Diabetes is a condition that impairs the body’s abiliy to process blood glucose.
“It is a chronic metabolic disorder which is characterized by chronic
hyperglycemia(increase glucose level in blood ),glycosuria, hyperlipemia, and negative
nitrogen balance, and altered metabolism of carbohydrate, lipids, and proines, and
increase the risk of vascular complications.”
Acute complications of diabetes are :
Chronic complications of diabetes are :
I. Microvascular disease:Retinopathy;nephropathy;
II. Diabetic foot
3. Etiopathogenesis of diabetes :
1) Type 1 diabetes :-
-B cell destruction, usually leading to absolute insulin deficiency.
2) Type 2 diabetes :-
may range from predominantly insulin resistance with relative
to a predominantly secretory defect with insulin resistance
3) Other specific types :-
Genetic defects of B cell function –
Genetic defects in insulin action –
Diseases of the exocrine pancreas
Drug- or chemical-induced
Uncommon forms of immune-mediated diabetes
Other genetic syndromes sometimes associated with diabetes.
5. Management of diabetes mellitus:-
• Relief from diabetes symptoms.
• Improvement in quality of life.
• Glycemic control.
• Prevention of acute complications.
• Prevention of infections.
• Identification and management of comorbid
conditions like obesity,hypertension and
• Prevention of microvascular complications such as
• Prevention of macrovascular camplications such as
7. Prevention of diabetes
I. Primordial prevention : is to reduce risk factors for
diabetes, e.g, reducing or preventing obesity
II. Primary prevention : targets people having prediabets
to prevent the onset of diabetes. It includes a healthy
diet, weight controland use of metforming if required.
III. Secondary prevention : prevent the onset of
complications in patients with diabetes.
IV. Tertiary prevention: of diabetes control physical
disability and rehabitation measures in patient with
8. Management of Type 1 DM
• Strict meal plan.
• Physical exercise
• Only Insulin
Management of Type 2 DM
• Strict meal plan.
• Physical exercise.
• Oral hypoglycaemic agents.
9. Non-Pharmacological Management of Diabetes :-
Take high proteinous diet and high fat and carbohydrate
Do not eat sweet food like jam,chocolate,cake,sweets cream
etc. Thay raise the levels of triglycerides in body.
Boiled or steam food to be eaten. Do not use excess oil for
Avoide alcohol intake.
Use of oils and colors to be avoided for making sweets.
Ample amount of water should be taken daily.
Exercise should be done regularly.
10. Pharmacological management :-
Oral hypoglycemic drugs : tolbutamide,chloropropamide,Glipizide.
Herbal drugs : Guargum,stevia,paneer booti
Surgery : surgery is done rarely. In this there is transplantation of β-cell of
pancreas, weight loss surgery and kidney transplantation.
12. 1. Insulin is a hormone that occurs naturally in the body
2. carbohydrates are broken down into blood glucose,
3. Which is where the body gets most of its energy
4. The pancreas makes and releases insulin to help the body use or
store that glucose and reduce the blood glucose level
13. Types of insulin
1. Rapid acting insulin: starts its action with in 5 minutes and peaks at
2. Short acting insulin: starts its action with in 30 minutes can be
taken before meals.
E.g. regular (Humulin R)
3. Intermediate acting: often used with rapid or short acting to take
care of insulin needs over long period usually half a day.
E.g. NPH Insulin
4. Long acting insulin: Its usually taken in the morning and balance
blood glucose level for a full day, used with rapid or short acting
5. Pre-mixed insulin: mixes short acting and intermediate acting
insulin and is usually taken twice a day, just before meals and used
mainly for people who have difficulty mixing there own insulin.
E.g. human mixtard
14. THYROID DISORDERS
Thyroid disorders are linked to a condition in which
the thyroid gland, a butterfly. shaped gland, stops
Various metabolic functions of our body are
regulated through thyroid glands The thyroid gland is
responsible for the production of two important
thyroid hormones: triedothyronine (T3) and thyroxine
17. 1. Hypothyroidism: Any state in which a person's thyroid
hormone production is below normal is known as hypothyroidism
2. Hyperthyroidism: Hyperthyroidism (excessive thyroid
hormone) is a condition in which there is an excessive amount of
18. Etiopathogenesis :
Hypothirodism : depending on causes, hypothyroidism is two types:primary
hypothyirodism and secondary hypothyirodism.
Causes of primary hypothirodism:
Iatrogenic hypothyroidism due to iodine 131.
Causes of secondary hypothyroidism:
19. Risk factors:
Are a woman.
Have a family history of thyroid disease.
Have an autoimmune disease, such as type 1 diabetes or
Have received treatment for hyperthyroidism.
Received radiation to your neck or upper chest.
Have had thyroid surgery.
20. • fatigue.
• weight gain.
• Trouble tolerating cold.
• joint and muscle pain.
• dry skin or dry, thinning hair.
• heavy or irregular menstrual periods or fertility
• slowed heart rate.
• Puffy face,hands,and feet
Symptom of hypothyroidism :
22. Diagnosis and investigation of thyroid disorders :-
1. Thyroid-stimulating harmone test: Increased TSH level
indicates hypothyroidism and decreased TSH level
2. T4: Thyroxine test: Low T4 indicates
hypothyroidism,wheres high T4 levels indicate
3. FT4: Free T4 or Free thyroxine tests
4. T3: Triiodothyronine tests.
5. FT3: Free T3 or Free triiodothyrinine.
6. Antithyroid peroxidase anti detection in autoimmune
23. Non-Pharmacological Management:
1. Non-pharmacological management of Myxoedema Coma involve
use of warm blanket and mechanical ventilation for respiratory
2.Non-pharmacological management of Graves' Orbitopathy
Maintain euthyroid state (The state of having normal
thyroid gland function)
Stop smoking (Smoking increases risk for Graves'
Avoid: Bright light, dust.
Sleep with head elevated.
Apply artificial tears and simple eye ointment at night.
25. Patients with recurrent thyrotoxicosis following surgery or when
surgery is refused or contraindicated.
Toxic multinodular goitre
Radioactive Iodine (RAI) Therapy:
Radioactive iodine therapy is used to treat thyrotoxicosis (hyperthyroidism). This
treatment damages the cells of thyroid gland, preventing it from making high
levels of thyroid hormones.
Patients with contraindications to antithyroid agents.
Patients who failed to achieve normal thyroid hormone
levels with antithyroid agent
Patients with comorbidities increasing surgical risk.
Females planning pregnancy in the future
This therapy is contraindicated in pregnant and
26. Surgery (Thyroidectomy) :
Thyroidectomy is the surgical removal of the hypersecreting thyroid gland.
This will stop synthesis and release of thyroid hormones permanently. This
will make it necessary to take thyroid replacement hormones lifelong.
A large thyroid gland (> 80 g)
Patients who failed to achieve normal thyroid hormone levels with
27. Pharmacological Management:
To restore normal thyroid hormone concentrations in tissue.
To provide symptomatic relief.
To prevent neurologic deficits in newborns and children,
To reverse biochemical abnormalities of hypothyroidism.
Tab.L- thyroxine-start with 50-100 mcg/day
Adjust by 12.5 or 25 mcg increments if TSH is high; decrement of the
same if TSH is low
During pregnancy, dose of L-thyroxine should be increased by 50%
and return to previous level after delivery.
Adjust dose based on TSH levels.
• L-thyroxine should be taken as a single daily dose, at least 30
28. The overall therapeutic objectives are:
Pharmacotherapy of Hyperthyroidism:
To eliminate the excess thyroid hormone.
To minimize the symptoms and
To minimize long-term consequences of hyperthyroidism
Type and severity of hyperthyroidism:
Patient age and gender.
Existence of nonthyroidal conditions, and
Response to previous therapy.