or young adults.
• In this disease, the body makes little or no insulin.
• Daily injections of insulin are needed.
 Diabetes Mellitus TYPE 2
• Type 2 diabetes mellitus is characterized by:
Diabetes  insulin resistance, which may be combined
Mellitus with relatively reduced insulin secretion.
TYPE 2 The defective responsiveness of body tissues
to insulin is believed to involve the insulin
receptor.
 • Type 2 diabetes makes up most diabetes
cases.
Diabetes • It most often occurs in adulthood.
Mellitus • However, because of high obesity rates,
teens and young adults are now being
TYPE 2 diagnosed with it.
Many people with type 2 diabetes do not
know they have it.
 • Gestational diabetes is high
blood sugar that develops at any
time during pregnancy in a woman
who does not have diabetes.

GESTATIONAL • GDM resembles type 2 diabetes

in several aspects, involving a
DIABETES combination of relatively
inadequate insulin secretion and
responsiveness.
 It occurs in about 2%–5% of all
pregnancies and may improve or
disappear after delivery.

GESTATIONAL • Gestational diabetes is fully

treatable, but requires careful medical
DIABETES supervision throughout the pregnancy.

• About 20%–50% of affected women

develop type 2 diabetes later in life.
What causes diabetes mellitus?

The cause of diabetes depends on the type

• Type 1 Diabetes Millitus
There is malfunctions and the immune system destroys healthy cells in the
pancreas, called B-cells, that produce insulin. Eventually it destroys so many of
these cells that the pancreas loses the ability to produce insulin at all.
What causes diabetes mellitus?

• Type 2 Diabetes
Usually, this Diabetes is due primarily to lifestyle factors.
What causes diabetes mellitus?

• Gestational Diabetes
Increased level of certain hormones made in placenta during pregnancy
High blood sugar levels can cause
several symptoms, including:
 Blurry vision
 Excess thirst
 Fatigue
 Hunger
 Urinating often
 Weight loss
ACUTE COMPLICATION
CHRONIC COMPLICATION
Other COMPLICATIONS

 Diabetic nephropathy,scarring changes in

the kidney tissue, loss of small or
progressively larger amounts of protein in the
urine chronic kidney disease.
 Diabetic neuropathy numbness, tingling
and pain in the feet skin damage (due to
altered sensation)
 Together with vascular disease in the legs,
neuropathy diabetes-related foot problems
(such as diabetic foot ulcers) difficult to
treat require amputation.
 Recommended test for Diagnosing
Diabetes:

DIAGNOSIS
1. Fasting plasma glucose (FPG)- 8-14
hours
2. Random plasma glucose (RPG)
3. 2 hour Plasma glucose in 75 grams OGTT
Criteria for diagnosis of Diabetes
• FPG greater or equal to 126 mg/dl (7.0mmol/L)
• RPG greater or equal to 200mg/dL (11.1mmol/L) in patient
with classic symptoms of hypergylycemia.
• 2-h plasma glucose in 75-g OGTT greater or more than 200
mg/dL (11.1 mmol/L).
• Fasting plasma glucose (FPG) is the preferred test due to its wide availability, lower cost
and better reproducibility

• If the FPG falls with in the Impaired fasting glucose range (5.6-6.9 mmol/L) the 75-g OGTT
is recommended
• Symptomatic patients- random of FPG.
HBA1C
This blood test which doesn’t require fasting, indicated your average blood sugar for the
past 2 to 3 months. It measure the percentage of blood sugar attached to hemoglobin. The
higher the blood sugar level the more hg you'll have the sugar attached.
If initial test (s) are negative, when should repeat testing be done?

Repeat testing should ideally be done annually for Filipino with risk factors
owing to the significant prevalence and burden of diabetes in our country.

Among asymptomatic individuals with positive results, any of the three test
should be repeated within two weeks for confirmation.
 Risk of diabetes typically increase when you are:
Older age (45 years or older)
less active (sedentary life)
 Overweight or obese
RISK  Family history of diabetes
FACTOR  Pacific Islander, Asian, African, Hispanic,
Native American ancestry
Pre-diabetes
High blood pressure
High lipids (triglycerides and low HDL)
Diabetes during pregnancy or baby >9 lbs.
MEDICAL MANAGEMENT
OF DIABETES
MEDICAL
MANAGEMENT OF
DIABETES

1. Educate the patient

2.Diet
a. obese patient, weight reducing diet,
restrict calorie content
b. Ideal body weight- maintenance
diet
carbohydrate-55-65%
protein- 10-15 %
Fat- 20-30 %
MEDICAL
MANAGEMENT OF
DIABETES
Exercise -Aerobic exercise
- Walking, swimming, cycling -
Brisk walking – 30mins for 5
days / week –
- Evaluate CVS status before
advising exercise
MEDICAL MANAGEMENT OF
DIABETES
PRIMARY TREATMENT GOALS
• Achieving blood glucose levels that are as close to normal
• Prevention of diabetic complications.
• Normal body weight
• Avoidance of sustained hyperglycemia or symptomatic hypoglycemia
• Prevention of diabetic ketoacidosis and nonketotic acidosis
• Immediate detection and treatment of long-term diabetic
complications
Diabetes mellitus and its treatment

• Diet, exercise, weight control and medications are the mainstays of

diabetic care
• The primary medication used in type 1 diabetes management is insulin, on
which the type 1 diabetic patients are dependent for survival.
• Type 2 diabetic individuals frequently take oral medications although many
also use insulin to improve glycemic control.
SOME
DIABETES
MYTHS
People with diabetes should not exercise – not true!!
 Exercise is important for people with diabetes, as it is for everybody
else. 
 Dıabetes patients should discuss exercise with their doctors before starting
the exercise.
Fat people always develop type 2 diabetes eventually
 This is not true.Being overweight or obese raises the risk of becoming
diabetic, they are risk factors, but do not mean that an obese person will
definitely become diabetic.
Children can outgrow diabetes
 This is not true. Nearly all children with diabetes have type 1; insulin- producing beta cells in the
pancreas have been destroyed.
 These never come back. Children with type 1 diabetes will need to take insulin for the rest of their
lives, unless a cure is found one day.
 Only older people develop type 2 diabetes –
 Things are changing. A growing number of children and teenagers are developing type 2 diabetes
due to the explosion in childhood obesity rates, poor diet, and physical inactivity.
If you have diabetes you cannot eat chocolates or sweets
 People with diabetes can eat chocolates and sweets if they combine them with exercise or eat them
as part of a healthy meal.
Diabetics cannot eat bread, potatoes or pasta
 people with diabetes can eat starchy foods. However, they must keep an eye on the size of the
portions.
Diabetes diets are different from other people’s
 the diet doctors recommend healthy nutritions; healthy for everybody
 Meals should contain plenty of vegetables, fruit, whole grains, and they should be low in salt and
sugar, and saturated or trans fat.