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| Date post: | 13-Aug-2015 |
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What is DM Causes of DM Risk factors Types of DM DM trends- Global and BD Sign/symptom Complications Management – Prevention, Treatment, Care BD- BERDAM hospital and asso
Diabetes Mellitus
What is
Diabetes mellitus is a chronic condition that is characterized by raised blood glucose levels (Hyperglycemia) from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
The development of diabetes is projected to reach pandemic proportions over the next10-20 years.
International Diabetes Federation (IDF) data indicate that by the year 2025, the number of people affected will reach 333 million –90% of these people will have Type 2 diabetes.
In most Western societies, the overall prevalence has reached 4-6%, and is as high as 10-12% among 60-70-year-old people.
The annual health costs caused by diabetes and its complications account for around 6-12% of all health-care expenditure.
Blood sugar and health
Sugar (glucose) is an important source of energy
What is eaten is absorbed into the blood
Insulin is producedby the pancreas whenblood sugar is high
Insulin keeps bloodsugar level withinthe normal range for health
Islet of Langerhans
Insulinb-cells
Pancreas contains insulin-making cells in “islets”
Carbohydrate Digestion
Diabetes in a ‘nutshell’
Insufficient insulin to meet the body’s needs
Either a complete lack (type 1) or relative lack
(type 2) of insulin
Results in raised blood glucose levels
Untreated diabetes results in short-term
symptoms and serious long-term complications
Treatment aims to keep blood glucose levels as
close to the normal range as safely possible
Symptoms of Diabetes
People with diabetes often have typical complaints (symptoms):
Thirst and frequent drinking
More frequent urination, particularly at night
Unexplained weight loss
Fatigue
Blurred vision
Frequent infections : skin, genital
Risk Factors
Family history of Diabetes Over weight Unhealthy diet Physical inactivity Gestational Diabetes Genetically (type 1 diabetes,
pre-diabetes, gestational) Can develop due to poor diet &
inadequate exercise (pre-diabetes, type 2 diabetes, gestational diabetes)
Complications
Cardiovascular disease: (Heart attack, stroke)
Kidney disease (diabetic nephropathy)
Nerve disease (diabetic neuropathy)
Eye disease (diabetic retinopathy)
Pregnancy complications
Source: http://www.idf.org
Types of diabetes
There are 4 major types of diabetes:1. Type 1 Diabetes - Childhood
2. Type 2 Diabetes - Adulthood
3. Gestational Diabetes - Pregnancy
4. Others- Pre-diabetic -
Types of Diabetes…..
1) Type 1 Diabetesusually diagnosed in childhoodaffected by hereditarysometimes there are no symptomsImperative to inject insulin daily because the body makes little or no insulinfrequently called the ‘insulin-needed’ groupPatients with type 1 diabetes need insulin daily to survive
Types of Diabetes…..
2)Type 2 Diabetes
most common usually occurs in adulthood
but diagnosis is increasing in the younger generation
affects many children Body is incapable of
responding to insulin Rates rising due to increased
obesity and failure to exercise and eat healthy
Types of Diabetes…..
3) Gestational Diabetes
blood sugar levels are high during pregnancy in women
Women who give birth to children over 9 lbs.
high risk of type 2 diabetes and cardiovascular disease
Types of Diabetes…..
4) Pre-diabetes Starts with unhealthy eating
habits & inadequate exercise At least 79 million people are
diagnosed with pre-diabetes each year
above average blood glucose levels, not high enough to be classified under type 1 or type 2 diabetes
long-term damage to body, including heart and circulatory system
Diabetes is a huge and growing problem, and the costs to society are high and escalating
Globally 382 million people have diabetes By 2035, this number will rise to 592 million
In Bangladesh 8.4 million people had diabetes in 2013
Source: http://www.idf.org
Number of People with Undiagnosed with Diabetes
Source: http://www.idf.org
Proportion of Death due to Diabetes
Source: http://www.idf.org
Socio-economic status with diabetes and pre-diabetes in Bangladesh, 2011
Source: Akter, S., Rahman, M. M., Abe, S. K., & Sultana, P. (2014). Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey.
Educational level of the people with diabetes and pre-diabetes in Bangladesh, 2011
Source: Akter, S., Rahman, M. M., Abe, S. K., & Sultana, P. (2014). Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey.
Rural-Urban ration of diabetes prevalence in Bangladesh during the
year 2011
Source: Akter, S., Rahman, M. M., Abe, S. K., & Sultana, P. (2014). Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey.
Differences between type-1 and type-2 Diabetes Mellitus
Type 1 Young age Normal BMI, not obese No immediate family
history Short duration of
symptoms (weeks) Can present with
diabetic coma (diabetic ketoacidosis)
Insulin required
Type 2 Middle aged, elderly Usually
overweight/obese Family history usual Symptoms may be
present for months/years
Do not present with diabetic coma
Insulin not necessarily required
Previous diabetes in pregnancy
These differences are not absolute
Management of Diabetes
Follow a Healthy Meal Plan
Take your Medication
Regular Exercise
Test blood sugarRegularly
Management of DMManagement of DM
The major components of the treatment of diabetes are:
PreventionPrevention starts with a
better lifestyle eating healthier being active taking medicine as directed taking care of your body check feet to make sure there is no
nerve damage or interruption of blood flow
take care of teeth control blood pressure and high no smoking! check in with your doctor at least
once a month have your blood sugar checked along
with weight, blood pressure, and feelings
Check blood sugar levels daily by using home monitoring device
At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.
There is a lot of evidence that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes.
Prevention of Diabetes
Management of Diabetes Mellitus
Nutrition Blood glucoseMedications Physical activity/exerciseBehavior modification
Medical Nutrition Therapy
Primary Goal – improve metabolic control
Blood glucose Lipid (cholesterol) levels
Medical Nutrition Therapy
Maintain short and long term body weight
Reach and maintain normal growth and development
Prevent or treat complications Improve and maintain nutritional
status Provide optimal nutrition for
pregnancy
Nutritional Management for Type I Diabetes
Consistency and timing of meals
Timing of insulinMonitor blood glucose regularly
Nutritional Management for Type II Diabetes
Weight loss Smaller meals and snacks Physical activity Monitor blood glucose and
medications
Person living with Diabetes
Action of Insulin on the Cell Metabolism
Action of Insulin on Carbohydrate, Protein and Fat Metabolism
Carbohydrate Facilitates the transport of glucose
into muscle and adipose cells Facilitates the conversion of glucose
to glycogen for storage in the liver and muscle.
Decreases the breakdown and release of glucose from glycogen by the liver
Action of Insulin on Carbohydrate, Protein and Fat Metabolism
Protein Stimulates protein synthesis Inhibits protein breakdown; diminishes
gluconeogenesis.
Action of Insulin on Carbohydrate, Protein and Fat Metabolism
Fat Stimulates lipogenesis- the
transport of triglycerides to adipose tissue
Inhibits lipolysis – prevents excessive production of ketones or ketoacidosis
Type I Diabetes
Low or absent endogenous insulin Dependent on exogenous insulin for
life Onset generally < 30 years 5-10% of cases of diabetes Onset sudden
Symptoms: 3 P’s: polyuria, polydypsia, polyphagia
Type I Diabetes Cell
Type II Diabetes
Insulin levels may be normal, elevated or depressed Characterized by insulin resistance, diminished tissue sensitivity to insulin, and impaired beta cell function (delayed or
inadequate insulin release) Often occurs >40 years
Type II Diabetes
Type II Diabetes
Risk factors: family history, sedentary lifestyle, obesity and aging
Controlled by weight loss, oral hypoglycemic agents and or insulin
