INTRODUCTION

Diabetes mellitus is a chronic medical

condition that affects how the body
processes blood sugar (glucose). Glucose
is an essential source of energy for the
body’s cells, but in people with diabetes,
the body either does not produce enough
insulin or cannot use insulin properly.
Insulin is a hormone produced by the
pancreas that helps regulate blood sugar
levels.
 Prevalence and Impact

Diabetes Mellitus is a major

public health concern, affecting
over 460 million people
worldwide.
If left unmanaged, diabetes can
lead to serious complications,
such as:-
Cardiovascular disease-
Kidney damage-
Blindness-
Amputations-
Cognitive impairment
 DEFINITION

What is Diabetes Mellitus?

Diabetes Mellitus is a chronic metabolic disorder

characterized by high blood sugar levels, resulting
from defects in insulin secretion, insulin action, or
both.
 TYPES OF DIABETES
1.Type 1 Diabetes:
An autoimmune disease in which the body's immune system attacks and destroys the
insulin-producing beta
cells in the pancreas.
2. Type 2 Diabetes:
A metabolic disorder characterized by insulin resistance and impaired insulin
secretion.
3. Gestational Diabetes:
A type of diabetes that develops during pregnancy, usually in the second or third
trimester.
4. LADA (Latent Autoimmune Diabetes in Adults):
A form of type 1 diabetes that develops in adults.
5. MODY (Maturity-Onset Diabetes of the Young):
A rare form of diabetes caused by genetic mutations.
1.Type 1 Diabetes:
•Caused by the destruction of insulin-producing beta cells in the pancreas.
•When 80–90% of beta cells are destroyed, insulin levels drop, leading to high blood sugar
(hyperglycemia).
•Patients require insulin injections to prevent complications like ketosis and maintain
normal metabolism.
2.Type 2 Diabetes:
•Caused by a combination of insulin resistance and reduced insulin secretion.
•The body produces insulin, but the cells don’t respond properly (insulin resistance).
•Over time, the pancreas cannot produce enough insulin to maintain normal blood sugar
levels.
3.Insulin Resistance:
•Cells in muscles and fat don’t take up glucose effectively.
•The liver continues to produce glucose even when not needed, leading to high blood sugar.
•The pancreas works harder to produce more insulin, but this becomes ineffective over
time.
Both types result in high blood sugar, which needs to be controlled to prevent long-term
complications.
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
 CAUSES OF DIABETES MELLITUS
Type 1 Diabetes
1. Genetic predisposition: Family history of
Type 1 diabetes.
2. Autoimmune response: The immune
system mistakenly attacks and destroys
the insulin-producing beta cells in the
pancreas.
3. Environmental factors: Exposure to
certain viruses, toxins, or other
environmental factors may trigger the
autoimmune response.
Type 2 Diabetes

1. Insulin resistance: The body becomes less responsive to insulin, making it harder
for glucose to enter cells.
2. Pancreatic beta-cell dysfunction: The pancreas produces less insulin, or the insulin
produced is not effective.
3. Genetic predisposition: Family history of Type 2 diabetes.
4. Obesity: Excess body fat, particularly around the abdominal area, increases insulin
resistance.
5. Physical inactivity: Sedentary lifestyle contributes to insulin resistance.
6. Diet: Consuming a diet high in sugar, refined carbohydrates, and saturated fats.
7. Age: Risk increases with age, especially after 45.
8. Ethnicity: Certain ethnic groups, such as African Americans, Hispanics/Latinos,
and American Indians, are at higher risk.
9. History of gestational diabetes: Women who had gestational diabetes during
pregnancy are at increased risk.
10. Polycystic ovary syndrome (PCOS): Women with PCOS are at higher risk.
 SYMPTOMS
1. Increased thirst and hunger:
Due to high blood sugar levels, the body tries to flush out excess glucose by
producing more urine, leading to dehydration and hunger.
2. Frequent urination:
High blood sugar levels cause the kidneys to produce more urine, leading to
frequent trips to the bathroom.
3. Fatigue:
High blood sugar levels can cause fatigue, weakness, and a feeling of being tired all
the time.
4. Blurred vision:
High blood sugar levels can cause the lens in the eye to swell, leading to blurred
vision.
5. Slow healing of cuts and wounds:
High blood sugar levels can affect the body's ability to heal wounds.
6. Tingling or numbness in hands and feet:
High blood sugar levels can damage the nerves, causing tingling or numbness in
the hands and feet.
Diagnostic Tests
DIAGNOSIS OF DIABETES
1. Fasting Plasma Glucose (FPG) Test: Measures blood glucose levels after an overnight
fast.
2. Oral Glucose Tolerance Test (OGTT): Measures blood glucose levels after consuming a
sugary drink.
3. Random Plasma Glucose Test: Measures blood glucose levels at any time of day.
4. Hemoglobin A1c (HbA1c) Test: Measures average blood glucose levels over the past 2-3
months.
5. Urine Glucose Test: Measures glucose levels in urine. Diagnostic Criteria
6. FPG Test: - Normal: <100 mg/dL
7. Prediabetes: 100-125 mg/dL
8. Diabetes: ≥126 mg/dL2. OGTT:
9. Normal: <140 mg/dL
10.Prediabetes: 140-199 mg/dL
11.Diabetes: ≥200 mg/dL3. HbA1c Test:
12.Normal: <5.7%
13. Prediabetes: 5.7-6.4%
14. Diabetes: ≥6.5%
 COMPLICATION OF DIABETES
● Acute complications:
● Diabetic Ketoacidosis (DKA)
● The hyperglycemic hyperosmolar nonketotic
syndrome
● Hypoglycemia
● Chronic complications:
● Disorders of the microcirculation
● Neuropathies
● Nephropathies
● Retinopathies
● Macrovascular complications
● Footulcers
What Happens in DKA: Symptoms of DKA:
•DKA occurs when the body produces too many •Excessive thirst (polydipsia) and
ketones because the liver makes more ketones frequent urination (polyuria).
than the body can use or excrete. •Nausea, vomiting, and extreme fatigue.
•It is common in people with Type 1 diabetes •Abdominal pain without a clear cause.
due to a lack of insulin. •Sweet or fruity-smelling breath due to
•Without insulin, fat is broken down into fatty ketones.
acids, which are converted into ketones in the •Rapid breathing (Kussmaul’s
liver. respiration) to balance blood pH.
•Stress, like infections, pregnancy, or anxiety, •Low blood pressure (hypotension) and
can trigger DKA by increasing certain fast heart rate.
hormones. •Confusion or even coma in severe cases
•Skipping or not taking enough insulin can also
lead to DKA.
Hyperglycemic •Main Issues:
Hyperosmolar Nonketotic • Insulin resistance
• Too much sugar intake
Syndrome (HHNK):
•Effects on the Body:
•Definition: HHNK is a severe
• Pulls water out of cells, including brain cells,
condition with very high blood
leading to dehydration and possible blood clots.
sugar (above 600 mg/dL),
Symptoms of HHNK:
dehydration, and altered mental
•Severe thirst
state, but no ketoacidosis.
•Dry mouth and dehydration
•Common Causes:
•Seizures (violent shaking)
• Type 2 diabetes
•Partial paralysis or difficulty speaking
• Severe infections
•Muscle twitching and eye movement issues
• Pancreatitis
•Hallucinations or vision problems
• Heart attacks
•High body temperature
• High-carbohydrate diets or
Treatment Risks: Rehydration can lead to brain
certain nutrition treatments
swelling, and potassium levels need careful
correction.
Hypoglycemia (Low Blood Sugar)

•Definition: Low blood sugar Symptoms of Hypoglycemia:

occurs when insulin is too high, •Brain-related:
causing glucose levels to drop • Headache
too low. • Difficulty thinking or unusual behavior
•Common in: People using • Coma or seizures in severe cases
insulin injections or certain •Body-related:
diabetes pills. • Hunger
•Triggers: • Fast heartbeat
•Too much insulin • Sweating
•Skipping meals • Anxiety
•Increased exercise • Cold, clammy skin
•Stress changes
•Alcohol consumption
 Somogyi Effect (Rebound Dawn Phenomenon
Hyperglycemia)
•Definition: A condition where low blood •Definition: High fasting blood sugar in
sugar (hypoglycemia) caused by insulin the early morning (5–9 AM) without a
leads to high blood sugar (hyperglycemia) preceding drop in blood sugar.
later. •Cause: A change in the body's natural
•Cause: Insulin lowers blood sugar too rhythm or the release of growth
much, triggering the body to release stress hormones that raise blood sugar.
hormones (like cortisol and glucagon) that •Effect: When combined with the
raise blood sugar. Somogyi effect, it can lead to very high
•Cycle: High blood sugar is often treated blood sugar levels.
with more insulin, which can make the •Management: Adjust insulin or diet
problem worse. based on blood sugar monitoring.
•Timing: Hypoglycemia often happens at
night, making it hard to detect.
•Prevention: Adjust meal timing,
carbohydrate intake, and insulin dosage.
 CHRONIC COMPLICATION
Diabetic Neuropathies
•Nerve damage affects about 50% of people
with diabetes.
•Good blood sugar control can help prevent or
delay it.
Types of Neuropathy:
1.Peripheral Neuropathy:
1. Tingling, pain, numbness, or weakness in
hands and feet.
2.Autonomic Neuropathy:
1. Problems with digestion, bladder, and
sexual function.
2. Dizziness, fainting, or changes in
sweating.
3. Loss of warning signs for low blood sugar
or heart attack
Diabetic Nephropathy (Kidney Disease)
•Leading cause of kidney failure in diabetes.
•Risk factors: High blood pressure, poor blood
sugar control, smoking, high cholesterol.
•Damage happens due to high blood sugar and
high blood pressure.
•Symptoms: Protein in urine, swelling, and high
blood pressure
Diabetic Retinopathy (Eye Disease)
•Most common eye problem in diabetes.
•Damages blood vessels in the retina, causing
vision problems.
•Symptoms: Blurred vision, swelling, bleeding,
or blindness.
•Risk factors: Poor blood sugar control, high
blood pressure, and high cholesterol.
 Macrovascular Complications

•Diabetes increases the risk of heart

disease, stroke, and poor blood flow to
the limbs.
•Risk factors: Obesity, high blood
sugar, high blood pressure, high
cholesterol, and blood clotting issues.
•Type 2 diabetes: Macrovascular
problems can appear at diagnosis.
•Type 1 diabetes: Risk increases with
age and diabetes duration
 Diabetic Foot Ulcers

•Nerve damage reduces pain awareness, leading to unnoticed foot

injuries.
•Weak foot muscles can cause deformities and pressure spots.
•Common injury sites: Heel, toe, and ball of the foot
 INFECTIONS

•Diabetes increases the risk of

infections like:
•Skin and soft tissue infections
•Bone infections (osteomyelitis)
•Urinary infections
•Fungal infections (e.g., Candida)
•Dental infections and tuberculosis
•High blood sugar weakens the
immune system and slows healing.
 SKIN INFECTION
Skin Changes:
● Dry skin and feet. TYPES OF SKIN INFECTIONS
● Seal remaining moisture in with plain ● Bacterial infections
petroleum jelly, unscented hand cream, or a ● Fungal infections
similar product. ● Itching
● It is important not to put oils or creams ● Diabetic Dermopathy
between toes. ● Atherosclerosis
● Calluses ● Allergic Reactions
● Occur more often and build up faster. ● Diabetic Blisters
● May need therapeutic shoes and inserts. ● Acanthosis Nigricans
● Calluses can lead to ulcers (open sores).
● Never try to cut calluses yourself– this can
lead to infection.
● Let your healthcare provider cut them
 GASTROPARESIS
Occurs due to nerve damage that control the ● Erraticblood glucose (sugar) levels
stomach ● Lack of appetite
● Lead stop or muscle control of the stomach ● Gastroesophageal reflux
and intestines. Movement of food is slowed or ● Spasm soft he stomach wall
stopped. ● Gastroparesis makes it harder to manage
● Signs and symptoms: blood glucose.
● Heartburn ● Slower digestion can result in:
● Nausea ● Bacterial overgrowth due to fermentation
● Vomiting of undigested food ● Food can harden into solid masses called
● An early feeling of fullness when eating bezoars that may cause nausea, vomiting, and
● Weight loss obstruction of the stomach.
● Abdominal bloating ● Bezoars can be dangerous if they block the
passage of food into the small intestine
 NUTRITIVE MANAGEMENT
•Individualized Diet Plan:
•The diet should match the person’s eating habits, lifestyle, and treatment goals.
•Regular monitoring of blood sugar, weight, cholesterol, and overall health is essential.
•Energy Needs:
•For overweight individuals, reduce calorie intake by about 500 kcal per day.
•60–70% of daily energy should come from carbohydrates and healthy fats (like olive oil).
•Limit saturated and trans fats to less than 10% of total energy.
•Healthy Fat Choices:
•Include foods with omega-3 fatty acids, such as oily fish, regularly.
•Protein:
•Protein should not exceed 20% of total daily energy.
•Carbohydrates:
•Focus on high-fiber, antioxidant-rich foods like fruits, vegetables, and legumes.
•Choose foods with a low glycemic index to help control blood sugar.
 FOODS TO EAT
1.Green Leafy Vegetables:
1. Spinach, kale, cabbage, broccoli – high in fiber and antioxidants.
2.Whole Grains:
1. Brown rice, whole grain bread, quinoa, millet, bulgur – lower in sugar spikes
compared to white rice or bread.
3.Fatty Fish:
1. Salmon, mackerel – rich in omega-3 fatty acids, good for the heart.
4.Beans:
1. Lentils, chickpeas, black beans – high in fiber and plant protein.
5.Nuts (e.g., Walnuts):
1. Good source of healthy fats and omega-3 for heart health.
6.Citrus Fruits:
1. Oranges, lemons, grapefruits – provide vitamins and minerals.
7.Berries:
1. Strawberries, blueberries – rich in antioxidants for heart and cell he
•Sweet Potatoes:
•Better than white potatoes as they don’t cause quick sugar
spikes.
•Chia Seeds:
•High in fiber, antioxidants, and omega-3 fatty acids.
•General Tips:
•Eat fruits, vegetables, lean proteins, and foods with low added
sugar
 FOODS TO AVOID

1.Sugary Drinks:
1. Soda, energy drinks, and sweetened beverages.
2.Refined Grains:
1. White bread, white rice, pastries.
3.Fried Foods:
1. Chips, fries, and deep-fried items.
4.High-Sugar Foods:
1. Candy, cakes, cookies, and sugary snacks.
5.Processed Foods:
1. Packaged snacks, instant noodles, and processed meats.
6.Trans Fats:
1. Found in margarine and many baked goods.
7.Alcohol:
1. Limit or avoid, especially sugary cocktails
 Management and Treatment

While there is no cure for diabetes, it can be

effectively managed through:-
Lifestyle modifications (diet, exercise, weight
management)- Medications (oral
hypoglycemic agents, insulin)- Monitoring
blood sugar levels- Regular health check-up
Importance of Awareness and Education

Raising awareness and promoting education about diabetes are crucial

for
:- Early detection and diagnosis-
Effective management and treatment-
Prevention of complications-
Improving quality of life for people with diabetes