Diabetes mellitus

1. Diabetes Mellitus
[Dr] Amzad Ali
Email: ali.amzad@gmail.com
Skype: ali.amzad
Cell: +8801713 004696

2.  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

3. 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.

4.  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.

5. Blood sugar and health
Sugar
(glucose) is
an important
source
of energy
What is eaten is
absorbed into
the blood
Insulin is produced
by the pancreas
when
blood sugar is high
Insulin keeps blood
sugar level within
the normal range
for health

6. Islet of Langerhans
Insulin
b-cells
Pancreas
contains
insulin-
making
cells in
“islets”

7. Carbohydrate Digestion

8. 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

9. 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

10. 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)

11. 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

12. 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 -

13. Types of Diabetes…..
1) Type 1 Diabetes
usually diagnosed in childhood
affected by hereditary
sometimes there are no symptoms
Imperative to inject insulin daily
because the body makes little or no
insulin
frequently called the ‘insulin-
needed’ group
Patients with type 1 diabetes need
insulin daily to survive

14. 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

15. 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

16. 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

17. 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

18. Number of People with Undiagnosed with Diabetes
Source: http://www.idf.org

19. Proportion of Death due to Diabetes
Source: http://www.idf.org

20. 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.

21. 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.

22. 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.

23. 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

24. Management of Diabetes
Follow a
Healthy
Meal Plan
Take your
Medication
Regular Exercise
Test blood
sugar
Regularly

25. Management of DMManagement of DM
 The major components of the treatment of
diabetes are:

26. Prevention
Prevention 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

27.  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

28. Management of Diabetes Mellitus
Nutrition
Blood glucose
Medications
Physical activity/exercise
Behavior modification

29. Medical Nutrition Therapy
 Primary Goal – improve
metabolic control
 Blood glucose
 Lipid (cholesterol) levels

30. 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

31. Nutritional Management for Type I
Diabetes
Consistency and timing
of meals
Timing of insulin
Monitor blood glucose
regularly

32. Nutritional Management for Type II
Diabetes
 Weight loss
 Smaller meals and snacks
 Physical activity
 Monitor blood glucose and
medications

33. Person living with Diabetes

35. Action of Insulin on the Cell
Metabolism

36. 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

37. Action of Insulin on Carbohydrate, Protein
and Fat Metabolism
 Protein
 Stimulates protein synthesis
 Inhibits protein breakdown; diminishes
gluconeogenesis.

38. 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

39. 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

40. Type I Diabetes Cell

41. 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

42. Type II Diabetes

43. Type II Diabetes
 Risk factors:
 family history,
 sedentary lifestyle,
 obesity and
 aging
 Controlled by weight loss, oral
hypoglycemic agents and or insulin