DIABETES MELLITUS Glucose0

							DIABETES
MELLITUS

Done by ; Hajer Ali
DIABETES MELLITUS
group of metabolic diseases characterized by high blood sugar (glucose) levels,
that result from defects in insulin secretion, or action, or both


PATHOPHYSIOLOGY OF DM.
Metabolic disorder of the pancreas; 
in which the body is unable to control the amount of sugar in blood,
because the mechanism that converts sugar to energy is no longer functioning
properly.
 ·    This leads to an abnormally high level of sugar in the blood, which 
gives rise to a variety of symptoms.
 ·    Glucose cannot enter the cells when insulin is absent. 
§ Because blood sugar cannot be converted to energy, amount of sugar 
in blood  then spills into the urine.
§ In an attempt to compensate for the lack of energy, the liver will 
make much more sugar than normal.
§ Another energy source has to be found! The body’s stores of fat and 
protein are broken down to release more sugar into the bloodstream 
consequent loss of weight.

§     In complete absence of insulin, excessive breakdown of fat will 
result in ketones which will be found in the blood then spilled into the
urine.



Types of diabetes
      Type 1 diabetes: results from the body's failure to produce insulin, and
       presently requires the person to inject insulin.
      Type 2 diabetes: results from insulin resistance, a condition in which cells fail
       to use insulin properly, sometimes combined with an absolute insulin
       deficiency.



Type 2 diabetes mellitus
· Runs in families; no gene isolated 
· Beta cells of langerhans secrete insulin into blood stream 
§ Glucose level remains because of peripheral insulin resistance 
§ Conversion of glycogen to glucose by liver 
§ Insulin resistance: linked to obesity, especially intra-abdominal 
obesity.
· Lack of response to usual amount of insulin. 
§ Beta cells to secrete insulin 
(hyperinsulinemia) 
§ Blood glucose remains elevated 
§ Overstimulation exhausts beta cells 
  Decline in insulin production 

Type 2 diabetes mellitus becomes insulin deficient          
  Glucose in blood 
(appears when blood glucose > 180mg/dl)
Hypertonicity from concentrated amounts of glucose in the blood pulls 
fluid into vascular system.
urinary frequency urine production + 
  Water lost    polydipsia 
Body’s fuel requirement continue while needed glucose is being wasted 
§ Client feels hungry & eats more (polyphagia) 
 § But client loses weight as body uses fat & protein to substitute for 
glucose

SIGNS & SYMPTOMS
  polyuria, polydipsia, polyphagia, glycosuria weakness ,hyperglycemia
 (may occur in both types)
In IDDM only - weight loss and unstable blood glucose.
In NIDDM only - obesity, more stable blood glucose, poor circulation, infection,
slow wound healing.

Diagnostic tests
URINE TEST
Fasting blood sugar.Diagnostic
Post prandial glucose test: PPBS/PPGT
G.T.T.- Glucose tolerance test:
Glycosylated hemoglobin Test AIC


COMPONENTS OF TREATMENT
1.        DIET & WEIGHT LOSS 
2.        EXERCISE 
3.        INSULIN 
4.        ORAL ANTIDIABETIC AGENTS 
5.        PANCREAS TRANSPLANTATION 
6.        ISLET CELL TRANSPLANTATION 

Management of diabetes
* control blood glucose 
 * foot care         

Foot care for diabetic clients
1.    Inspect feet daily. 
 2.    Wash in warm water & mild soap. 
 3.    Dry well & apply cream. 
 4.    Cut nails straight across. 
 5.    If with corn or callus – go to doctor. 
 6. Wear properly fitting shoes & clean socks. 
 7. Do not walk barefoot. 
 8. Never use hot water bottle or pad. 
  (easy to get burned because of numbness). 
 9. Elevate feet whenever able. (because of poor circulation) 
10. Any infection or crack, see doctor immediately. 
 11. Stop smoking: smoking constricts 
blood vessels and reduces blood
circulation.