Diabetes Mellitus

• What is diabetes?
• Diabetes is a group of metabolic diseases
characterized by increased levels of glucose in
the blood (hyperglycemia).
• it results from defects in insulin secretion, insulin
action, or both
• The major sources of the glucose that circulates in
the blood are through the absorption of ingested
food in the gastrointestinal tract and formation of
glucose by the liver from food substances.

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1. Glucose metabolism in the absorptive
state (just after a meal)

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• When a person eats a meal, insulin secretion increases
and moves glucose from the blood into body cells,
muscle, liver, and fat cells.
• In those cells, insulin has the following actions:
– Transports and metabolizes glucose for energy
– Stimulates storage of glucose in the liver and muscle (in the
form of glycogen)
– Signals the liver to stop the release of glucose
– Enhances storage of dietary fat in adipose tissue
– Accelerates transport of amino acids into cells
– Inhibits the breakdown of stored glucose, protein, and fat
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2. Glucose metabolism in the post absorptive state (fasting):

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• During fasting periods (between meals and overnight),
the pancreas continuously releases a small amount of
insulin (basal insulin);
• another pancreatic hormone called glucagon (secreted
by the alpha cells of the islets of Langerhans) is released
when blood glucose levels decrease, which stimulates
the liver to release stored glucose through:
– Glycogenolysis: the liver produces glucose through the
breakdown of glycogen ().
– Gluconeogenesis: the liver forms glucose from the breakdown
of noncarbohydrate substances, including amino acids ().

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 Classification of DM
– type 1 diabetes,
– type 2 diabetes, &
– gestational diabetes

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 Type 1 diabetes
– Affects 10% of world population with diabetes
– Common at child age and young people(but at any age)
– It is characterized by the destruction of the pancreatic
beta cells. Combined genetic, immunologic, and
environmental (e.g., viral) factors contribute to beta-cell
destruction.
– This results in decreased insulin production, increased
glucose production by the liver, and fasting
hyperglycemia.
– In addition, glucose derived from food cannot be stored
in the liver but instead remains in the bloodstream and
contributes to postprandial (after meals)
hyperglycemia.
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• Type 2 diabetes:
– Affects 90% of world population with diabetes
– Common at old age(>30 years old)
– the pancreas still produces insulin, though the amount reduces over
time.
– The main problem is that the body cells become increasingly
resistant to the action of insulin
• Gestational diabetes mellitus
– Is glucose intolerance during pregnancy.
– it results from the secretion of placental hormones, which causes
insulin resistance.
– After delivery, blood glucose levels in women with GDM usually
return to normal or later on develop type 2 DM.

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 Risk factors for DM
• Type 1 DM
– Family history of diabetes (Genetics factors)
– Environmental factors – viral infections
– Autoimmune reaction
• Type 2 DM
– Being overweight or obese
– Lack of exercise
• Gestational diabetes mellitus
– Overweight
– Genetics – family history
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PATHOPHYSIOLOGY T1DM

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T2DM

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 Clinical manifestations
• Polyuria or increased urination
• Polydipsia or increased thirst
• Polyphagia or increased appetite
• Fatigue and weakness
• Sudden vision changes
• Tingling or numbness in hands or feet
• Dry skin
• Skin lesions or wounds that are slow to heal
• Recurrent infections
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 Assessment and Diagnostic Findings

• Criteria for the Diagnosis of Diabetes

1. Symptoms of diabetes plus Random plasma glucose
concentration > 200 mg/dL (11.1 mmol/L).
OR
2. Fasting plasma glucose > 126 mg/dL (7.0 mmol/L).
Fasting is defined as no caloric intake for at least 8 hrs.
OR

3. Two-hour postload glucose > 200 mg/dL (11.1 mmol/L)

during an oral glucose tolerance test.
OR
4. Glycated hemoglobin (HgbA1C) ≥6.5%
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 Complications
• If diabetes mellitus is left untreated, several
complications may arise from the disease
• Acute complications:
– Hypoglycemia
– Diabetic ketoacidosis(DKA)
– Hyperglycemic hyperosmolar Non-ketotic syndrome
• Chronic complications:
– retinopathy (damage to small blood vessels that nourish
the retina),
– nephropathy (damage to kidney cells), and
– neuropathy (damage to nerve cells).
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 Hypoglycemia Hyperglycemia
Ketoacidosis/DKA
Due to: Low blood glucose Presence of ketones

Time of Fast – within seconds Slow - within hours or days

onset:
Causes: Too much insulin Insufficient insulin
Too little food Missed insulin dose(s)
Too much exercise without food Infections/illness
Missing or delayed meals/snacks Stress response
Stress/overexcitement in young undiagnosed and untreated
children diabetes
Blood Low (less than 60 mg/dL) High (greater than 200
glucose: mg/dL)
Ketones: None in urine or blood Moderate/large in urine or
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blood
Hypoglycemia …

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DKA

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 Hyperglycemic Hyperosmolar
Syndrome (HHS)
• Elevated blood glucose levels >600 mg/dL, frequently
exceeds 1000 mg/dL
• Elevated serum osmolality (over 320 mOsm/kg H2O)
• Little or no ketone accumulation
• Severe dehydration (dry mucous membranes, poor skin
turgor)
• Postural hypotension accompanies the dehydration
• Altered mental status(e.g., alteration of consciousness,
seizures, hemiparesis)

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 Prevention
• Appropriate management of lifestyle can effectively
prevent the development of type 2 diabetes mellitus:
 Achieve and maintain a weight reduction of ≥7% of initial
body weight.
 Have a healthy, low-calorie, low-fat diet.
 Engage in physical activity of moderate intensity for at
least 150 minutes a week.
 It also included behavior modification strategies that
can help patients achieve their weight reduction goals
and participate in exercise.
 Taking metformin

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 Self-care and diet for someone with diabetes
• How can you support the people with diagnosed diabetes in your
community?
• You should advise Everyone with diabetes to :
– take their medication regularly
– attend regular medical checkups
– be aware of possible wound infection if they hurt themselves
and seek urgent treatment if this occurs
– always wear shoes that fit correctly; wounds, blisters or sores
on the feet can lead to tissue damage that is difficult to heal
– have an eye test once every year to check for early signs of
eye damage
– always include exercise as a routine part of their lifestyle
– attend health education classes (if they are available) for
people with diabetes to learn about self-care.
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 Maintaining a healthy diet
Recommended diet in diabetes

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