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- 1. Diabetes Mellitus By Pete Kelly Diabetes Specialist Nurse Diabetes Education Services
- 2. Any burning questions? Diabetes Education Services
- 3. Definition ‘Diabetes Mellitus is a chronic disease caused by deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 Diabetes Education Services
- 4. Definition ‘Diabetes Mellitus is a chronic disease caused by deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON Diabetes Education Services
- 5. Definition ‘Diabetes Mellitus is a chronic disease caused by deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON Diabetes Education Services
- 6. Definition ‘Diabetes Mellitus is a chronic disease caused by deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON MELLITUS = MEANS SUGAR, SWEET OR HONEY Diabetes Education Services
- 7. UK Prevalence • Currently 2.8 million people are diagnosed with diabetes • Further 850,000 who don’t know they have diabetes • By 2010 it is anticipated there will be 3 million diagnosed Diabetes UK 2009 • Within EU ~ estimated to be 25 million people with diabetes and the same amount Diabetes undiagnosed Education Services
- 8. Diagnosis of Diabetes Diabetes symptoms (polyuria, polydipsia) Random Laboratory venous plasma glucose > 11.1 mmol/l. Random Laboratory fasting venous plasma glucose > 7.0 mmol/l. Advisable to have two tests results to confirm diagnosis, or one oral glucose tolerance test. Oral glucose tolerance test (OGTT). Patient takes 75g oral glucose and two hours later has bloods taken, if venous plasma glucose >11.1 mmol/l, Diabetes is diagnosed. More recently the WHO have agreed to use the HbA1c as a method of diagnosis Diabetes Education Services
- 9. • Types of diabetes Type One • Type Two • Mature onset of diabetes in young (MODY) • Gestational diabetes mellitus • Secondary to genetic conditions Diabetes Education Services
- 10. The physiology of normal • The pancreas controls blood glucose levels. • It lies behind the stomach. • The pancreas does two jobs: 1. Produces pancreatic juices which aids food digestion. Alpha cells release Glucagons, which increases blood glucose by prompting the release of glucose (from the Liver) into the blood. Beta cells release Insulin, a hormone which encourages the absorption of glucose into muscle cells, fat cells, and Diabetes connective tissue cells etc, this reduces blood sugars. Education Services
- 23. Causes and Risk Factors Type 1 Type 2 Diabetes Education Services
- 24. Causes and Risk Factors Type 1 Type 2 Diabetes Education Services
- 25. Causes and Risk Factors Type 1 Type 2 • Being overweight •Close member of the family has type 2 diabetes •Waist measurement •Hypertension •POS and being overweight •Impaired glucose tolerance •Gestational diabetes •Mental health problems Diabetes Education Services
- 26. Complications of all types Diabetes Education Services
- 27. Complications of all types Vascular disease Ischaemic heart disease Gangrene / amputations Nerve Damage (Neuropathy) Eye Disease (Retinopathy) Cataracts Diabetes Blindness Education Services Renal disease (Nephropathy)
- 28. Newly diagnosed Type 1 Diet, exercise + Insulin Type 2 Diet and exercise for 3 months ↓ Oral hyperglycaemic agent: Sulphonylurea for those not overweight (eg. Gliclazide, Glibenclamide) Biguanide for those overweight (eg. Metformin) Can use together if not individually effective ↓ Newer agents – Glitazones, Gliptins and GLP-1 ↓ Diabetes Education Insulin Metformin can also be added if patient is overweight Services
- 31. Diabetes diet Diabetes Education Services
- 32. Hypoglycaemia Diabetes Education Services
- 33. Hypoglycaemia Classed as a blood sugar below 4mmols/l. Symptoms of a hypoglycaemic event. Sweating Shaking Drowsiness Vagueness Mood changes Diabetes Education Services
- 34. Treatment of a Hypoglycaemic Episode. Diabetes Education Services
- 35. Treatment of a Hypoglycaemic Episode. • If the patient is conscious provide 4 dextrose tablets or 20mls of polycal or 50mls of lucozade. • If the patient is conscious but confused or uncooperative treat with Glucogel (Hypostop). • Provide a carbohydrate snack when the patient is alert again. (ie sandwiches, toast or bowl of cereal. • Continue to test the blood sugar every 20 minutes until stable. Diabetes • Expect higher blood sugars that day Education Services • Remember do not omit the next insulin dose a
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- Some of the risks factors associated with Type 2 diabetes are out of your control while others, such as being overweight, you can act on to reduce the risk of developing diabetes. You should ask your GP for a test for diabetes, if you:\nare white and over 40 years old , are black, Asian or from a minority ethnic group and over 25 years old \nhave one or more of the following risk factors.\nThe risk factors\nA close member of your family has Type 2 diabetes (parent or brother or sister). \nYou're overweight or if your waist is 31.5 inches or over for women; 35 inches or over for Asian men and 37 inches or over for white and black men. \nYou have high blood pressure or you've had a heart attack or a stroke. \nYou're a woman with polycystic ovary syndrome and you are overweight. \nYou've been told you have impaired glucose tolerance or impaired fasting glycaemia. \nIf you're a woman and you've had gestational diabetes. \nYou have severe mental health problems.\n\nSome things that do not cause diabetes\nEating sweets and sugar does not cause diabetes,but eating a lot of sugary and fatty foods can lead to being overweight. \nYou cannot catch diabetes, like a cold. \nStress does not cause diabetes, although it may make the symptoms worse in people who already have the condition. \nAn accident or an illness will not cause diabetes but may reveal diabetes if it is already there.\n
- Some of the risks factors associated with Type 2 diabetes are out of your control while others, such as being overweight, you can act on to reduce the risk of developing diabetes. You should ask your GP for a test for diabetes, if you:\nare white and over 40 years old , are black, Asian or from a minority ethnic group and over 25 years old \nhave one or more of the following risk factors.\nThe risk factors\nA close member of your family has Type 2 diabetes (parent or brother or sister). \nYou're overweight or if your waist is 31.5 inches or over for women; 35 inches or over for Asian men and 37 inches or over for white and black men. \nYou have high blood pressure or you've had a heart attack or a stroke. \nYou're a woman with polycystic ovary syndrome and you are overweight. \nYou've been told you have impaired glucose tolerance or impaired fasting glycaemia. \nIf you're a woman and you've had gestational diabetes. \nYou have severe mental health problems.\n\nSome things that do not cause diabetes\nEating sweets and sugar does not cause diabetes,but eating a lot of sugary and fatty foods can lead to being overweight. \nYou cannot catch diabetes, like a cold. \nStress does not cause diabetes, although it may make the symptoms worse in people who already have the condition. \nAn accident or an illness will not cause diabetes but may reveal diabetes if it is already there.\n
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