Diabetes mellitus

Diagnosis, monitoring and

complications.

Mr. Shankar Shahi, Lab Technologist

Pathology dep.
APC, Ktm

What is diabetes?

Diabetes mellitus (DM) is a metabolic

disorder caused by the inability of the
pancreases to produce enough insulin for
the body or the body fails to use insulin
properly.
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Regulation of Plasma
Glucose Level

How Insuline Decrease Plasma

Glucose Level?

Classification of DM
1. Type 1 DM
It is due to insulin deficiency
and is formerly known as.
Type I
Insulin Dependent DM (IDDM)
Juvenile onset DM

2. Type 2 DM
It is a combined insulin
resistance and relative
deficiency in insulin secretion
and is frequently known as.
Type II
Noninsulin Dependent DM (NIDDM)
Adult onset DM

2. Etiology of Type 2 Diabetes

3. Gestational Diabetes
Mellitus (GDM):
Gestational Diabetes
Mellitus (GDM)
developing during some
cases of pregnancy but
usually disappears after
pregnancy.

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Who are
at risk?

Risk
Factors

Obesity
Race
History of CVD
HTN
Physical inactivity
Familial history
Polycystic Ovary Syndrome
Gestational Diabetes

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Sign & symptoms

Clinical Presentation

Type 1 DM

Type 2 DM

Polyuria
Polydipsia
Polyphagia
Weight loss
Weakness
Dry skin
Ketoacidosis

Patients can be asymptomatic

Polyuria
Polydipsia
Polyphagia
Fatigue
Weight loss
Most patients are discovered
while performing urine glucose
screening
15

Lab diagnosis

Laboratory Tests

Urinalysis
1.Glucosuria

To detect glucose in urine by a

paper strip
Semi-quantitative

2. Ketonuria
To detect ketonbodies in urine by a paper
strip
Semi-quantitative

3. Urine micro albumin.

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Laboratory Tests (Contd)

Blood Test:
Fasting blood glucose
Glucose blood concentration in samples
obtained after at least 8 hours of the last meal

PP Blood Test: exact 2 hours after a regular

meal. No food beverage in between 2 hours.
Random Blood glucose
Blood Glucose concentration in samples obtained at any time.
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Laboratory Tests (Contd)

Oral Glucose tolerance test (OGTT/GTT)
75 gm of glucose are given to the patient with 300 ml of water
after an overnight fast
Blood samples are drawn 1, 2, and 3 hours after taking the glucose
This is a more accurate test for glucose utilization if the fasting
glucose is borderline

Glucose challenge test (GCT): The glucose challenge

test is done during pregnancy to screen for gestational
diabetes.
50 gm of glucose are given to the patient with 300
ml of water at any time.
Blood sample is drawn exact 1 hours after taking
the glucose
This is a more accurate test for glucose utilization
if the fasting glucose is borderline
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Laboratory Tests (Contd)

Glycosylated hemoglobin (HbA1C)
HbA1C is formed by condensation of
glucose with free amino groups of the
globin component of hemoglobin
Normally it comprises 4-6% of the total
hemoglobin.
Increase in the glucose blood concentration
increases the glycated hemoglobin fraction.
HbA1C reflects the glycemic state
during
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the preceding 8-12 weeks.

(HbA1c
)

Self Monitoring Test

Self-monitoring of blood glucose
Extremely useful for outpatient monitoring
specially for patients who need tight control
for their glycemic state.
A portable battery operated device that
measures the color intensity produced from
adding a drop of blood to a glucose oxidase
paper strip.
e.g. One Touch, Accu-Chek,

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Diagnostic Criteria

This criteria for diagnosis should be

confirmed by repeating the test on a
different day.

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Monitoring
Yearly- hole body check up
3 monthly- F,PP, HbA1c
6 monthly lipid profile, micro
albumin, RFT
EYE test, ECG,ECHO

Complications of Diabetes

Complications
Metabolic complications of low blood glucose levels
(hypoglycaemia) and of high blood glucose levels
(hyperglycaemia).
e.g. Diabetic coma

Damage to small blood vessels (microvascular) leading

in turn to damage of:
retina (retinopathy)
kidney (nephropathy)
nerves (neuropathy)

Damage to the larger arteries (macrovascular) leading

to damage of:
brain (leading to stroke)
heart (leading to coronary heart disease)
legs and feet (leading to peripheral vascular disease)

 Hypoglycemia

low blood glucose (usually below 60mg/dl)

results from too much insulin, not enough food, and/or
excessive physical activity
may occur 1-3 hrs after regular insulin injection

Sign & symptoms

1. Sweating, tremor, pallor, tachycardia,
palpitations and nervousness
caused by release of epinephrine from the CNS when
blood glucose falls rapidly

2. Headache, light-headedness, confusion,

numbness of lips and tongue, slurred
speech, drowsiness, convulsions and coma
caused by depression of the CNS because of glucose
supply of brain cells

1. Give simple sugar orally if pt. is

conscious and can swallow orange
juice, candy, glucose tablets, lump of
sugar
2. Give Glucagon (SQ or IM) if pt. is
unconscious or cannot take sugar by
mouth
3. As soon as pt. regains consciousness,
he should be given carbohydrate by
mouth
4. If pt. does not respond to the above
measures, he is given 50 ml of 50%
glucose I.V. or 1000 ml of 5%-10%

CHRONIC COMPLICATIONS OF
DIABETES MILLETUS
NEPHROPATHY
DAMAGE & OBLITERATION OF CAPILLARIES SUPPLYING
THE KIDNEY

HEART DISEASE
MI FROM ATHEROSCLEROSIS

SKIN CHANGES
DIABETIC DERMOPATHY HYPERPIGMENTED & SCALY
PRETIBIAL AREAS (Acanthosis Nigricans)

LIVER CHANGES
ENLARGEMENT & FATTY INFILTRATION
EYE COMPLICATIONS FROM ANOXIA
CATARACT
DIABETIC RETINOPATHY
RETINAL DETACHMENT

ACUTE COMPLICATIONS OF DIABETES

MILLETUS
DIABETIC KETO-ACIDOSIS (DKA)
INSULIN SHOCK
HYPERGLYCEMIC, HYPEROSMOLAR,
NONKETOTIC (HHONK) COMA

Dawn phenomenon
The dawn phenomenon is a normal rise in blood
sugar as a person's body prepares to wake up.
In the early morning hours, hormones (
growth hormone,cortisol, andcatecholamines)
cause theliverto release large amounts of sugar
into the bloodstream. For most people, the body
produces insulinto control the rise in blood
sugar.
If the body doesn't produce enoughinsulin,
blood sugar levelscan rise. This may cause high
blood sugar in the morning (before eating).

Somogyi effect
If the blood sugar level drops too low in the
early morning hours, hormones (such as growth
hormone, cortisol, and catecholamines) are
released. These help reverse the
low blood sugarlevel but may lead to blood
sugar levels that are higher than normal in the
morning. An example of the Somogyi effect is:
A person who takesinsulindoesn't eat a
regularbedtimesnack, and the person'sblood
sugar level drops during the night.
The person's body responds to the
low blood sugarby releasing hormones that
raise thebloodsugar level. This may cause a
high blood sugar level in the early morning

Diabetes Mellitus
Summary
Treatable, but not curable.
Preventable in obesity, adult
client.
Controllable- DIET and EXERCISE
Diagnostic Tests
Signs and symptoms of
hypoglycemia and
hyperglycemia.
Nursing implications
monitoring, teaching and
assessing for complications.

Any Questions???

Quiz - 1
Abnormally high levels of blood
glucose is called: a) Hypercalcaemia
b) Hyperglycaemia
c) Hypernatremia
d) Hyperinsulinism

Quiz - 2
Excessive amounts of glucose are
converted to glycogen and stored: a) In the stomach
b) In the spleen
c) In the liver
d) In the kidneys

Quiz - 3
Insulin is secreted by:

A. Liver
B. Kidney
C. Pancrease
D. Heart

Quiz - 4

Type 1 diabetes is:

A. Insulin dependent
B. Non Insulin dependent
C. Both A & B
D. Non of the above

Quiz - 5
Amount of glucose required for OGTT
test is.
A. 75 gm
B.50 gm
C. 1.75gm/kg body weight
D. 100 gm

Quiz - 6
Blood sample is collected for PP test
is:
A. After 2 hours of regular meal
B. After 1 hour of break fast
C. Exact 2 hour after a regular lunch
D. any time in between 7am to 7 pm.

MODIFICATION IN LIFESTYLE

Of
course too
much is
bad for U.
O
Y
you
K
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TH