A.

First Speaker
Definition
Diabetes mellitus is a disorder in which the level of blood glucose is
persistently raised above the normal range. Diabetes mellitus is a
syndrome with disordered metabolism and inappropriate hyperglycemia
due to either a deficiency of insulin secretion or to a combination of
insulin resistance and inadequate insulin secretion to compensate.

Classification of Diabetes Mellitus

There are several different types of diabetes mellitus, they may differ in
cause, clinical course, and treatment. The major classifications of diabetes
are:

1. Type 1 diabetes (insulin dependent diabetes mellitus) is caused by

B-cell destruction, usually leading to absolute insulin deficiency
a) Immune mediated
b) Idiopathic

2. Type 2 diabetes (previously referred to as non insulin dependent

diabetes mellitus) ranges from those with predominant insulin
resistance associated with relative insulin deficiency, to those with
a predominantly insulin secretory defect with insulin resistance

B. Second Speaker

Causes for Diabetes Mellitus

The cause of both type 1 and type 2 diabetes remains unknown, although
genetic factors may play a role. Diabetes mellitus results from insulin
deficiency or resistance. Insulin transports glucose into the cell for use as
energy and storage as glycogen. It also stimulates protein synthesis and
free fatty acid storage. Insulin deficiency or resistance compromises the
body tissues access to essential nutrients for fuel and storage. The
resulting hyperglycemia can damage many of the bodys organs and
tissues.

Type 1 diabetes is due to pancreatic islet B cell destruction predominantly

by an autoimmune process, and these patients are prone to ketoacidosis.
Type 2 diabetes is the more prevalent form and results from insulin
resistance with a defect in compensatory insulin secretion
Insulin, a hormone produced by the pancreas, controls the level of glucose
in the blood by regulating the production and storage of glucose.
 Risk Factors For Diabetes Mellitus Include:
1. Obesity.
2. Physiologic or emotional stress, which can cause prolonged elevation
of stress hormone levels.
3. Pregnancy, which causes weight gain and increases levels of estrogen
and placental hormones, which antagonize insulin
4. Metabolic syndrome, which is considered a precursor to the
development of type 2 diabetes mellitus.
5. Some medications that can antagonize the effects of insulin, including
thiazide diuretics, adrenal corticosteroids, and hormonal contraceptives

C. Third Speaker

DIABETES MANAGEMENT
The main goal of diabetes treatment is to normalize insulin activity and
blood glucose levels to reduce the development of vascular and
neuropathic complications.
a. Drugs for Treating Hyperglycemia
The drugs for treating type 2 diabetes fall into several categories:
1) Drugs that primarily stimulate insulin secretion by binding to the
sulfonylurea receptor. Sulfonylureas remain the most widely
prescribed drugs for treating hyperglycemia. The meglitinide
analog repaglinide and the D-phenylalanine derivative nateglinide
also bind the sulfonylurea receptor and stimulate insulin secretion.
2) Drugs that alter insulin action: Metformin works in the liver. The
thiazolidinediones appear to have their main effect on skeletal
muscle and adipose tissue.
3) Drugs that principally affect absorption of glucose: The
glucosidase inhibitors acarbose and miglitol are such currently
available drugs.
4) Drugs that mimic incretin effect or prolong incretin action:
Exenatide and DPP 1V inhibitors fall into this category.
5) Other: Pramlintide lowers glucose by suppressing glucagon and
slowing gastric emptying.
Insulin
Insulin is indicated for type 1 diabetes as well as for type 2 diabetic
patients with insulinopenia whose hyperglycemia does not respond to diet
therapy either alone or combined with other hypoglycemic drugs.
Therefore, the therapeutic goal for diabetes management is to achieve
normal blood glucose levels (euglycemia) without hypoglycemia and
without seriously disrupting the patients usual lifestyle and activity.

There are five components of diabetes management

Nutritional management
Exercise
Monitoring
Pharmacologic therapy
Education