Diabetes mellitus

Diabetes mellitus : 

Diabetes mellitus It is a life style

Insulin : 

Insulin

Insulin : 

Insulin Insulin is a hormone that has extensive effects on metabolism and other body functions, such as vascular compliance. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle, and stopping use of fat as an energy source. Produced by β-cells in the islets of Langerhans

Physiological effects : 

Physiological effects The actions of insulin on cells include: Increased glycogen synthesis Increased fatty acid synthesis Increased esterification of fatty acids Decreased proteolysis Decreased lipolysis Decreased gluconeogenesis Decreased autophagy Increased amino acid uptake Increased potassium uptake Arterial muscle Increase in the secretion of hydrochloric acid by Parietal cells in the stomach.

Mechanism of insulin Release : 

Mechanism of insulin Release

Relation between Glucose and Insulin : 

Relation between Glucose and Insulin

Diabetes millets : 

Diabetes millets

Diabetes mellitus : 

Diabetes mellitus Diabetes mellitus – general term referring to all states characterized by hyperglycemia.

Types : 

Types

Types : 

Types Type 1: Results from the body's failure to produce insulin. Type 2: Results from Insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with relative insulin deficiency. Many people destined to develop type 2 diabetes spend many years in a state of Pre-diabetes. Pre-diabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Gestational diabetes: Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women. It may precede development of type 2 (or rarely type 1).

Insulin resistance : 

Insulin resistance Insulin resistance (IR) is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. Insulin resistance in fat cells reduces the effects of insulin and results in elevated hydrolysis of stored triglycerides Increased mobilization of stored lipids in these cells elevates free fatty acids in the blood plasma Insulin resistance in muscle cells reduces glucose uptake (and so local storage of glucose as glycogen) Insulin resistance in liver cells results in impaired glycogen synthesis and a failure to suppress glucose production

Signs & Symptoms : 

Signs & Symptoms

Signs and Symptoms : 

Signs and Symptoms Polyuria (excessive urination) Polydipsia (excessive thirst ) Polyphagia (strong desire to eat) Weight loss Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes symptoms usually develop much more slowly and may be subtle or completely absent

Later Symptoms : 

Later Symptoms Fatigue Dry skin Abnormal high frequency of infection Feet Ulceration Loss of sensibility in inferior extremities Erectile dysfunction Slow Healing of wounds or sores Changes in vision

Causes : 

Causes

Causes : 

Causes Type1 Type 1 diabetes appears to be triggered by some (mainly viral) infections. even in those who have inherited the susceptibility, Type 1 diabetes mellitus seems to require an environmental trigger. Type2 There is a stronger inheritance pattern for type 2 diabetes. Those with first-degree relatives with type 2 have a much higher risk of developing type 2, increasing with the number of those relatives. About 25% of those with the disease have a family history of diabetes.

Diagnosis : 

Diagnosis

Blood glucose laboratory tests : 

Blood glucose laboratory tests fasting blood sugar (ie, glucose) test (FBS) urine glucose test two-hr postprandial blood sugar test (2-h PPBS) oral glucose tolerance test (OGTT) intravenous glucose tolerance test (IVGTT) glycosylated hemoglobin (HbA1C) self-monitoring of glucose level via patient testing

Fasting blood sugar (FBS) : 

Fasting blood sugar (FBS) Simple blood test, called a fasting plasma glucose test, does the trick. The test measures the level of sugar in your blood after you have been fasting for at least 8 hours. Normal fasting blood glucose is between 70 and 100 mg/dL. If two separate blood tests show this level is greater than or equal to 126 mg/dL, type 2 diabetes is diagnosed.

Prediabetes : 

Prediabetes Patients with fasting glucose levels from 100 to 125 mg/dL are considered to have impaired fasting glucose. Patients with plasma glucose at or above 140 mg/dL, but not over 200, are considered to have impaired glucose tolerance. Of these two pre-diabetic states. the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease. lifestyle changes and medication can help prevent the progression to type 2 diabetes.

Screening : 

Screening

Screening : 

Screening Many medical conditions are associated with diabetes and warrant screening Testosterone deficiency High blood pressure Elevated cholesterol levels Coronary artery disease Past gestational diabetes Polycystic ovary syndrome Chronic pancreatitis Fatty liver Cystic fibrosis The risk of diabetes is higher with chronic use of several medications long term corticosteroids some chemotherapy agents (especially L-asparaginase) some of the antipsychotics and mood stabilizers

Risk Factors : 

Risk Factors

Risk Factors You Can Control : 

Risk Factors You Can Control Your habits and lifestyle can affect your odds of developing type 2 diabetes. Factors that boost your risk include: Being overweight, defined as a body mass index (BMI) over 25. Abnormal cholesterol and blood fats, such as good cholesterol (HDL) lower than 35 mg/dL or a triglyceride level over 250 mg/dL. High blood pressure, greater than 140 /90 in adults. Sedentary lifestyle.

Risk Factors You Can't Control : 

Risk Factors You Can't Control Other risk factors are out of your control, including: Race or ethnicity: Hispanics, blacks, Native Americans, and Asians have a higher than average risk. Family history of diabetes: Having a parent or sibling with diabetes boosts your risk. Age: Being 30 and older increases your risk of type 2 diabetes. The more risk factors your have, the greater your odds of developing type 2 diabetes.

Prevention Type 2 Diabetes : 

Prevention Type 2 Diabetes Study group participants whose "physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes. Eat a healthy diet Exercise for 30 minutes 5 days a week Maintain a healthy weight Avoid smoking Avoid alcohol consumption Talk to your doctor about being screened for prediabetes

Management : 

Management

Management : 

Management Dietetic support Sensible exercise Self monitoring of blood glucose, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds Various oral diabetic drugs (type 2 only) Insulin use (type 1 and for type 2 not responding to oral medications, mostly those with extended duration diabetes) Wearing diabetic socks & shoes If necessary, taking any of several drugs to reduce blood pressure

Insulin : 

Insulin Many people with type 2 diabetes eventually develop "beta-cell failure." This means the cells in the pancreas no longer produce insulin in response to high blood sugar levels. In this case, insulin therapy – injections or an insulin pump – must become part of the daily routine.

Insulin pump : 

Insulin pump

Complications : 

Complications

Complications : 

Complications Acute complications Chronic complications

Acute complications : 

Acute complications DKA HNS Hypoglycemia

Diabetic ketoacidosis (DKA) : 

Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency. On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply. Abdominal pain is common and may be severe. May progress to coma. Ketoacidosis can easily become severe enough to cause hypotension, shock, and death. Urine analysis will reveal significant levels of ketone bodies (which have exceeded their renal threshold blood levels to appear in the urine, often before other overt symptoms).

Hyperosmolar nonketotic state (HNS) : 

Hyperosmolar nonketotic state (HNS) Is an acute complication sharing many symptoms with DKA, but an entirely different origin and different treatment. The osmotic effect of high glucose levels, combined with the loss of water, will eventually lead to dehydration. The body's cells become progressively dehydrated as water is taken from them and excreted. Urgent medical treatment is necessary, commonly beginning with fluid volume replacement. Lethargy may ultimately progress to a coma, though this is more common in type 2 diabetes than type 1

Hypoglycemia : 

Hypoglycemia Is an acute complication of several diabetes treatments. It is rare otherwise, either in diabetic or non-diabetic patients. The patient may become agitated, sweaty, weak. Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death. In patients with diabetes, this may be caused by several factors, such as too much or incorrectly timed insulin, too much or incorrectly timed exercise (exercise decreases insulin requirements) or not enough food (specifically glucose containing carbohydrates)

Chronic complications : 

Chronic complications Microvascular diseases (due to damage to small blood vessels) Macrovascular diseases (due to damage to the arteries)

Microvascular diseases : 

Microvascular diseases Diabetic cardiomyopathy, damage to the heart, leading to diastolic dysfunction and eventually heart failure. Diabetic nephropathy, damage to the kidney which can lead to chronic renal failure Diabetic neuropathy, abnormal and decreased sensation Diabetic retinopathy, growth of friable and poor-quality new blood vessels in the retina as well as macular edema (swelling of the macula), which can lead to severe vision loss or blindness

Macrovascular diseases : 

Macrovascular diseases Coronary artery disease, leading to angina or myocardial infarction ("heart attack") Diabetic myonecrosis ('muscle wasting') Peripheral vascular disease, which contributes to intermittent claudication Stroke Diabetic foot: often due to a combination of sensory neuropathy (numbness or insensitivity) and vascular damage, increases rates of skin ulcers and infection and, in serious cases, necrosis and gangrene.

Screening for Complications : 

Screening for Complications People with a confirmed diagnosis of diabetes are tested routinely for complications. yearly urine testing for microalbuminuria examination of the retina of the eye for retinopathy.

Geographical data : 

Geographical data

Prevalence of diabetes worldwide : 

Prevalence of diabetes worldwide

Disability-adjusted life year for diabetes mellitus : 

Disability-adjusted life year for diabetes mellitus

Message : 

Message

Non Diabetic : 

Non Diabetic

Facts : 

Facts The American Diabetes Association cite the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that 1 in 3 Americans born after 2000 will develop diabetes in their lifetime. International Diabetes Federation estimates that there are currently about 194 million people aged 20 to 79 with diabetes worldwide and that this will increase to 333 million by 2025.  Around 3.2 million deaths every year are attributable to complications of diabetes; six deaths every minute. It has been termed "America's largest healthcare epidemic," affecting more than 57 million Americans. Prediabetes is also referred to as borderline diabetes, impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG).

Prevention Type 2 Diabetes : 

Prevention Type 2 Diabetes Study group participants whose "physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes. Eat a healthy diet Exercise for 30 minutes 5 days a week Maintain a healthy weight Avoid smoking Avoid alcohol consumption Talk to your doctor about being screened for prediabetes

Diabetes Patient : 

Diabetes Patient

Facts : 

Facts Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world. Around 3.2 million deaths every year are attributable to complications of diabetes; six deaths every minute. Some of those with type 2 diabetes who exercise regularly, lose weight, and eat healthy diets may be able to keep some of the disease or some of the effects of the disease in 'remission.‘ 60% of diabetics who carefully control their blood sugar avoid developing neuropathy

Management : 

Management Dietetic support Sensible exercise Self monitoring of blood glucose, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds Various oral diabetic drugs (type 2 only) Insulin use (type 1 and for type 2 not responding to oral medications, mostly those with extended duration diabetes) Wearing diabetic socks & shoes If necessary, taking any of several drugs to reduce blood pressure

Oral Diabetes Medications : 

Oral Diabetes Medications

What Types of Diabetes Pills Are Available? : 

What Types of Diabetes Pills Are Available? Diabetes pills are grouped in categories based on type. There are several categories of diabetes pills -- each works differently. Sulfonylureas. Biguanides. Thiazolidinediones. Alpha-glucosidase inhibitors, Meglitinides, Dipeptidyl peptidase IV (DPP-IV) inhibitors Combination therapy.

Sulfonylureas. : 

Sulfonylureas. Sulfonylureas. These diabetes pills lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent and shorter-acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, and Amaryl. These drugs can cause a decrease in the hemoglobin A1c ( HbA1c) of up to 1%-2%.

Biguanides : 

Biguanides Biguanides. These diabetes pills improve insulin's ability to move sugar into cells especially into the muscle cells. They also prevent the liver from releasing stored sugar. Biguanides should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients. Biguanides can decrease the HbA1c 1%-2%. An example includes metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza).

Thiazolidinediones : 

Thiazolidinediones These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Actos and Avandia are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications. These drugs may take a few weeks before they have an effect in lowering blood sugar. They should be used with caution in people with heart failure. Your doctor will do periodic blood testing of your liver function when using this diabetes medicine.

Alpha-glucosidase inhibitors : 

Alpha-glucosidase inhibitors Alpha-glucosidase inhibitors, including Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.

Meglitinides : 

Meglitinides Meglitinides, including Prandin and Starlix. These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.

Dipeptidyl peptidase IV (DPP-IV) inhibitors : 

Dipeptidyl peptidase IV (DPP-IV) inhibitors Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia. The DPP-IV inhibitors (Januvia) work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain. The medication may be taken alone or with other medications such as metformin.

Combination therapy : 

Combination therapy Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.

Healthy cooking : 

Healthy cooking Cook of boil meat instead of frying Take the skin of chicken before cooking Use less salt and sugar when preparing food Avoid fat Use fresh or frozen fruits and vegetables when eating or between meals Use low fat cheese instead of regular cheese Use low fat milk Drink fruit juice instead of powder juice

Thank you : 

Thank you