Diabetes

• Diabetes


  A chronic metabolic disorder characterized by elevated levels of glucose (sugar) in the blood
• Insulin

  A hormone produced by the pancreas that helps regulate blood sugar levels and allows cells to absorb glucose for energy
• Types of diabetes

  • Type 1
  • Type 2
  • Gestational Diabetes
• Type 1 diabetes

  • Autoimmune disease in which a person's pancreas stop producing insulin
  • Has nothing to do with diet or lifestyle and it cannot be prevented
• Causes of Type 1 diabetes

  • Autoimmune disease
  • Virus and infections
  • Autoimmune destruction of beta cells
  • Damage or removal of the pancreas
  • Unfavorable environmental factors
  • Drugs and chemical toxins
  • Endocrine disease
  • Hereditary predisposition
• Risk factors for Type 1 diabetes

  • Family history
  • Age (usually develops in children, teens, or young adults)
  • Genetics
  • Viral exposure
• Symptoms of Type 1 diabetes in adults

  • Increase in frequency of urination
  • Feeling very weak and hungry
  • Mood fluctuations
  • Excessive thirst
  • Blurred vision
  • Weight loss
  • Vaginal infections
• Symptoms of Type 1 diabetes in children

  • Reduction in weight
  • Increase urine frequency/bedwetting (in children more than four years)
  • Feeling excess hunger and thirst
  • Bad breath/ Fruity-smell
  • Feeling tired or lack of energy
• Short-term complications of Type 1 diabetes

  • Hypoglycemic episodes
  • Hyperglycemic episodes
  • Insulin non-compliance
  • Diabetic ketoacidosis
• Long-term complications of Type 1 diabetes

  • Diabetic retinopathy
  • Diabetic nephropathy
  • Diabetic neuropathy
  • Cardiovascular disease
  • Heart attack
  • Stroke
  • Peripheral vascular disease
• Diabetic ketoacidosis (DKA)


  A serious complication of diabetes that can be life-threatening, caused by a lack of insulin leading to the buildup of ketones in the body
• Causes of DKA


  • Illness
  • Missing insulin shots, a clogged insulin pump, or the wrong insulin dose
• Symptoms of DKA


  • Fast, deep breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity-smelling breath
  • Headache
  • Muscle stiffness or aches
  • Being very tired
  • Nausea and vomiting, stomach pain
• Diagnostic criteria for DKA

  • Blood glucose > 11mmol/L
  • HCO3 <15 mmol/L &/or venous pH <7.3
  • Ketonaemia > 3mmol/L or ketonuria (> ++ on urine ketostix)
• Diagnostic tests for diabetes

  • Fasting blood sugar test
  • Random blood sugar test
  • Oral Glucose Tolerance Test (OGTT)
  • Hemoglobin A1C
  • Urinalysis
  • C-peptide testing
  • Diabetes autoantibody testing
  • Genetic testing
• Fasting plasma glucose (FPG)


  Normal levels are <100 mg/dL, diabetes is diagnosed at >126 mg/dL on two occasions
• Oral Glucose Tolerance Test (OGTT)

  Measures how the body metabolizes glucose 2 hours after ingesting it, used to diagnose gestational diabetes
• Hemoglobin A1c (HbA1c)

  Measures the percentage of glycated hemoglobin, indicates average blood glucose levels over 2-3 months, normal is <5.7%, prediabetes is 5.7-6.4%, diabetes is >6.4%
• Treatment for Type 1 diabetes

  • Education
  • Insulin
  • Careful Glucose Monitoring
• Dietary management

  Monitor carbohydrate intake, consume foods with high fiber and low glycemic load, limit saturated fat and sugary/processed foods
• Exercise and weight management

  • Lowers HbA1c, improves insulin resistance, reduces risk of heart disease
• Types I treatment -insulin

  • Bolus (short- or rapid-acting)
  • Basal (intermediate- or long-acting)
  • Basal-Bolus regimen
• Ways to take insulin

  • Needle and syringe
  • Pen
  • Insulin pump
  • Artificial pancreas
  • Inhaled insulin
• Continuous Glucose Monitoring (CGM)

  Measures glucose levels in subcutaneous fat tissue, enables early detection of low/high blood sugar
• Recommended blood glucose targets

  Before meals: 80-130 mg/dL, 2 hours after meals: <180 mg/dL
• CGM systems measure the sugar levels in the subcutaneous fat tissue and aim to contribute to better insulin therapy management. In particular, they make living with diabetes easier for people who need to regularly test their glucose levels and adjust their amount of insulin and generally lead to an improvement in diabetes therapy. Individually adjustable alarm functions enable the early detection of low and high blood sugar levels.
• Recommended targets for blood glucose levels

  • Before a meal: 80 to 130 mg/dL
  • About 2 hours after a meal starts: less than 180 mg/dL
• How to test your blood glucose

  1. Wash your hands with warm water and dry your hands completely

  2. Insert the test strip into a meter

  3. Choose a spot on your finger

  4. Prick your finger with a lancing device

  5. Apply a drop of blood to the inserted test strip

  6. Check the confirmation window of the strip to ensure sufficient blood sample has been applied for an accurate reading

  7. Read & record the blood glucose level displayed

  8. Discard the lancet & used test strip
• Testing should be done at least 4 times a day (before each meal and before bed).
• Hypoglycemia

  When blood glucose level drops below 70 mg/dL, which is too low
• Hypoglycemia can be life threatening and needs to be treated right away.
• Hyperglycemia

  High blood glucose levels
• Symptoms of high blood glucose levels

  • Feeling thirsty
  • Feeling tired or weak
  • Headaches
  • Urinating often
  • Blurred vision
• Prevention of type 1 diabetes mellitus is not possible as it is mainly caused by the destruction of the pancreas (beta cells of Langerhans) by the body's immune system
• Type 2 diabetes mellitus

  A chronic metabolic disorder characterised by increased blood sugar levels, caused by insulin resistance and relative insulin deficiency
• Causes of Insulin resistance diabetes II

  • Decreased ability of peripheral tissues to respond to insulin
  • Beta cell dysfunction manifested by inadequate insulin secretion in response to insulin resistance and hyperglycemia
• How insulin works

  Food is broken down into blood sugar, which signals the pancreas to release insulin, insulin helps blood sugar enter cells, lower insulin levels alert the liver to release stored blood sugar
• Insulin resistance

  Cells in muscles, fat and liver don't respond as they should to insulin, can be temporary or chronic and is treatable in some cases
• HOMA-IR

  A blood test that measures the body's resistance to insulin in diabetes II
• How does insulin resistance affect the body? Insulin resistance typically increases insulin production (hyperinsulinemia) so the body can maintain healthy blood sugar levels. Elevated insulin can result in weight gain, which makes insulin resistance worse.