What is Diabetes Mellitus?
Diabetes mellitus is a state of chronic hyperglycaemia sufficient to cause long-term damage to specific tissues,notably the retinae,kidneys,nerves and arteries and is often accompanied by other clinical and biochemical abnormalities.
How is it classified?
Type-1
(5-15 %).
Genetic(30 % ) :-1.IDDM1;Chromosome 6 MHCII receptor site of Th lymphocytes. 2.IDDM2 gene (insulin gene) on Chromosome 11.
Environment Factors:
Type-2
(85-90%)
Genetic:- Low / inappropriate insulin secretion.
Environmental factors:-Obesity (Syndrome X:- HTN, DM,dyslipidaemia & truncal obesity).
What are the other causes of Diabetes Mellitus?
Viruses ; Coxsackie, CMV,rubella& retroviruses.
b.Bovine albumin-cow milk.
c:Toxins:-nitrosourea streptozotocin etc
Autoimmune: ICA,GAD ,IAA antibodies.
Pregnancy, intercurrent illnesses & drugs.
Low birthweight.
Lack of exercise.
What is the clinical picture of diabetes mellitus?
Classical :- Polyurea,polydypsia & polyphagia.
Loss of weight/ DM1 - obesity in / DM2.
Blurred vision.
Infections:-Skin,genital candidial & UTI.
Malaise,tiredness,lack of energy and muscle weakness(DM1).
Screening.
How diabetes is diagnosed or what is the diagnostic criteria of DM?
Diabetes mellitus :Fasting venous plasma glucose greater than 7.0Mmol/l(126mg/dl) on more than one occasions or a value exceeding 11.1 mmol/l(200mg/dl) at 2h in oral glucose tolerance test with 75 Gm or in random sample. ALL BASAL VALUES.
Impaired Glucose Tolerance (IGT):FPG <> 6 mmol or RPG(02h in OGTT) between 7.8-11.1 mmol/l.Risk of IHD.
Impaired Fasting Glucose(IFG):FPG 6.1 to 6.9mmol /l (110-124mg/dl).IHD Risk.
What are the Investigations carried out for diagnosis,monitoring and control of diabetes?
Diagnosis:-
Fasting Plasma Glucose,Random Plasma Glucose,Oral Glucose Tolerance Test.
Control:-
Urine,Fasting Plasma Glucose,02Hour Post Prandial &HbA1c
Complications:-
1.Proteinurea:- Microalbuminaemia &24 hrs- protein.urea,creatinine,Na &K
2.ECG,Lipids ,ETT,Echo &angio.
3.Doppler studies.
4.Fluorescein angiography retina.
5.Nerve conduction studies:(NCS)
What is the general management of Diabetes Mellitus?
LIFESTYLE THERAPY:
Autoimmune: ICA,GAD ,IAA antibodies.
Pregnancy, intercurrent illnesses & drugs.
Low birthweight.
Lack of exercise.
What is the clinical picture of diabetes mellitus?
Classical :- Polyurea,polydypsia & polyphagia.
Loss of weight/ DM1 - obesity in / DM2.
Blurred vision.
Infections:-Skin,genital candidial & UTI.
Malaise,tiredness,lack of energy and muscle weakness(DM1).
Screening.
How diabetes is diagnosed or what is the diagnostic criteria of DM?
Diabetes mellitus :Fasting venous plasma glucose greater than 7.0Mmol/l(126mg/dl) on more than one occasions or a value exceeding 11.1 mmol/l(200mg/dl) at 2h in oral glucose tolerance test with 75 Gm or in random sample. ALL BASAL VALUES.
Impaired Glucose Tolerance (IGT):FPG <> 6 mmol or RPG(02h in OGTT) between 7.8-11.1 mmol/l.Risk of IHD.
Impaired Fasting Glucose(IFG):FPG 6.1 to 6.9mmol /l (110-124mg/dl).IHD Risk.
What are the Investigations carried out for diagnosis,monitoring and control of diabetes?
Diagnosis:-
Fasting Plasma Glucose,Random Plasma Glucose,Oral Glucose Tolerance Test.
Control:-
Urine,Fasting Plasma Glucose,02Hour Post Prandial &HbA1c
Complications:-
1.Proteinurea:- Microalbuminaemia &24 hrs- protein.urea,creatinine,Na &K
2.ECG,Lipids ,ETT,Echo &angio.
3.Doppler studies.
4.Fluorescein angiography retina.
5.Nerve conduction studies:(NCS)
What is the general management of Diabetes Mellitus?
LIFESTYLE THERAPY:
Diet - Less sugar- Carbohydrates 55% soluble fibres ( cereals,vegetables &fruits) preference of less glycaemic index (cereals,pulses).Total sucrose <50>
WEIGHT i.e Standard for age ,sex &body habitus. By diet (600 Cal less/day),exercise,drugs & surgery at times(>40kg/m2) -gastric banding or by-pass.
Exercise:-GLUT-4 in muscles &fats.
NO Smoking.
Minimum Alcohol.
Goal :-Preprandial;4-6/& Bed time;6-8 -ideal ,Postprandial <10mmol-reasonable.prenancy;>
Goal :-Preprandial;4-6/& Bed time;6-8 -ideal ,Postprandial <10mmol-reasonable.prenancy;>
Oral Hypoglycaemics
Sulphonylurea :- Insulin secretogogues, lower glucose by > 2-4mmol/l.
Repaglinide :-Non-sulphonylurea part of glibenclamide).
Biguanides :- Gluconeogenesis inhibitors(2-4 mmol/l).
Thiozoladinediones :-Insulin sensitizers (Rosiglitazones & pioglitazones) 2-3 mmol/l <>
Diffuse Symmetrical Polyneuropathy:- Sensory &motor -Glove &stocking.
Diffuse Small Fibre(pain,temp &autonomic)
Acute mononeuropathy/mononeuritis multiplex.
Amyotrophy.
Pressure palsies.
Insulin neuritis :-Transient after insulin start-pain ,dysthesia.
Nephropathy
Glomerular basement membrane(GBM) thickening
UAER(Urinary albumin excretion rate):- 30-300 mg/day -microalbuminuria or incipient nephropathy,overt albuminuria or clinical nephropathy(0.5 gm/day) or uaer 300mg/day.
ACR(Albumin : creatinine ratio).
Examination of a Diabetic Patient -At Least Annual.
Thorough Physical Exam.
Feet:- Crack ,crevices,callosity,interdigital & sensation.
CNS :- Pain,temp,&vibration& jerks.
Face,Scalp, Oedema& Genitalia.
Eyes:-Visual acuity,fundoscopy &Slit lamp.
CVS:- B.P,Pulses & signs of heart failure
Biguanides :- Gluconeogenesis inhibitors(2-4 mmol/l).
Thiozoladinediones :-Insulin sensitizers (Rosiglitazones & pioglitazones) 2-3 mmol/l <>
Acarbose :-Glucosidase inhibitors (1-2 mmol/l)
Insulins
Bovines &Porcine :-Pure,purified &highly purified(monocomponent)-immune reaction.
Human:- Recombinant DNA on yeast-faster and shorter than bovine or porcine’s. Humann Analogues:-Modified at C-terminal act faster.
Injections S/C,pumps(s/c & intraperitoneal), pressure,aerosols,pancreatic transplant.
Complications
Acute Coma--Ketoacidosis, Hyoerosmolar Non Ketotic coma,CVA,Uremia & hypoglycaemia
Chronic a.
Macrovascular:- Athersclerosis ; CVA, IHD,peripheral vascular disease.
b.Microvascular :- Retinopathy,nephropathy & neuropathy. Diabetic Ketoacidosis Antibiotics.
Insulin:- .1U/kg/hr (I/V-6U/hr or 10U/2h i/m). Hydration:- 100 ml/ kg -Saline For cardiac,renal or cirrhotic 01 L/08h -measure CVP. If glucose <10>5.mol/l.
Complications:-Shock,cerebral odema, ARDS, gastroparesis &hypothermia.
Chronic Complications
Cause:-Advanced Glycation Endproducts (AGE) interfere with tissue structure.
Polyols:- Sorbitol and myoinositol Microvasculopathy.
Chronic Complications
Cause:-Advanced Glycation Endproducts (AGE) interfere with tissue structure.
Polyols:- Sorbitol and myoinositol Microvasculopathy.
Retinopathy
Neuropathy
Diffuse Symmetrical Polyneuropathy:- Sensory &motor -Glove &stocking.
Diffuse Small Fibre(pain,temp &autonomic)
Acute mononeuropathy/mononeuritis multiplex.
Amyotrophy.
Pressure palsies.
Insulin neuritis :-Transient after insulin start-pain ,dysthesia.
Nephropathy
Glomerular basement membrane(GBM) thickening
UAER(Urinary albumin excretion rate):- 30-300 mg/day -microalbuminuria or incipient nephropathy,overt albuminuria or clinical nephropathy(0.5 gm/day) or uaer 300mg/day.
ACR(Albumin : creatinine ratio).
Examination of a Diabetic Patient -At Least Annual.
Thorough Physical Exam.
Feet:- Crack ,crevices,callosity,interdigital & sensation.
CNS :- Pain,temp,&vibration& jerks.
Face,Scalp, Oedema& Genitalia.
Eyes:-Visual acuity,fundoscopy &Slit lamp.
CVS:- B.P,Pulses & signs of heart failure
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Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood suga. Nursingpedia