GNIP

Presented by: Guided By:-

Sarabjeet kaur Shamsherjit kaur
8th sem
DIABETES MELLITUS
Diabetes mellitus (DM) consists of a group of
syndromes characterized by hyperglycemia; altered
metabolism of lipids, carbohydrates, and proteins.
It results from defects in insulin secretion, insulin
sensitivity, or both.
TYPES OF DIABETES MELLITUS
 Type 1: Insulin dependent; juvenile on set, caused by
an absolute deficiency of insulin.

Type 2: Non-insulin dependant diabetes mellitus,

defined by the presence of insulin resistance with an
inadequate compensatory increase in insulin secretion.

Gestational diabetes: Women who develop diabetes

due to the stress of pregnancy
Symptoms
 Polyphagia
Polydypsia
Polyurea
Weight loss
Continous hunger
Fatigue
Dry skin
Frequent infection
Lack of energy
RISK FACTORS FOR DIABETES
Age
Overweight(BMI>25)
Hypertension
Abnormal lipid levels
Family history of diabetes
Race
History of gestational diabetes
Sign of insulin resistance
CRITERIA FOR THE DIAGNOSIS OF DIABETES
MELLITUS
Symptoms of diabetes plus a casual plasma glucose
concentration greater than or equal to 200 mg/dl (11.1
mmol/L).
Or
Fasting plasma glucose greater than or equal to 126
mg/dl (7.0 mmol/L). Fasting is defined as no caloric
intake for at lest 8 hours.
Or
Two-hour postload glucose greater than or equal to 200
mg/dL(11.1 mmol/L) during an oral glucose tolerance
test.
Type 1 DM is characterized by an absolute deficiency of insulin.
It results from immune-mediated destruction of pancreatic β cells, but rare
unknown or idiopathic processes may contribute.
The autoimmune process is mediated by macrophages and T lymphocytes
with circulating autoantibodies to various β-cell antigens.
The most commonly detected antibody associated with type1 DM is the
islet cell antibody.
Other more readily measured circulating antibodies include insulin
autoantibodies, antibodies directed against glutamic acid decarboxylase,
insulin antibodies against islet tyrosine phosphatase, and several others.
More than 90% of newly diagnosed persons with type 1 DMhave one or
another of these antibodies, as will 3.5% to 4% of unaffected first-degree
relatives.
PATHOPHYSIOLOGY
Insulin resistance means that body cells do not
respond appropriately when insulin is present
Other important contributing factors:
• Increased hepatic glucose production (e.g., from
glycogen degradation), especially at inappropriate
times
• Decrease insulin-mediated glucose transport in
(primarily) muscles & adipose tissues (receptor and
post-receptor defects)
• Impaired beta-cell function-loss of early phase of
insulin release in response to hyperglycemic stimuli
Complications
ACUTE COMPLICATIONS
Hypoglycemia
Diabetic ketoacidosis

LONG TERM COMPLICATION

Retinopathy
Neuropathy
Nephropathy
Cardiomyopthy
Treatment
Non Pharmacological Therapy
Diet and
physical activity
Weight Management
Exercise
Pharmacological Therapy
Insulin injections
Oral agents
 ORALLY AGENTS
 SULFONYL UREAS
1ST GENERATION 2ND GENERATION
Tolbutaminde Glibenclamide
Chlorpropamide Glipizide

BIGUANIDES
Metformin Phenformin

PHENYL ALANINE ANALOGUES

Repaglinide Nateglinide

THIAZOLIDINEDIONES
Rosiglitazone Pioglitazon

 GLUCOSIDASE INHIBITORS
Acarbose Miglitol