Abstract

CONTENT
Mankind knows Diabetes Mellitus since Diabetes Mellitus
ages. Indian medical History mentions madhumeha in
madhumeha Charak Samhita Charak Samhita (500-700
BC) and Has given description of this disorder in detail.
The following shlok Describes symptoms of diabetes.
Charak mentions a madhumehi person Passes large
amount of sweet urine.
In spite of knowing the disease for so long the reaction of
the Patient at the time of diagnosis remains almost the
same. The moment Of diagnosis brings a lot of
unnecessary despair. It is frightening to the Patient. But
most of the times this reaction is due to misconception
About the disease. India is going to be a country with
largest diabetes Population by year 2025. This would be
apparent from following figure.
Identity card for a DIABETES patient
Classi cation and external resources

Universal blue circle symbol for diabetes.

Diabetes mellitus

, or simply

Diabetes

, is a group of metabolic diseases in which a person hashigh blood sugar , either because
the pancreas does not produce enough insulin , or because cellsdo not respond to the
insulin that is produced. This high blood sugar produces the classicalsymptoms of polyuria
(frequent urination), polydipsia (increased thirst)and polyphagia (increased hunger).There
are three main types of diabetes mellitus (DM).

Type 1 DM

Results from the body’s failure to produce insulin, and currently requires the person to inject
insulin or wear an insulin pump. This form was previously referred to as”insulin-dependent
diabetes mellitus” (IDDM) or “juvenile diabetes”.

●
Type 2 DM

Results from insulin resistance , a condition in which cells fail to use insulin properly,
sometimes combined with an absolute insulin deficiency. This form was previously referred to
as non insulin-dependent diabetes mellitus (NIDDM) or “adult-onset diabetes”.

●
The third main form, gestational diabetes occurs when pregnant women without a previous
diagnosis of diabetes develop a high blood glucose level. It may precededevelopment of type
2 DM.Other forms of diabetes mellitus include congenital diabetes, which is due to genetic
defects of insulin secretion, cystic fibrosis -related diabetes, steroi
Untreated, diabetes can cause many complications. Acute complications include
diabeticketoacidosis and nonketotic hyperosmolar coma . Serious long-term complicationsinclude
cardiovascular disease , chronic renal failure , and diabetic retinopathy (retinal
damage).Adequate treatment of diabetes is thus important, as well as blood pressure control
and lifestylefactors such as stopping smoking and maintaining a healthy body weight

All forms of diabetes have been treatable since insulin became available in 1921, and type
2diabetes may be controlled with medications. Insulin and some oral medications cancause
hypoglycemia (low blood sugars), which can be dangerous if severe. Both types 1 and 2are
chronic conditions that cannot be cured. Pancreas transplants have been tried with limited
success in type 1 DM; gastric bypass surgery has been successful in many with morbid
obesity and type 2 DM..

Classification

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The document provides information about a certificate issued to Mr. Anil Kumar Sahdev for his project
on diabetes mellitus submitted in partial fulfillment of the requirements for a pharmacy degree from
Innovative College of Pharmacy. The certificate confirms that the work was carried out under the
supervision and guidance of Dr. Reni Kapoor, Principal of the Faculty of Pharmacy at Innovative College
of Pharmacy, and Mr. Anil Kumar Sahdev, Assistant Professor at the Department of Pharmacology at
Innovative College of Pharmacy. It further states that no part of the work has been submitted for any
other degree.

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Innovative College Of Pharmacy

Approved by AICTE, New Delhi and affiliated to UP Tech. Uni., LucknowPlot no. 6 knowledge Park -2
Greater Noida -201306

CERTIFICATE

This is to certify that the work contained in this project entitled “

Diabetesmellitus”

Submittedin partial ful llment of the requirements for the Degree of Pharmacy of

Innovative College of Pharmacy (AKTU UNIVERSITY)

Has been carried out during the academicyear2014-2018(Mar-Apr) by

Mr. ANIL KUMAR SAHDEV

Under oursupervision andguidance at the

M. M.G HOSPITAL GT ROAD GHAZIABAD.

It is further stated that no part of this work has been submitted either in partor in full for anyDegree in
Innovative College of pharmacy and is the original work of thecandidate

Forwarded ByDr. (Mrs.) RENI KAPOOR

PrincipalFaculty of PharmacyInnovative College Of Pharmacy

Mr. ANIL KUMAR SAHDEV

Assistant ProfessorDepartment of PharmacologyInnovative College Of Pharmacy

ACKNOWLEDGEMENT

It gives me immense pleasure to express my gratitude and thanks to my respected and beloved teacher
and guide,

Mr. ANIL KUMAR SAHDEV.,

Assistant Professor, Innovative college of pharmacy, Greater Noida for his priceless guidance, affection
and constant encouragement in preparing this dissertation

The inspiration, enthusiasm and passion of attaining higher education is the outcome of themassive
contribution of my mentors who always remained inclined to erect my glimmeringfuture and beckoned
the of mending an extremely scintillating career. And this dissertation is thecomplete reflection of their
efforts

Of course, God helps those, who help themselves and I have tried my level best to perform mywork to
the best of my abilities. In this I had the great fortune to work under auspicious guidanceof

Mr. ANIL KUMAR SAHDEV,

A symbol of versatile personalities and talented skills of hiskind. He set me along the correct path and
was always there at every turn with his wisesuggestion and guidance, which help me to complete this
work within the stipulated time. Aheartfelt thanks to both of them

I acknowledge with great gratitude and support of my Head of Department Asst.

Prof. Mr.ANIL KUMAR SAHDEV.

He established the Department of Pharmacy Practice. He provided all the necessary facilities and
guidance whenever & wherever required

I am highly obliged to

Dr. R. P. SINGH,

Medical Superintendent,

M. M. G Hospital,

GT Road Ghaziabad (up) for their kind support, encouragement and providing necessary facilities
tocarried out my work

.
ABREV AT ON

BP – Blood PressureCI- Confidence IntervalDKK- Danish CrownsGhb- Glycated HemoglobinHbA1c-

Glycated HemoglobinHTA- Health Technology AssessmentsLDL- Low-density lipoproteinLOCF- Last
Observation Carried Forward MINT- Motivational Interviewing Network of TrainersMITI- Motivational
Interviewing Treatment IntegrityOHA- Oral Hypoglycemic AgentsPAID- Problem Areas in DiabetesPCDS-
Perceived Competence for Diabetes ScaleQUOROM- Quality of Reporting of Meta-analysesRCT-
Randomized controlled trialSD- Standard Deviation

SPSS- Statistical Package for the Social SciencesWHO- World Health Organization

INTRODUCTION

DIABETES MELLITUS

Diabetes mellitus

Classi cation and external resources

Universal blue circle symbol for diabetes.

Diabetes mellitus

, or simply

Diabetes

, is a group of metabolic diseases in which a person hashigh blood sugar , either because the pancreas
does not produce enough insulin , or because cellsdo not respond to the insulin that is produced. This
high blood sugar produces the classicalsymptoms of polyuria (frequent urination), polydipsia (increased
thirst)and polyphagia (increased hunger).There are three main types of diabetes mellitus (DM).

Type 1 DM

Results from the body’s failure to produce insulin, and currently requires the person to inject insulin or
wear an insulin pump. This form was previously referred to as»insulin-dependent diabetes mellitus»
(IDDM) or «juvenile diabetes».

Type 2 DM
 Results from insulin resistance , a condition in which cells fail to use insulin properly, sometimes
combined with an absolute insulin deficiency. This form was previously referred to as non insulin-
dependent diabetes mellitus (NIDDM) or «adult-onset diabetes».

The third main form, gestational diabetes occurs when pregnant women without a previous diagnosis of
diabetes develop a high blood glucose level. It may precededevelopment of type 2 DM.Other forms of
diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic
fibrosis -related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of
monogenic diabetes .

Untreated, diabetes can cause many complications. Acute complications include diabeticketoacidosis
and nonketotic hyperosmolar coma . Serious long-term complicationsinclude cardiovascular disease ,
chronic renal failure , and diabetic retinopathy (retinal damage).Adequate treatment of diabetes is thus
important, as well as blood pressure control and lifestylefactors such as stopping smoking and
maintaining a healthy body weight

All forms of diabetes have been treatable since insulin became available in 1921, and type 2diabetes
may be controlled with medications. Insulin and some oral medications cancause hypoglycemia (low
blood sugars), which can be dangerous if severe. Both types 1 and 2are chronic conditions that cannot
be cured. Pancreas transplants have been tried with limited success in type 1 DM; Gastric bypass surgery
has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves
after delivery

Classification

1.1 Type 1 diabetes

1.2
1.3 Type 2 diabetes
1.4

1.3 Gestational diabetes

1.4 Other types

2 Signs and symptoms

2.1 Diabetic emergencies

2.2 Complications

3 Causes

4 Pathophysiology

5 Diagnosis

6 Management

6.1 Lifestyle

6.2 Medications

6.3 Support

7 Epidemiology

7.1 Australia

7.2 China

7.3 India

7.4 United Kingdom

7.5 United States

CLASSIFICATION

Comparison of type 1 and 2 diabetes

Feature Type 1 diabetes Type 2 diabetesOnset

Sudden Gradual

Age at onset

Mostly in children Mostly on adults

Body habitus

Thin or normal

Ketoacidosis

Common Rare

Autoantibodies

Usually present Absent

Concordancein identical twins

50% 90%

Prevalence

10% 90%Diabetes mellitus is classified into four broad categories: type 1 , type 2 , gestational diabetes
and «other specific types». The «other specific types» are a collection of a few dozen individualcauses.
The term «diabetes», without qualification, usually refers to diabetes mellitus. The raredisease diabetes
insipid us has similar symptoms as diabetes mellitus, but without disturbances inthe sugar metabolism (

Insipid us

Means «without taste» in Latin)

The term «type 1 diabetes» has replaced several former terms, including childhood-onsetdiabetes,
juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term»type 2 diabetes»
has replaced several former terms, including adult-onset diabetes,Obesity-related diabetes, and
noninsulin-dependent diabetes mellitus (NIDDM). Beyond thesetwo types, there is no agreed-upon
standard nomenclature

.
Chapter 1

TYPE 1 DIABETES ( INSULIN

DEPENDENT

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the isletsOf
Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-
mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta
cell loss is a T-cell -mediated autoimmune attack. There is no known preventive measure against type 1
diabetes, which causes approximately 10% of diabetesmellitus cases in North America and Europe. Most
affected people are otherwise healthy and of ahealthy weight when onset occurs. Sensitivity and
responsiveness to insulin are usually normal,especially in the early stages. Type 1 diabetes can affect
children or adults, but was traditionallytermed «juvenile diabetes» because a majority of these diabetes
cases were in children.»Brittle» diabetes, also known as unstable diabetes or labile diabetes, is a term
that wastraditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring

For no apparent reason in insulin -dependent diabetes. This term, however, has no biologic basisand
should not be used. There are many reasons for type 1 diabetes to be accompanied byirregular and
unpredictable hyperglycaemia , frequently with ketosis , and sometimesserious hypoglycaemia, including
an impaired counter regulatory response to hypoglycemia,occult infection, gastroparesis (which leads to
erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison’s disease) These
phenomena are believed to occur no morefrequently than in 1% to 2% of persons with type 1 diabetes

TYPE 2 DIABETES

Type 2 diabetes mellitus is characterized by insulin resistance , which may be combined withrelatively
reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve
the insulin receptor . However, the specific defects are not known. Diabetesmellitus cases due to a
known defect are classified separately. Type 2 diabetes is the mostcommon type

.
In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At thisstage,
hyperglycemia can be reversed by a variety of measures and medications that improveinsulin sensitivity
or reduce glucose production by the liver .

GESTATIONAL DIABETES

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving
acombination of relatively inadequate insulin secretion and responsiveness. It occurs in about2%–5% of
all pregnancies and may improve or disappear after delivery. Gestational diabetes isfully treatable, but
requires careful medical supervision throughout the pregnancy. About20%–50% of affected women
develop type 2 diabetes later in life.Though it may be transient, untreated gestational diabetes can
damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight),
congenital cardiac and centralnervous system anomalies, and skeletal muscle malformations. Increased
fetal insulin mayinhibit fetal surfactant production and cause respiratory distresssyndrome .
Hyperbilirubinemia may result from red blood cell destruction. In severe cases, prenatal death may
occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor
induction may be indicated with decreased placental function. A Caesareansection may be performed if
there is marked fetal distress or an increased risk of injuryassociated with macrosomia, such as shoulder
dystocia

A 2008 study completed in the U.S. found the number of American women entering pregnancywith pre-
existing diabetes is increasing. In fact, the rate of diabetes in expectant mothers hasmore than doubled
in the past six years. This is particularly problematic as diabetes raises the

Risk of complications during pregnancy, as well as increasing the potential for the children of diabetic
mothers to become diabetic in the future

OTHER TYPES

Prediabetes indicates a condition that occurs when a person’s blood glucose levels are higher than
normal but not high enough for a diagnosis of type 2 DM. Many people destined to developtype 2 DM
spend many years in a state of prediabetes which has been termed «America’s largesthealthcare
epidemic.»Latent autoimmune diabetes of adults (LADA) is a condition in which type 1 DM develops
inadults. Adults with LADA are frequently initially misdiagnosed as having type 2 DM, based onage rather
than etiology. Some cases of diabetes are caused by the body’s tissue receptors not responding to insulin
(evenwhen insulin levels are normal, which is what separates it from type 2 diabetes); This form is
veryuncommon. Genetic mutations ( autosomal or mitochondrial ) can lead to defects in betacell
function. Abnormal insulin action may also have been genetically determined in some cases.Any disease
that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis
and cystic fibrosis ). Diseases associated with excessive secretionof insulin-antagonistic hormones can
cause diabetes (which is typically resolved once thehormone excess is removed). Many drugs impair
insulin secretion and some toxins damage pancreatic beta cells

SIGN AND SYMPTOMS

Chapter 1

Overview of the most significant symptoms of diabetesThe classic symptoms of untreated diabetes are
loss of weight, polyuria (frequenturination), polydipsia (increased thirst) and polyphagia (increased
hunger).Symptoms maydevelop rapidly (weeks or months) in type 1 diabetes, while they usually develop
much moreslowly and may be subtle or absent in type 2 diabetes.Prolonged high blood glucose can
cause glucose absorption in the lens of the eye, which leads tochanges in its shape, resulting in vision
changes. Blurred vision is a common complaint leadingto a diabetes diagnosis. A number of skin rashes
that can occur in diabetes are collectivelyknown as diabetic dermadromes.

DIABETIC EMERGENCIES

People (usually with type 1 diabetes) may also present with diabetic ketoacidosis , a state of metabolic
dysregulation characterized by the smell of acetone , a rapid, deep breathing knownas Kussmaul
breathing, nausea, vomiting and abdominal pain , and altered states of consciousness.A rare but equally
severe possibility is hyperosmolar nonketotic state , which is more common intype 2 diabetes and is
mainly the result of dehydration.

COMPLICATIONS

Complications of diabetes mellitusAll forms of diabetes increase the risk of long-term complications.
These typically develop after many years (10–20), but may be the first symptom in those who have
otherwise not received adiagnosis before that time. The major long-term complications relate to damage
to blood vessels Diabetes doubles the risk of cardiovascular disease . The main «macrovascular»
diseases (related to atherosclerosis of larger arteries) are ischemic heart disease ( angina and
myocardialinfarction ), stroke and peripheral vascular disease

Diabetes also damages the capillaries (causes microangiopathy ).

[13]

Diabetic retinopathy , whichaffects blood vessel formation in the retina of the eye, can lead to visual
symptoms, reduced vision, and potentially blindness . Diabetic nephropathy , the impact of diabetes on
the kidneys,can lead to scarring changes in the kidney tissue , loss of small or progressively larger
amounts of protein in the urine and eventually chronic kidney disease requiring dialysis diabetic
neuropathy is the impact of diabetes on the nervous system , most commonly causing numbness,tingling
and pain in the feet and also increasing the risk of skin damage due to altered sensation.Together with
vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such
as diabetic foot ulcers ) that can be difficult to treat and occasionallyrequire amputation

CAUSES

The cause of diabetes depends on the type

Type 1 diabetes is partly inherited, and then triggered by certain infections, with some evidence pointing
at Coxsackie B4 virus . A genetic element in individual susceptibility to some of thesetriggers has been
traced to particular HLA genotypes (i.e., the genetic «self» identifiers relied upon by the immune
system). However, even in those who have inherited the susceptibility,type 1 DM seems to require an
environmental trigger. The onset of type 1 diabetes is unrelated tolifestyle

Type 2 diabetes is due primarily to lifestyle factors and genetics.The following is a comprehensive list of
other causes of diabetes:

Genetic defects of -cell function

Maturity onset diabetes of the young

Mitochondrial DNA mutations

Genetic defects in insulin processing or insulin action

Defects in proinsulin conversion

Insulin gene mutations

Insulin receptor mutations

Exocrine pancreatic defects

O
O

Pancreatectomy

Pancreatic neoplasia

Cystic fibrosis

Endocrinopathies

Growth hormone

Excess

Cushing syndrome

Hyperthyroidism

Pheochromocytoma

Glucagonoma

Infections

Cytomegalovirus

Coxsackievirus B

Drugs

O
Glucocorticoids

Hemochromatosis

Fibrocalculous pancreatopathy

Thyroid hormone

-adrenergic agonist

Statins

[16]

PATHOPHYSIOLOGY

This section

Does not cite any references or sources

. Please help improve this section by adding citations to reliable sources. Unsourced material may be
challenged and removed .The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin
(blue) in humansduring the course of a day with three meals – one of the effects of a sugar -rich a starch
-richmeal is highlighted

Mechanism of insulin release in normal pancreatic beta cells – insulin production is more or lessconstant
within the beta cells. Its release is triggered by food, chiefly food containing absorbableglucose

Chapter 1

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells(primarily
muscle and fat cells, but not central nervous system cells). Therefore, deficiency of insulin or the
insensitivity of its receptors plays a central role in all forms of diabetes mellitus

.
Humans are capable of digesting some carbohydrates , in particular those most common in food;starch,
and some disaccharides such as sucrose, are converted within a few hours to simpler forms, most
notably the monosaccharide glucose , the principal carbohydrate energy source used by the body. The
rest are passed on for processing by gut flora largely in the colon. Insulin isreleased into the blood by
beta cells (-cells), found in the islets of Langerhans in the pancreas,

In response to rising levels of blood glucose, typically after eating. Insulin is used by abouttwo-thirds of
the body’s cells to absorb glucose from the blood for use as fuel, for conversion toother needed
molecules, or for storage.Insulin is also the principal control signal for conversion of glucose to glycogen
for internalstorage in liver and muscle cells. Lowered glucose levels result both in the reduced release of
insulin from the -cells and in the reverse conversion of glycogen to glucose when glucose

Levelsfall. This is mainly controlled by the hormone glucagon , which acts in the opposite manner
toinsulin. Glucose thus forcibly produced from internal liver cell stores (as glycogen) re-enters the
bloodstream; Muscle cells lack the necessary export mechanism. Normally, liver cells do thiswhen the
level of insulin is low (which normally correlates with low levels of blood glucose).Higher insulin levels
increase some anabolic («building up») processes, such as cell growth and duplication, protein synthesis
, and fat storage. Insulin (or its lack) is the principal signal inconverting many of the bidirectional
processes of metabolism from a catabolic to an anabolicdirection, and

Vice versa

. In particular, a low insulin level is the trigger for entering or leavingketosis (the fat-burning metabolic
phase)

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin(insulin
insensitivity or resistance), or if the insulin itself is defective, then glucose will not haveits usual effect, so
it will not be absorbed properly by those body cells that require it, nor will it be stored appropriately in
the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis,
and other metabolic derangements, such as acidosis

When the glucose concentration in the blood is raised to about 9-10 mmol/L (except certainconditions,
such as pregnancy), beyond its renal threshold (i.e. when glucose level surpassesthe transport maximum
of glucose reabsorption), reabsorption of glucose in the proximal renaltubule is incomplete, and part of
the glucose remains in the urine ( glycosuria ). This increasesthe osmotic pressure of the urine and
inhibits reabsorption of water by the kidney, resulting inincreased urine production ( polyuria ) and
increased fluid loss. Lost blood volume will bereplaced osmotically from water held in body cells and
other body compartments, causing

Dehydration and increased thirst.

 DIAGNOSIS
Glycated hemoglobin and Glucose tolerance test Diabetes diagnostic criteria

Condition 2 hour glucose Fasting glucose HbA

1c

Mmol/l(mg/dl) mmol/l(mg/dl) % Normal <7.8 (<140) <6.1 (<110) <6.0Impaired fasting glycaemia <7.8
(<140) 6.1(110) & <7.0(<126) 6.0–6.4

≥≥

Impaired glucose tolerance 7.8 (140) <7.0 (<126) 6.0–6.4

≥≥

Diabetes mellitus

11.1 (200) 7.0 (126)

≥≥≥≥

6.5
≥

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed

bydemonstrating any one of the following:

Fasting plasma glucose level 7.0 mmol/l (126 mg/dl)

Plasma glucose 11.1 mmol/l (200 mg/dL) two hours after a 75 g oral glucose load as a glucose
tolerance test

Symptoms of hyperglycemia and casual plasma glucose 11.1 mmol/l (200 mg/dl)

Glycated hemoglobin (Hb 1C) 6.5%

≥
.

A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a

repeatof any of the above methods on a different day. It is preferable to measure a fasting
glucose level because of the ease of measurement and the considerable time commitment of
formal glucosetolerance testing, which takes two hours to complete and offers no prognostic
advantage over thefasting test. According to the current definition, two fasting glucose
measurements above126 mg/dl (7.0 mmol/l) is considered diagnostic for diabetes mellitus

People with fasting glucose levels from 110 to 125 mg/dl (6.1 to 6.9 mmol/l) are
considered tohave impaired fasting glucose . Patients with plasma glucose at or above 140
mg/dL(7.8 mmol/L), but not over 200 mg/L (d11.1 mmol/L), two hours after a 75 g
oral glucose load are considered to have impaired glucose tolerance . Of these two
prediabetic states, the latter in particular is a major risk factor for progression to full-blown
diabetes mellitus, as well ascardiovascular disease

Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular
disease and death from any cause

.DIABETES MANAGEMENT

Diabetes mellitus is a chronic disease which cannot be cured except in very specific
situations.Management concentrates on keeping blood sugar levels as close to normal
(“euglycemia”) as possible, without causing hypoglycemia. This can usually be accomplished
with diet, exercise,and use of appropriate medications (insulin in the case of type 1 diabetes,
oral medications, aswell as possibly insulin, in type 2 diabetes)

Patient education, understanding, and participation is vital, since the complications of

diabetesare far less common and less severe in people who have well-managed blood sugar
levels. Thegoal of treatment is an HbA1C level of 6.5%, but should not be lower than that,
and may be sethigher. Attention is also paid to other health problems that may accelerate the
deleterious effectsof diabetes. These include smoking , elevated cholesterol levels, obesity ,
high blood pressure , and lack of regular exercise. Specialised footwear is widely used to
reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the
efficacy of this remains equivocal,however.

Lifestyle
Diabetic dietThere are roles for patient education, dietetic support, sensible exercise, with the
goal of keeping both short-term and long-term blood glucose levels within acceptable bounds
. In addition, giventhe associated higher risks of cardiovascular disease, lifestyle modifications
are recommended tocontrol blood Medications

Oral medications- Anti-diabetic medicationMetformin is generally recommended as a first line

treatment for type 2 diabetes, as there is good evidence that it decreases mortality Routine
use of aspirin , however, has not been found toimprove outcomes in uncomplicated diabetes

InsulinInsulin therapyType 1 diabetes is typically treated with a combinations of regular and

NPH insulin , or synthetic insulin analogs . When insulin is used in type 2 diabetes, a long-
acting formulation isusually added initially, while continuing oral medications

Doses of insulin are then increased toeffect

Chapter 1

SUPPORT

In countries using a general practitioner system, such as the United Kingdom , care may take
place mainly outside hospitals, with hospital-based specialist care used only in case of
complications, difficult blood sugar control, or research projects. In other circumstances, general
practitioners and specialists share care of a patient in a team approach. Home telehealth
supportcan be an effective management technique.

Epidemiology

Prevalence of diabetes worldwide in 2000 (per 1,000 inhabitants) – world average was
2.8%.no data 7.5

7.5–1515–22.522.5–3030–37.537.5–4545–52.552.5–6060–67.567.5–7575–82.5 82.5

Disability-adjusted life year for diabetes mellitus per 100,000 inhabitants in

 AIMS AND OBJECTIVES
●

To study about the pa ents with diabetes mellitus with regards to variouslike age , sex and
occupa on.

To study the mode of presenta on of diabetes mellitus.

●
To study various predisposing factors of diabetes mellitus.

To study the diabetes mellitus at M.M.G Hospital, GT Road Ghaziabad (UP).

To study the analysis of the diabetes

 OBSERVATION AND RESULTS
During the period of my study, a total of 55 patients suffering from fever were selected for
thestudy in paediatric O.P.D. and I.P.D. of M M G Hospital over a period of 2 months.

GENDER DISTRIBUTION OF THE STUDY SUBJECTS

Among the 55 patients suffering from fever 65.89% were males and 34.11% were
females,indicating male population is more susceptible to various infections.

Table 1

Gender No. of Patients % of Patients

Male3065.89%Female2534.11%Total55100%

Graph 1DISTRIBUTION OF PAEDIATRIC PATIE

DISTRIBUTION OF PAEDIATRIC PATIENTS IN OPD AND IPD

Amongst 302 paediatric patients, the distribution of patients in OPD and IPD was 292
(96.68%)and 10(3.32%) respectively.

Table 2 DepartmentNo. Of patients% of patients

OPD29296.68%IPD103.32%Total302100%

Graph 2
Amongst 302 paediatric patients, the distribution of patients in OPD and IPD was 292 (96.68%)and
10(3.32%) respectively.

Table
2D e p a r t m e n t N o . o
f p a t i e n t s % o f
2 9 6
. 6 8
% I P
D 1
0 3
. 3
2 % T
o t a
l 3 0
2 1 0
0