Presentation by Dr A.Annapurna

Slide 1:

AN OVER VIEW OF DIABETES MELLITUS Guided for preparation of presentation and Presented by A.ANNAPURNA Associate Professor A.U College of Pharmaceutical Sciences, Andhra University Visakhapatnam – 530 003 Slides Prepared by SIVA REDDY CHALLA Associate Professor KVSR Siddhartha College of Pharmaceutical Sceinces, Vijayawada-520010 Email:sivareddypharma@gmail.com

Slide 2:

Diabetes mellitus is a group of syndromes characterized by Hyperglycemia, Altered metabolism of lipids, carbohydrates and proteins An increased risk of complications from vascular disease. The disorder is mainly due to relative or absolute deficiency of insulin. Diabetes can be divided into two groups based on their two groups based on their requirements for insulin 1 ) I D DM or Type I 2) NIDDM or Type I I DIABETES MELLITUS

Slide 3:

PREVALENCE OF DIABETES

Slide 4:

Insulin is a small protein consisting of two polypeptide chains that are connected by disulfide bonds. It is synthesized as a precursor protein proinsulin that undergoes proteolytic cleavage to form insulin and C peptide with both of which are secreted by β-cells of pancreas INSULIN

Slide 5:

Insulin secretion is regulated not only by blood glucose levels but also by other hormones and autonomic mediators . Secretion is most commonly triggered by high blood glucose levels which is taken up and phosphorylated in the β cells of pancreas. ATP levels rise and block K + channels leading membrane depolarization and an influx of Ca 2+ causes release of insulin. INSULIN SECRETION

Slide 6:

FACTORS REGULATING INSULIN SECRETION

Slide 7:

MECHANISM OF ACTION OF INSULIN The cellular response to insulin is mediated through a specific tetrameric α 2 β 2 glycoprotein receptor in the plasma membrane. The α units contain the insulin binding domains . β sub unit contains a tyrosine kinase.

THE SEQUENCE OF EVENTS OCCUR ARE :

THE SEQUENCE OF EVENTS OCCUR ARE Binding of insulin to α sub unit Conformational change occurs in the β sub unit Auto phosphorylation of tyrosine residues on the β sub unit Activation of protein tyrosine kinase Translocation of GLUT 4 from intracellular pool to plasma membrane Increased transport of glucose into cell by facilitated diffusion

EFFECTS OF INSULIN ON ITS TARGETS :

EFFECTS OF INSULIN ON ITS TARGETS

Slide 10:

GLYCEMIC CONTROL AND ITS VARIATIONS The final product of carbohydrate digestion in the blood is glucose . Blood glucose is distributed to various tissues of the body like brain, muscle, adipose tissue and liver etc and it may under various catabolic and anabolic changes. Normoglycemia : FBS 80-120 mg/100ml Hypoglycemia : below 60mg/100ml Hyperglycemia : more than 120mg/100ml

Hormones important for regulation of blood sugar level:

Hormones important for regulation of blood sugar level ↓blood sugar – Insulin Anti insulin hormones causing hyperglycemia Cortisol Glucagon Growth hormone Thyroxine Adrenaline Free fatty acids

DIFFERENT TYPES OF DIABETES MELLITUS:

DIFFERENT TYPES OF DIABETES MELLITUS Type I or I D D M Due to Viruses or chemical toxins or antibodies Over 10 -20% of the people are suffering with type-I Type II or NIDDM Due to reduced secretion of insulin or due to insulin resistance Over 80-90% of people suffering with type-II Endocrine diabetes due to Pancreatic diseases Cushing’s syndrome Acromegaly Hyperthyroidism Gestational diabetes Malnutritional diabetes Drug induced diabetes Diuretics, Corticosteroids Epinephrine, Nicotine Β2 agonists etc

Symptoms Of DM :

Symptoms Of DM Polyuria Polydypsia Polyphagia Weight loss Persistant hyperglycaemia Impaired glucose tolerance Elevated levels of HbA 1c Clinical symptoms

RISK FACTORS :

RISK FACTORS Genetic contribution Age > 45 years of age Obesity BMI > 45 ↑ TNF α ↑ Leptin Body fat distribution ↑FFA Visceral Truncal SC Raised waist hip ratio Men > 0.9 Women >0.85 Having relatives with diabetes Elevated triglycerides and cholesterol Stress Physical inactivity body weight glucose uptake Blood pressure ↑insulin resistance Smoking ↑adrenaline, noradrenaline ↑ cortisol ↑ GH ↑ACTH ↑ BP ↑ Platelet activity Alcohol Small amount ↑ blood sugar Excess alcohol produce hypoglycaemia because alcohol promotes hepatic uptake of glucose Various risk factors found to be associated with T2DM are :

Slide 15:

DIABETIC COMPLICATIONS Acute Diabetic Ketoacidosis Hyperglycemic non ketotic coma Hypoglycemia Symptoms Fatigue Headache Confusion Tremors Palpitations Sweating Apprehension Chronic Retinopathy Cataracts Nephropathy Cardiovascular diseases Neuropathy Periodontal diseases Gingivitis Periodontitis Psychosocial problems Anxiety Depression Impaired cognitive and intellectual functions

TREATMENT FOR Diabetes Mellitus:

TREATMENT FOR Diabetes Mellitus Pharmacological Insulin Oral hypoglycemic agents Non pharmacological Diet Exercise Yoga Stress management

Drugs used for the treatment of DM:

Drugs used for the treatment of DM Insulin : s.c or i.v admn Rapid acting Intermediate acting Prolonged acting Standard treatment V S Intensive treatment Twice daily administration 3 or more times 225- 275 mg/100ml 150mg/ml100ml HbA 1c 8-9 % HbA 1c 7%

Oral hypoglycemic agents :

Oral hypoglycemic agents Sulphonyl Ureas Tolbutamide Glipizide Gliclazide Glyburide Biguanides Metformin Thiozolidinediones Rosiglitazone Pioglitazone α –glucosidase inhibitors Acarbose, miglitol

Slide 19:

NON PHARMACOLOGICAL MANAGEMENT FOR DIABETES MELLITUS Fiber rich Low calorie Less fatty More complex carbohydrates Less refined sugars 20-25gm of raw onion daily Intake of cinnamon, garlic, karela, guarbeam Less sodium More leafy and fresh boiled vegetables or salads Sprouts DIET

NON PHARMACOLOGICAL MANAGEMENT FOR DIABETES MELLITUS:

NON PHARMACOLOGICAL MANAGEMENT FOR DIABETES MELLITUS Exercise Adequate physical activity Gardening Walking Jogging Sports ↓ body weight ↑glucose uptake by cells ↓ blood lipids

Yogic Treatment for Diabetes ::

Yogic Treatment for Diabetes : Following asanas have great effect on the pancreas and other glands, such as adrenal, thyroid and sex glands. The muscle and organs of abdominal area are fully activated due to these asanas. Because of this activation the condition and functioning of the pancreas is energized and strengthen. It increases the blood supply to various parts of body, improving insulin administration in the body, it also cures the constipation, and corrects the malfunctioning of stomach. Following pranayamas found useful in diabetes as Alternate nostril breathing has calming effect on nervous system, which reduces stress levels, helping in diabetes treatment Surya Namaskara Pavanamukta Asana Utthan Pada Asana ArdhaMatsyendr asana Bhujanga Asana Paschimothan Asana Salabha Asana Matsya Asana Bhramari Nadi shodhan Kunjal Kriya

Stress management:

Stress management Developing stress relief hobbies Relaxation practices Counselling Developing positive thinking Acceptance

PROPHYLAXIS:

PROPHYLAXIS BMI Waist/hip ratio Glucose tolerance test Age > 40 years Family history Stress level Regulating the diet habits Having adequate physical activity Avoiding smoking and alcohol ENGAGING THE BODY AND MIND IN FRUITFUL AND PRODUCTIVE WORK Assessing the pre-diabetic state by taking into consideration of the following

PRECAUTIONS TO BE TAKEN DURING THERAPY:

PRECAUTIONS TO BE TAKEN DURING THERAPY Regular check-ups Regular use of medicines Regular intake of meals Observation of Hypoglycemic attacks and immediate Attention - Sweets, snacks or sugar or fruit juices IV glucose IM or SC glucagon Carrying medicines and sweet snacks while away from home Strict adherence to the guidelines given by the physician

Slide 25:

“LET YOUR FOOD BE YOUR MEDICINE AND YOUR MEDICINE BE YOUR FOOD.EACH ONE OF THE SUBSTANCES OF A PERSON’S DIET ACTS UPON HIS BODY AND CHANGES IT IN SOME WAY AND UPON THE CHANGES HIS WHOLE LIFE DEPENDS” HIPPOCRATES

Slide 26:

THANK YOU