Diabetes is a multisystem disease related to abnormal insulin production or impaired insulin utilization, leading to heart disease, stroke, blindness and limb amputations. There are three main types of diabetes: Type 1 is characterized by the inability to produce insulin and usually occurs in younger people; Type 2 accounts for 90% of cases and is associated with insulin resistance and overweight individuals; Gestational diabetes develops during pregnancy. The major components of diabetes management are diet, exercise, oral hypoglycemic therapy or insulin therapy, and self-care education.
2. Diabetes Mellitus
Definition
A multisystem disease related to:
Abnormal insulin
production, or
Impaired insulin
utilization, or
Both of the above
Leading cause of heart disease,
stroke, adult blindness, and non-
traumatic lower limb amputations
3. Normal Insulin Metabolism
o Insulin
Produced by the
cells in the
islets of
Langherans of
the pancreas
Facilitates
normal glucose
range of 3.9 – 6.7
mmol/L
4. Normal Insulin Metabolism
Promotes glucose
transport from the
bloodstream across the
cell membrane to the
cytoplasm of the cell
Analogous to a “key” that
unlocks the cell door to
allow glucose in
5. Types of Diabetes
There are major 3
types of diabetes
Type 1 diabetes
Type 2 Diabetes
Gastational Diabetes
6. Type 1 Diabetes Mellitus
Formerly known as
“juvenile onset” or “insulin
dependent” diabetes
Most often occurs in people
under 30 years of age
Peak onset between ages 11
and 13
7. Type 1 Diabetes Mellitus
Pancrease can no longer produce
insuline
Symptoms
Weight loss
Polydipsia (excessive thirst)
Polyuria (frequent urination)
Polyphagia (excessive hunger)
Weakness and fatigue
Ketoacidosis
8. Type 2 Diabetes Mellitus
Accounts for 90% of
patients with diabetes
Usually occurs in
people over 40 years
old
80-90% of patients are
overweight
9. Type 2 Diabetes Mellitus
• Insulin resistance
• Body tissues do
not respond to
insulin
• Results in
hyperglycemia
• Decreased (but not
absent) production of
insulin
11. Gestational Diabetes
Develops during pregnancy
Detected at 24 to 28 weeks
of gestation
Associated with risk for
cesarean delivery, perinatal
death, and neonatal
complications
13. • Diet and Exercise
A
• Oral hypoglycaemic
therapyB
• Insulin Therapy
C
Management of DM
The major components of the treatment of
diabetes are:
14. Diet
Diet is a basic part of management in
every case. Treatment cannot be
effective unless adequate attention is
given to ensuring appropriate
nutrition.
Dietary treatment should aim at:
◦ensuring weight control
◦providing nutritional requirements
◦allowing good glycaemic control
with blood glucose levels as close
to normal as possible
◦correcting any associated blood
lipid abnormalities
15. Diet
Dietary fat should provide 25-35% of total
intake of calories but saturated fat intake
should not exceed 10% of total energy.
Cholesterol consumption should be restricted
and limited to 300 mg or less daily.
Protein intake can range between 10-15%
total energy (0.8-1 g/kg of desirable body
weight). Requirements increase for children
and during pregnancy. Protein should be
derived from both animal and vegetable
sources
16. Diet
Carbohydrates provide 50-60% of total
caloric content of the diet.
Carbohydrates should be complex and
high in fibre.
Excessive salt intake is to be avoided. It
should be particularly restricted in
people with hypertension and those
with nephropathy
17. Exercise
Together with dietary treatment, a
programme of regular physical activity
and exercise should be considered for
each person. Such a programme must
be aimed to the individual’s health
status and fitness.
People should, however, be
educated about the potential
risk of hypoglycaemia and how
to avoid it.
Physical activity promotes weight
reduction and improves insulin
sensitivity, thus lowering blood glucose
levels.
18. Self-Care
Patients should be
educated to practice self-
care. Self-care should
include
◦Blood glucose monitoring
◦Body weight monitoring
◦Foot-care
◦Personal hygiene
◦Healthy lifestyle/diet or physical activity
◦Identify targets for control
◦Stopping smoking
