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DIABETES MELLITUS

DIABETES MELLITUS. DR. J. PRATHEEBA DEVI. Definition. Diabetes is a metabolic disorder characterized by raised levels of glucose in the blood. Epedemiology. India has around 33 million people with Diabetis and 19% of the worlds diabetic population is from India. ANATOMY. Anatomy.

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DIABETES MELLITUS

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  1. DIABETES MELLITUS DR. J. PRATHEEBA DEVI

  2. Definition Diabetes is a metabolic disorder characterized by raised levels of glucose in the blood.

  3. Epedemiology • India has around 33 million people with Diabetis and 19% of the worlds diabetic population is from India.

  4. ANATOMY

  5. Anatomy

  6. Insulin Action insulin is a key • Insulin is required for glucose to enter the cells of the body where it is utilised it is as if insulin is a key which opens doors of the cells to allow glucose to enter. When insulin is absent or defective glucose cannot enter the cells and remains in blood in high amounts.

  7. Types of diabetes Type 1 (juvenile diabetes) • Pancreas does not produce insulin. Occurs in young adults and children Type 2 diabetes • Pancreas does not produce enough insulin or its action is prevented Gestational diabetes • Occurs during pregnancy

  8. Hyperglycemia Symptoms • Frequent need to urinate • Extreme thirst • Dry skin or mouth • Hunger • Blurred vision • Drowsiness • Slow healing of wounds or infections

  9. Risk factors • Obesity • Family history • Sedentary life style • Hypertension

  10. Urine glucose test • Urine glucose monitoring is a viable, cost-effective way of monitoring diabetes control, especially when the cost of blood glucose monitoring makes it inaccessible or when people do not wish to perform blood testing.

  11. Urine glucose strips

  12. Blood sugar • Fasting blood sugar (FBS) measures blood glucose after fasting for at least 8 hours.. • 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after meal. • Random blood sugar (RBS) measures blood glucose regardless of when we eat.

  13. Blood sugar monitoring

  14. NORMAL VALUES • Fasting -normal -70 -100 mgs% -diabetic ->126 mgs % • Post prandial –normal-<140 mgs % diabetic >200 mgs % Values between these normal values is said to be impaired diabetic

  15. Oral glucose tolerance test • The oral glucose tolerance test (OGTT) measures the body's ability to use glucose, that is the body's main source of energy. An OGTT can be used to diagnose prediabetes and diabetes. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes

  16. procedure • Eat a balanced diet that contains at least 150 to 200 grams (g) of carbohydrate per day for 3 days before the test. Fruits, breads, cereals, grains, rice,, and starchy vegetables such as potatoes, beans, and corn are good sources of carbohydrate. • Do not eat, drink, smoke, or exercise strenuously for at least 8 hours before your first blood sample is taken

  17. For the standard glucose tolerance test, you will drink 75 g to 100 g; pregnant women drink 100 g of glucose. • Blood samples will be collected at timed intervals of 1, 2, and 3 hours after you drink the glucose. Blood samples may also be taken as soon as 30 minutes to more than 3 hours after you drink the glucose.

  18. Normal values • Glucose tolerance diagnostic test (for gestational diabetes)100 g of glucose Fasting:Less than 95 mg/dL or 5.2 mmol/L1-hour:Less than 180 mg/dL or 10.0 mmol/L2-hour:Less than 155 mg/dL or 8.6 mmol/L3-hour:Less than 140 mg/dL or 7.7 mmol/L  • Glucose tolerance screening test (75 g of glucose) 2-hour:Less than 140 mg/dL or 7.8 mmol/LHigh values

  19. Glycosylated haemoglobin • Clinically, hemoglobin A1c values are used most frequently to assess glucose control in insulin-dependent diabetics whose glucose levels are very labile and in whom single blood glucose measurements may not accurately reflect the level of control present over the preceding few weeks.

  20. Complications • Cardiovascular • Renal • Ocular • Neurological • Dental • Dermatological • Foot amputation

  21. Diabetic retinopathy

  22. Diabetic nephropathy In diabetics there is damage to the filters and there is proteinuria

  23. Diabetic foot

  24. Diabetic neuropathy

  25. Diabetic ketoacidosis

  26. Management • Diet • Exercise • Drugs

  27. Diabetic diet

  28. Diet schedule

  29. Walking

  30. Oral Anti Diabetic Drugs • Insulin secretagogues sulfonyl ureas • Insulin sensitizers metformin • Inhibitors of GI absorption @_Glucosidaseinhibitors

  31. INSULIN • Rapid acting_fast insulin -insulin aspart lispro • Short acting –actrapid • Intermediate acting-protophane,HUMULIN NPH • Mixed –novomix 30 mixtard 30/70

  32. Methods of insulin injection

  33. Novo pen

  34. Symptoms Tiredness Nervousness Headache Sweating Tachycardia Blurred vision Complications of diabetis hypoglycemia

  35. Hypoglycemia management • If patient is conscious –oral glucose is preferred • If unconscious -50 ml of 25 % dextrose followed by a maintainence dose of 10%dextrose

  36. Thank You

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