SIGNIFICANCE OVERVIEW WHAT IS DIABETES? DEFINITION MECHANISM PREVELANCE EPIDEMIOLOGY CLASSIFICATION GESTATIONAL DIABETES RISK FACTORS DIAGNOSIS COMPLICATIONS MEDICAL TEST MEDICAL NUTRITIONAL THERAPY HERBS FOR DIABETES MYTHS AND FACTS REFERENCES

2. 
CONTENTS:
 SIGNIFICANCE
 OVERVIEW
 WHAT IS DIABETES?
 DEFINITION
 MECHANISM
 PREVELANCE
 EPIDEMIOLOGY
 CLASSIFICATION
 GESTATIONAL DIABETES
 RISK FACTORS
 DIAGNOSIS
 COMPLICATIONS
 MEDICAL TEST
 MEDICAL NUTRIONAL THERAPY
 HERBS FOR DIABETES
 MYTHS AND FACTS
 REFERENCES

3. 
 Diabetes mellitus affects approximately 2.8 million people in united state
 It is a metabolic process that results from a lack of insulin secretion or
action
 Insulin is a hormone that is secreted by beta cells in the pancreas
 This hormone then allows the cells in our body to absorb the glucose and
convert it into energy to maintain metabolic process
Significance:

4. 
 Diabetes is a serious disease
 It has no cure and last a lifetime
 In diabetes the body does not use glucose properly
 The body’s cell need glucose for energy
 High level of glucose remain in blood
 A lack of insulin causes this problem
 People have known about diabetes since ancient times
 Diabetes mellitus is a vascular disease
Overview:
BOOK: Diabetes by Judith Peacock

5.  The medical name for diabetes is diabetes mellitus.
 Doctors in ancient Greece and Rome named the disease.
 Diabetes means passing through in Greek
 Mellitus means sweet or honeyed in Latin
 The urine of diabetic people contains sugar. It passes through the body quickly.
What is Diabetes?

6.  Diabetes mellitus is a metabolic disorder characterized by high glucose level associated with other
manifestations. Diabetes means polyuria and mellitus means honey.
Discovery:
 the name diabetes mellitus was coined by Thomas Willis. Who discovered sweetness of urine form
diabetic in 1675.
 In most of the cases diabetes develops due to deficiency of insulin.
Definition:

7. 
Mechanism Of Too Much Sugar In Blood

8. 
The healthy body turns
carbohydrate such as
bread, rice and potato
into glucose. The body
need glucose, or blood
sugar, for energy
The blood stream delivers
glucose to body cells. then
the waits for the pancreas to
do its job
The pancreas is a small organ
behind the stomach.it
contains glands called the
islets of Langerhans. These
glands are made up of special
cells .
Beta cells are one type of cells in the
islets of Langerhans. After a person
eats, glucose foods the bloodstream.
The beta cells quickly produce a
hormone called insulin. Hormones are
chemical produced by the body. The
insulin allows glucose to pass into the
body cells.
in diabetes, the body makes glucose as
usual. The glucose enters the blood
stream but then something goes wrong.in
some people, pancreas makes too little
insulin or none at all. In others the
pancreas makes insulin, but the body
doesn’t use it well. Either way, the
glucose cannot get into the body’s cells. It
builds up in the blood. Eventually it
passes out of the body in urine

9. Baqai institute of Diabetology and endocrinology, Karachi Pakistan
 The international Diabetes federation (IDF) estimates that there
are approximately 7.1 million people with diabetes in Pakistan.
Ranking it with seventh worldwide, and with the highest number
of adults with diabetes.
 This number is predicted to increase to 13.8 million by 2030.
 These predictions are based upon population based studies
conducted in Ural and urban areas of the four province of
Pakistan
Prevalence:
BOOOK :Prevention of diabetes edited by peter Schwarz, Perasuna Reddy

10. 
 Diabetes ranging from 3.7-16.2% in men
 And in women 4.8- 8.2%
 Impaired glucose tolerance ranges from 4.5-8.2% in men and 5.8-14.3% in women
 The frequency of people with coronary arteries is 15.1%
 Peripheral vascular disease 5.5%
 Cerebrovascular disease 4.5%
 Retinopathy 4% with foot ulcers
EPIDEMOLOGY:

11. 
Classifications of diabetes

12.  there are several forms of diabetes mellitus which occurs due to different causes.
 Diabetes may be primary or secondary
 Primary diabetes is unrelated to other disease
 Secondary diabetes occurs due to damage or disease of pancreases by another disease
or factor
 Recent classification divides primary diabetes mellitus into two types
Classification:

13. Diabetes mellitus is classified into:
 Type 1
 LADA
 MODY
 Type 2
 Gestational Diabetes
 Pre-diabetic
Classifications:

14.  Type 1 diabetes mellitus occurs due to deficiency of insulin because of destruction of beta- cells
in islets of Langerhans. This type of diabetes mellitus may occur at any age of life. But it usually
occurs before 40 years of life, person affected by this require insulin injection that’s why this is
called insulin dependent diabetes mellitus.
 When it occurs in childhood or infancy it is called JUVENILE DIABETES.
 It is associated with acidosis and ketosis
Type 1 diabetes:

15. 1.Latent autoimmune diabetes in adults:
LADA or slow onset diabetes has slow onset and slow progress then IDDM and it occurs later
in life after 35 years.
2. Maturity onset diabetes (MODY):
It occurs in young individuals, it occurs before 25 years.
It is due to heredity defects in insulin secretion.
Other forms:

16.  It is called non-insulin diabetes mellitus
 It can be controlled by oral hypoglycemic drugs
 It usually occurs after 40 years
 It is associated with obesity
Type 2:

17.  In this type beta cells functions are normal, blood level of insulin are normal.
Common cause of insulin resistance are:
 Genetic disorder
 Lifestyle changes
 Physical inactivity
 stress
Causes:

18.  Gestational diabetes
 Pre- diabetes
Other forms:

19. 

20.  It is also called chemical, subclinical, latent or borderline diabetes
 It is a stage between normal condition and diabetes.
 The person doesn’t show signs of diabetes
 Though pre-diabetes is reversible , the affected person are at risk of diabetes type 2
diabetes mellitus.
 It is also called impaired glucose tolerence
Pre-diabetes:

21.  Pre-diabetic is diagnosed if a person has:
 A fasting glucose level between 100-125 mg/dl
 Blood glucose level between 140-199 mg/dl two after eating high carbs (200 mg/dl
considered as diabetes)
Diagnosis:

22.  Gigantism, Cushing syndrome, acromegaly
 Liver disease such as hepatitis c
 Excessive use of drugs like steroids, diuretic, beta blockers, chemotherapy drugs etc
 Autoimmune disease such as celiac disease
Secondary disorder:

24. 
 During pregnancy the human body undergoes changes and there is a huge amount of
metabolic stress due to significant of growing another human being inside you.
 Most commonly occurs around 28 weeks of pregnancy.
Introduction:

25. 
 It just means that the body is unable to control blood sugar level within normal range and
this is the essence of gestational diabetes
Does it mean that you have been eating
sugar too much?

26.  The goal standard for diagnosing gestational diabetes is a specific test called an oral
glucose tolerance test.
 The test should ideally done at 24-28 weeks pregnancy, with testing being performed
earlier on in pregnancy if the person has had GDM earlier.
How is gestational diabetes
diagnosed?

27.  A blood test is done to see background blood glucose level (when you have fasted)
 A sugary drink is then taken and the patient has to relax for next 2 hours
 A final blood test is taken and the two blood test are compared to see how well the body
was able to handle the large glucose load
 The normal range for blood glucose levels in bloodstreams are roughly 3.0 to 5.0
milimoles (mmols) per liter when a person has not been eating and roughly 5.0 to 7.0
mmols per liter after having a meal.
Diagnosis:

28.  Urinary glucose monitoring
 Fasting blood glucose and random methods of measurements
Test which should not be used for GDM:

29.  Lucozade test
 It is a test to tell whether you are at risk of GDM.
test steps:
1. You will be asked to drink original Lucozade
2. One hour after you will have a blood test to measure blood glucose
3. During hour you’ll have nothing else except sips of water
4. Is the results are high then you are at risk of getting diabetes
5. Then OGTT will be recommended
Screening test:

30. 
Diagnostic level for diagnosis of
GDM:
Gestational Diabetes: Your survival guide to diabetes in pregnancy
By Paul Grant

31.  It has been recommended by NICE (NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE)
that a specific blood test for something called hemoglobin A1c (HbA1c) is performed in all the
women with GDM.
 Hba1c relates to something called ‘glycosylation of red blood cells’ (hemoglobin) as a measure of
how much glucose remain in blood for few months in bloodstream
 Red blood cells lives for 120 days on average, whizzing around the circulation picking up glucose as
they go.
What about HbA1c test?

32.  When testing in pregnancy (usually between 24- 28 weeks), the dose of 50 – 100 grams of
glucose solution is used and then blood sample is drawn of at least 8-12 hours of fast and
time intervals after the glucose rich solution
Oral glucose test:
Book: Medifocus Guidebook On: Type 2 Diabetes Mellitus

33. 

34.  Family history of diabetes
 Obesity
 Age >45
 Hypertension
 HDL <35mg per dl
 Triglyceride > 250 mg per dl
 Women with polycystic syndrome
 History of Gestational diabetes
Risk factor for type 2 :

35. 
Diagnosis of diabetes:

36.  Weakness and fatigue
 Weight loss
 Excessive thirst
 Frequent urination
 Blurred vision
 Excessive hunger
Sign and symptoms of type 2:

37.  Hypoglycemia is also called insulin shock
 It occurs when blood glucose levels fall
 Caused by insufficient intake of food, exercise, alcohol consumption
 Using occur in person using insulin
 Glucose level <65 mg/dl
Hypoglycemia:

38.  Sweating
 Headache
 Hunger
 Thirst
 Rapid heart beat
 Coma (rare)
 Death (rare)
 Seizures (rare)
 Weakness
 Mood changes
Symptoms:

39. 

40.  Loss of glucose in urine
 When glucose level rises above 180mg/dl in blood , glucose appear in urine.
Glycosuria:
Book: Essentials of Medical Physiology, jaypee

41. Polyuria: frequent urination
Polydipsia: excessive water intake
Polyphagia: excessive food intake
Asthenia: body weakness
Acidosis: large amount of fats is broken down to release energy it causes the formation of
ketoacidosis that lead to acidosis, then ketoacidosis in combination with sodium ions through
urine (ketouria)
Other:

42.  Acetone breathing: in case of severe ketoacidosis, acetone are expired in air giving the
fruity breath odor, it is life threatening condition of severe diabetes
 Circulatory shock: osmotic diuresis leads to dehydration it is called circulatory shock
 Osmotic diuresis: it is due to osmotic effect, excessive glucose in renal causes the effect,
it effects the absorption of water that leads to polydipsia and polyuria.
Cont.:

43. 

44. ACUTE COMPLICATIONS:
 Hypoglycemia.
 Diabetes ketoacidosis(DKA) type 1
 Non ketotic hyperosmolar coma (type 2)
CHRONIC COMPLICATIONS:
 Retinopathy
 Nephropathy
 Neuropathy
COMPLICATIONS OF DIABETES

45.  Coronary artery disease.
 Cerebral ischemia .
 Peripheral vascular disease.
can be prevented by glycemic control.
Macrovascular complications

46.  Occurs in mainly type 1 diabetes
Characterized By:
 Hyperglycemia (> 250mg/dl)
 Positive ketone bodies in urine.
Can be managed by:
 Fluid replacement by IV(NaCl)
 Insulin infusion.
 Antibiotics if infections are present.
DIABETIC KETOACIDOSIS

47. 
Mainly type 2 diabetes
Characterized By:
 Hyperglycemia 600-2400mg/dl
 There is no ketone bodies
Managed by:
 Fluid replacement.
 Insulin infusion.
HYPEROSMOLAR NON-KETOTIC COMA

48. It is nerve damage that is caused by diabetes.
In this condition patient have:
 Paraesthesia in feet and hands.
 Sense of numbness in feet.
 Burning sensations in sole.
Managed By:
glycemic control
DIABETIC NEUROPATHY:

49.  The kidney may be damaged by diabetes in three main ways:
1. Thickening of glomerular basement membrane which leads to proteinuria.
2. Necrosis of tissue due to decrease blood supply.
3. Any infection occur in the kidney.
DIABETIC NEPHROPATHY:

50.  Low protein diet.
 Managed insulin dose.
 Control hypertension.
MANAGED BY:

51.  It increase thickness of basement membrane of retinal capillaries.
 Cataract
Managed By:
Glycemic Control.
DIABETIC RETINOPATHY:

52. 
r
MEDICAL TEST

53.  Fasting glucose test
 Oral glucose test
 Hemoglobin A1c test
 Random blood glucose test
Diagnostic test

54.  After fasting for a period of 12-24 hours a sample of blood is taken from the patient and
level of glucose is measured
 Normal fasting glucose level are lower than 100mg/dl and are range in 70 to 90 mg/dl
 Fasting glucose level 100-126 mg/dl is signals pre-diabetic
 Fasting glucose level lower than 70 mg/dl signals hypoglycemia
Fasting plasma glucose test:

55.  It is used to detect pre-diabetes and gestational diabetes
 A person glucose is measured after a fast of 8- 12 hours
 Normal glucose level below 140mg/dl
 Pre-diabetes levels between 140- 200 mg/dl
 Diabetes levels that exceed 200mg/dl
Oral glucose test

56.  The HbA1c test is done in doctor’s office.
 A sample of blood is drawn from patient’s arm and the blood sample is sent to laboratory
to measure the hemoglobin A1c level.
 The results are expressed in percentage of the sugar that is bound to hemoglobin
 For people without diabetes, the normal range A1c usually in the range of 4.5-6.0%
 6-6.5% indicates pre-diabetes
 Type 2 have greater than 6.5%
Hemoglobin A1 test:

57.  It can be done at any time
 The sample of blood is drawn from patients arm
 Blood glucose levels are 120mg/dl or higher indicates diabetes
Random blood glucose test:

58.  It is also called glucometer
 This procedure is easy and can be done at home
 A drop of blood is obtained with a lancet and placed on the test strip and inserted into
small, hand held machine
 Test strips are available in many pharmacies
Finger stick blood monitoring:
Book: Medifocus Guidebook On: Type 2 Diabetes Mellitus

59. 

60.  To promote and support helpful eating patterns, emphasizing a variety of nutrient dense foods and appropriate
portion sizes to improve overall diet and specifically to:
 Attain individualized glucose, blood pressure and lipid goals.
 Achieve and maintain body weight goals
 Delay or prevent complications of diabetes.
 To address individualized needs based on personal and cultural preferences, health literacy and numeracy,
access to healthy food choices willingness and ability to make behavioral changes. 0. To maintain the pleasure of
eating by providing positive messages about food choices while limiting food choices only when indicated by
scientific evidence. 0. To provide the individual with diabetes with practical tools for day to day meal planning
rather than focusing on an individual.
Medical nutrition therapy Goals

61. •There is no ideal percentage of calories from carbohydrates for people with diabetes
•Total energy intake rather than source of energy is a priority
•Look carbohydrate diet may seem to be a logical approach to lower post prandial glucose
•However food that contains carbohydrates ( legumes, whole grain, fruits and veggies, dietary fiber) are
excellent sources without added fats and sugars.
•
Carbohydrate Intake

62.  The total amount of carbs eaten at a meal regardless if the source is starch or
sucrose is the primary determinant of post prandial glucose
 •Starches are 100% metabolized into glucose whereas sucrose is metabolized
50% into glucose and 50% into fructose( which has lower glycemic response)
that is stored in the liver as glycogen.
 •Beverage are highly avoided due to added sugars along with sports drinks.
CONT.

63. 
•The amount of protein normally consumed by diabetics has minimal acute effects on glycemic
response, lipids, hormones and no long term effect on insulin requirement.
•Non essential amino acids undergo gluconeogenesis which is likely stored in liver as glycogen
rather than entering circulation
•When glycolysis occurs it is unknown that the source of glucose was protein or carbs
•Adding excess protein to diet doesn’t prevent hypoglycemia but adds unnecessary and usually
unwanted calories neither does it slows down the absorption by adding with carbs
Proteins

64. 
•Evidence lacks in recommending a high fiber diet to diabetic patients
•The recommendation of daily fiber is almost same as the whole population.
•Date and containing 44 to 50 g of fiber daily improves glycemia
•Consumption of grains should be half from whole grains
Fiber:

65. 
• Goals should be individualised
• Type of fats consumed is more important that totals fats in-terms of metabolic goals and
influencing CVD risks
• Amount should be moderate to maintain or loose weight (27-30%)
• MUFA are associated with improved glycemic control and improved CVD risk factors
• PUFA and MUFA are recommended as a substitute for saturated fats
• The amount of saturated, trans fats cholesterol is same as the normal population
Fat:

66. 
• No clear evidence established for benefit from vitamins and minerals in
diabetics
• Insufficient evidence to Support the use of micronutrients supplements such
as that of chromium, magnesium, vitamin D.
Micronutrients:

67. 
Herbs for diabetes

68.  It is useful for diabetes type 2 patients
 The gel active ingredients include polysaccharide and glycoproteins helps to transport
excess glucose from blood into tissue cells where it is needed
 Half tablespoon aloe gel is taken daily
 But it should be used by breastfeeding or pregnant women
Aloe Vera:
American Diabetes Association Guide to Herbs and
Nutritional Supplements ...

69.  It is used to make oral form of supplement for treating diabetes type 2
 It is used for weight loss
 But its effect on glucose has not been confirmed
 No side effects
 For GDM consult the doctor
Banaba leaves:
American Diabetes Association Guide to Herbs and
Nutritional Supplements ...

70.  Improves ability to respond to diabetes type 2
 Lowers blood glucose level
 1 teaspoon of cinnamon powder is used daily
 For GDM consult the doctor
Cinnamon:
Book: Journal medical association of Thailand

71. 
Myths and Facts :

72. 
Myths Vs Facts
Myth
 Gestational diabetes means you will
develop diabetes.
Fact
 If you had gestational diabetes during your
pregnancy, you are at greater risk for
developing diabetes after you give birth—but
this is not written in stone, Rodriquez says,
“Your body may go back to regulating blood
sugar properly after delivery,” she says. Make
sure your doctor checks your blood sugar
during your annual well-visits so you can catch
any changes early.

73. 
Myths Vs Facts
Myth
 Every diabetic will need
insulin therapy.
Fact
 Not everyone with type 2 diabetes will
end up needing insulin to control blood
sugar,” says Rodriguez.
 Other medications and lifestyle changes
such as weight loss and regular exercise
may be enough to manage your
diabetes.

74. 
Myths Vs Facts
Myth
 Thin people don’t get type 2
diabetes.
Facts
 While some 85 percent of people with type 2 diabetes
are overweight or obese, that means 15 percent of
people with diabetes are at a healthy weight.(Harvard
Health Publications).
 In fact, a 2012 study in JAMA found that normal-weight
people with type 2 diabetes have double the risk of
dying from heart disease and other causes than
overweight people with diabetes.
 Excess fat clings to your abdominal organs, where it
affects the production of inflammatory compounds that
affect your liver and pancreas and could lower your
insulin sensitivity, putting you at risk of type 2
diabetes(Women’s Health magazine)

75. 
Myths Vs Facts
Myth
 There is no way to prevent
diabetes.
Fact
 Pre diabetes is a wake-up call that you are at risk for
developing diabetes. It occurs when your blood sugar
or glucose is higher than it should be, but not quite at
diabetes level—yet.

A simple blood test can tell if you have prediabetes and
get you on the path to prevention. These are the best
and worst foods to turn the table on prediabetes.

76. 
Myths Vs Facts
Myth
 All people with diabetes should
follow the same diet.
Fact
 There is no one-size-fits-all diet for people
with diabetes in the same way that there is no
single diet for people without diabetes, Dr.
Sanchez says.
 There are many styles of eating that can help
manage diabetes including a Mediterranean-
style diet that is rich in whole grains,
vegetables, healthy fats, and lean proteins.

77. 
Myths Vs Facts
Myth
 Diabetics have to follow a
strict: no-sugar diet.
Fact
 sugar is not off the table, either for type 1 or
type 2 diabetes.

With type 2 diabetes, the key is moderation;
keep sweets a small portion of your overall
diet and fill the rest with fiber-packed whole
grains, veggies, and lean protein.

78.  https://books.google.com.pk/books?id=p8DYAqhYSe0C&pg=PT95&dq=diabetes+in+pakistan&hl=en&sa=X&ved=0ahUKEwjF-
fmD4PbeAhWBRY8KHX95DTkQ6AEINjAD#v=onepage&q=diabetes%20in%20pakistan&f=false
 https://books.google.com.pk/books?id=A8DA3oPHzQAC&printsec=frontcover&dq=diabetes&hl=en&sa=X&ved=0ahUKEwjXg5eF2fbeAh
WKT30KHRFBBlIQ6AEINjAD#v=onepage&q=diabetes&f=false
 https://www.diabetesselfmanagement.com/about-diabetes/diabetes-basics/12-diabetes-myths-debunked/
 https://www.rd.com/health/conditions/diabetes-myths/
 https://books.google.com.pk/books?id=i8vIBAAAQBAJ&printsec=frontcover
 Short textbook of medical diagnosis and management by Inam Danish 11th edition.
 Davidson medicine
 Krause’s Medical Nutrition Therapy
 Gestational Diabetes: Your survival guide to diabetes in pregnancy
References:

79.  Medifocus Guidebook On: Type 2 Diabetes Mellitus
 https://books.google.com.pk/books?id=Boh5o72fABIC&pg=PA22&dq=type+2+diabetes+mellitus+tes
t+normal+range&hl=en&sa=X&ved=0ahUKEwjCiN_imqTfAhUD36QKHW_VD34Q6AEITzAH#v=onepa
ge&q=type%202%20diabetes%20mellitus%20test%20normal%20range&f=false
 Davidson medicine
 https://books.google.com.pk/books?id=i8vIBAAAQBAJ&printsec=frontcover
 https://books.google.com.pk/books?id=GYYsDQAAQBAJ&printsec=frontcover&dq=herbs+for+diab
etes&hl=en&sa=X&ved=0ahUKEwi9_KnM0aTfAhUP1BoKHQrfBVEQ6AEINzAD#v=onepage&q=herbs
%20for%20diabetes&f=false
References:

80.  https://books.google.com.pk/books?id=Xqw5_Uv9EOcC&pg=PT218&dq=cinnamon%5D+for+dia
betes&hl=en&sa=X&ved=0ahUKEwjN2r_N1qTfAhWjXhUIHZR_D3kQ6AEIKjAA#v=onepage&q=
cinnamon%5D%20for%20diabetes&f=false

81. 
Thank You!