Diabetes Mellitus YPO · 2010. 12. 17. · Unit: 2 Diabetes Diabetes Mellitus (Fig. 7) Type 1 Diabetes Insulin Dependent Diabetes Mellitus Diabetes Mellitus, often called Diabetes

Disclaimer

This movie is an educational resource only and should not be used to manage Diabetes or blood sugar control.All decisions about management of diabetes must be made in conjunction with your Physician or a licensed healthcare provider.

Multimedia Health Education

Diabetes Mellitus

Multimedia Health EducationDiabetes Mellitus

SECTION CONTENT

MULTIMEDIA HEALTH EDUCATION MANUAL

TABLE OF CONTENTS

1. Introductiona. Introductionb. Glucose Balance c. Insulin Resistance

2. Diabetesa. Diabetes Mellitusb. Types & Causesc. What goes wrong? d. How will you feel?e. Complications

3. Management

a. Diagnosesb. Treatment

c. Tips for control

INTRODUCTION


Diabetes Mellitus, often called Diabetes is a disorder of metabolism where the body is unable to automatically regulate blood glucose (blood sugar) levels, resulting in too much glucose in the blood.

Diabetes Mellitus


Introduction Diabetes Mellitus should not be confused with Diabetes Insipidus, which is a rare disease where the kidneys are unable to conserve water, which leads to frequent urination and pronounced thirst.

IntroductionUnit:1

(Refer fig.1)

Diabetes Mellitus

To understand Diabetes Mellitus, it is important to understand glucose balance and Insulin Resistance.

(Fig. 1)

FoodInsulin & Exercise

Food raises blood glucose.Insulin and exercise lower blood glucose.Keep them in balance!

Glucose Balance

Glucose is the main source of energy for the body and all the food that we consume is digested and converted into glucose to use as energy in the cells or stored in the liver as glycogen for future use.

Following digestion, glucose is picked up by the blood and carried to different cells of the body.

Insulin is a hormone produced by beta cells in the pancreas. Insulin secretion from the pancreas depends on food intake, blood glucose levels, etc.

(Fig. 2)

(Refer fig. 2 & 4)

(Fig. 3)

Food

Stomach

Pancreas


Insulin Resistance

IntroductionUnit:1

Diabetes Mellitus

(Fig. 4)

Insulin

(Refer fig. 2 & 4)

In order for blood glucose to get into the cells, insulin must be present to open the glucose channels on the cell surface.

Insulin resistance is when the normal amount of insulin secreted by the pancreas is not able to unlock the cell doors for glucose.

To maintain normal blood glucose, the pancreas secretes additional insulin which over time may find it difficult to keep up with the increasing need for insulin.

Obesity and physical inactivity aggravate insulin resistance.

(Refer fig. 5 & 6)

(Fig. 6)

Insulin

(Fig. 5)


DiabetesUnit: 2

Diabetes Mellitus

(Fig. 7)

Type 1 Diabetes Insulin Dependent

Diabetes MellitusDiabetes Mellitus, often called Diabetes is a disorder of metabolism where the body is unable to automatically regulate blood glucose (a sugar) levels, resulting in too much glucose in the blood.

(Fig. 8)

Type 2 Diabetes Non- Insulin Dependent

(Fig. 9)

Gestational Diabetes During pregnancy

Types & CausesThere are three main types of Diabetes.

Type 1 DiabetesDiabetes is an autoimmune disease where the immune system (body's system for fighting infection) attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin.

Type 2 Diabetes

(Refer fig. 7 to 9 )

This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. Patients with Type 2 Diabetes have poor glucose balance due to insulin resistance and reduced Insulin.

Gestational DiabetesGestational Diabetes develops only during pregnancy and the blood sugar returns to normal levels after the baby is born. In pregnancy, the placenta produces hormones that help the baby to grow and develop. These hormones also block the action of the mother’s insulin leading to insulin resistance. Hence the need for insulin in pregnancy is higher than normal.


DiabetesUnit: 2

Diabetes Mellitus

What goes wrong? Insulin acts as the key to open the cell doors for glucose. Let us compare this with normal entry of glucose with insulin.

(Fig. 10)

Normal entry of glucose with insulin

Insulin acts as the key to open the cell doors for glucose. Let us compare this with normal entry of glucose with insulin.

(Fig. 11)

Glucose denied entry into the cells

(Refer fig.10 & 11)

How will you feel?However, symptoms of diabetes include:

Thirst

Frequent urinationTiredness or lack of energy

Blurred visionInfections (eg. Thrush)

Weight loss (in Type 1 diabetes)

Diabetes is a silent disease, and symptoms of diabetes may not appear until blood glucose levels are significantly high over a long period of time. So, it is common to have diabetes without knowing about it.


DiabetesUnit: 2

Diabetes Mellitus

Complications

Many of the complications of diabetes are related to high blood sugars over a long period of time. Diabetes affects all organs in the body.

(Fig. 12)

Heart

Heart (Cardiovascular)

Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack) and strokes.

Diabetic patients carry an increased risk of heart attack, stroke, and other complications related to poor circulation.

(Refer fig.12)

(Fig. 13)

Kidneys

Kidneys

Diabetes can damage the kidneys and is called "Diabetic Nephropathy". This is a common long-term complication of diabetes. It is a progressive disorder which starts as minor damage causing poor filtration leading to chronic kidney failure requiring blood dialysis or kidney transplant, especially if left untreated.

(Fig. 14)

Eye Complications

Eye Complications

(Refer fig.13)

Diabetic Retinopathy is a common complication of diabetes affecting the blood vessels in the retina (light sensitive layer inside the eye). If untreated, it may lead to blindness.

High blood glucose levels cause the lens of the eye to shrink or swell with fluid causing blurry vision.(Refer fig.14)


DiabetesUnit: 2

Diabetes Mellitus

Nervous systemHigh blood glucose damage both large and small blood vessels that carry oxygen and other nutrients to the nerves. Nerve damage is due to poor circulation and affects every system in the body manifesting as loss of sensation, digestive disorders, erectile dysfunction, impotence, etc.

(Refer fig.15)

(Fig. 15)

Nervous system

Foot ComplicationsPeople with diabetes can develop many different foot problems. Poor circulation (blood flow) can make your foot less able to fight infection and leads to poor wound healing.

(Fig. 16)

Foot Complications

Loss of sensation to the feet causes Diabetics to be unaware of damage to their feet which results in wounds and foot ulcers which are worsened by poor circulation.

Hence diabetics SHOULD ALWAYS WEAR PROTECTIVE FOOTWEAR.

(Refer fig.16)

(Fig. 17)

Skin

SkinSkin is the most common site for fungal infections and high blood sugars favor fungal infections. In fact, such problems are sometimes the first sign that a person has diabetes.

Reduced capillary blood flow may cause some brown patches on the legs. Dry, cracked skin can lead to serious infections for Diabetics so it is very important to keep the skin moisturized.

(Refer fig.17)


ManagementUnit: 3

Diabetes Mellitus

Diagnoses

Blood Glucose test

How is Diabetes Detected?

The best diagnostic test for diabetes is a fasting blood glucose test. This is the preferred test for diagnosing both type 1 and type 2diabetes. The results are most reliable when the test is done in the morning after an overnight fast.

Glucose Tolerance Test GTTThis test involves blood samples taken at two different times (2 hours apart).

The first sample is a fasting blood test following which you will be asked to consume a drink containing 75gms of glucose dissolved in water. The second sample is collected 2 hours after the drink. (Some labs may collect an extra sample at one hour after the drink).

In a person without diabetes, the glucose levels in the blood rise following the glucose drink, but then fall quickly back to normal (because insulin is produced in response to the glucose.) In a diabetic, glucose levels rise higher than normal after drinking the glucose drink and come down to normal levels much slower due to insulin resistance.

Management

There is no cure for Diabetes at present, but the disease is usually preventable.

Type 1 or Insulin Dependent Diabetes MellitusDiet, exercise and taking insulin via injections or an insulin pump are the basic therapies for type 1 diabetes. This type of diabetes is insulin dependent and there are no oral medications to treat it.

Type 2 or Non Insulin Dependent Diabetes MellitusThere are different stages in blood glucose control in type 2 diabetes.

Initial control is by diet and exercise, which is followed by oral medications. When oral medications fail to control blood glucose levels, then it is combined with insulin or insulin alone later. Diabetic medications and Insulin are discussed later.

Gestational DiabetesOral diabetic medications are contra indicated in pregnancy and during breast feeding. Treatment is based on managing the glucose balance with diet, physical activity and Insulin.

The main principle of diabetes management is maintaining the glucose balance through diet, exercise and medications. Let's find out more about the individual management of the different types of Diabetes.


ManagementUnit: 3

Diabetes Mellitus

Treatment

Anti Diabetic oral Medications

Medications frequently prescribed for Diabetic patients include:

There is no cure for Diabetes at present, but the disease is usually preventable.

SulphonylureasThis group of tablets helps the pancreas to secrete more insulin and improves the insulin resistance. This tablet should be taken ½ hour before a main meal or with the first mouthful of food.Side effects of Sulphonylureas include:

Low blood glucose/hypoglycemia

Weight GainMild nausea/diarrheaSkin Rash

MeglitinidesThese tablets work like the sulphonylureas, making the pancreas release more insulin. However unlike the sulphonylureas this tablet only works for short periods.

Biguanide (or Metformin)This group works in three ways:

delaying the absorption of glucose from the bowel,

Reducing glucose put into the blood by the liver and

Increasing insulin sensitivity.

Diarrhea is a major side effect therefore it is advised to take this medication with food.

Thiazolidinidione

These tablets are new and work by reversing insulin resistance and decreasing glucose released from the liver in the blood. They make insulin work much more effectively to lower blood glucose levels.

InsulinInsulin can only be given by injection- if taken by mouth it is destroyed by the stomach juices.In the past insulin was made from the pancreas of pigs and cattle. Now it is genetically manufactured in a laboratory and is identical to human insulin. This is the most commonly used insulin today. There are many different types of insulin available, some of them quick acting and others longer acting or a combination of both. Your Doctor will select the most appropriate type of insulin for your needs.

If you are unable to control your blood glucose levels with healthy eating and physical activity, medications are needed. However, healthy eating and regular physical activity is still very important even if you are on medications for your diabetes.


ManagementUnit: 3

Diabetes Mellitus

Tips for controlHealthy life choices will improve your overall health and can help you slow the progression of your diabetes. Some healthy choices for Diabetes include:

Understand all about Diabetes, risk factors, symptoms, related conditions, complications, Etc.

Eat Healthy- Stick to a diabetes-healthy low carbohydrate, low cholesterol, low fat, and low sodium diet.

Quit smoking- No matter how long you have smoked, when you quit, you lower your risk for diabetes, heart disease and most diseases.

Exercise - Exercising and being active are important and can reduce stress and help you sleep. Walking is always an easy way to begin. Check with your doctor before starting any new exercise program.

Lose weight - If you are considered overweight or obese talk with your doctor about the best way for you to shed the extra pounds.

Treat related conditions, such as high blood cholesterol, high blood pressure, obesity & Overweight.

Regular health checkup and follow your doctors advice.

Keeping your blood sugar in control may prevent or delay serious health problems from diabetes. Your healthcare provider may suggest different targets for you.


Unit 3: DisclaimerUnit 2: Gastritis LessonsUnit 3: Disclaimer

Disclaimer

Diabetes Mellitus

Although every effort is made to educate you on DIABETES and take control, there will be specific information that will not be discussed. Talk to your doctor or health care provider about any concerns you may have about DIABETES.


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Diabetes Mellitus

Diabetes Mellitus YPO · 2010. 12. 17. · Unit: 2 Diabetes Diabetes Mellitus (Fig. 7) Type 1 Diabetes Insulin Dependent Diabetes Mellitus Diabetes Mellitus, often called Diabetes

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