Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUS

DIABETES MELLITUS
INTRODUCTION
Diabetes is a lifelong (chronic) disease and is a group of metabolic disorder
characterized by high levels of sugar in blood (hyperglycemia) [1]. It is caused due to
deficiency of insulin or resistance to insulin or both. Insulin is secreted by β-cells of
pancreas to control blood sugar levels. Blurry visions, excess thirst, fatigue, frequent
urination, hunger, weight loss are some of the symptoms commonly seen in diabetic
patients [2].

SIGN AND SYMPTOMS OF DIABETES
MELLITUS
Increased Thirst
Frequent Urination
Unexpected Weight Loss
Increased Fatigue
Blurred Vision
Numbness And Tingling ,Especially In Your Feet And
Hands
Slow Healing Sores
Red , Swollen ,Tender Gums
Skin Itchy
Irritability

TYPES OF DIABETESDIABETES MELLITUS
DIABETES MELLITUS
TYPE 1 (IDDM) TYPE 2 (NIDDM) GESTATIONAL DM OTHER TYPES
NEONATAL DM MODY

TYPE 1 DIABETES MELLITUS
(IDDM)
 T1D, also called as the insulin-dependent diabetes mellitus (IDDM), manifests due to
the autoimmune damage of the β-cells which then leads to the suppression or
cessation of insulin production. T1D is also called the “juvenile diabetes’’ [5] People
with Diabetes Type 1 are unable to produce insulin. Most patients with Diabetes Type
1 developed the condition before the age of 40. Approximately 15% of all people with
diabetes have Type 1.

Risk Factors For Type 1 DM
 The presence of damaging immune system cells that make
auto antibodies:-Sometimes family members of people with type 1 diabetes are
tested for the presence of diabetes auto antibodies.[6] If you have these auto
antibodies, you have an increased risk of developing type 1 diabetes. But, not
everyone who has these auto antibodies develops type 1.
 Dietary factors:- A number of dietary factors have been linked to an increased
risk of type 1 diabetes, such as low vitamin D consumption; early exposure to cow's
milk or cow's milk formula; or exposure to cereals before 4 months of age. However,
none of these factors has been shown to cause type 1 diabetes.
 Race:-.Type 1 diabetes is more common in whites than in other races
 Geography:- Certain countries, such as Finland and Sweden, have higher rates
of type 1 diabetes.

TYPE 2 DIABETES MELLITUS
(NIDDM)
Non insulin dependent diabetes mellitus (NIDDM),
maturity onset diabetes mellitus
There is no loss or moderate reduction in beta cell mass(30-40%); insulin in
circulation is low , normal or even high. Over 90% cases are types 2 DM.
The majority of people with Type 2 have developed the condition because they are
overweight. Type 2 generally appears later on in life, compared to Type 1. Type 2 is
the most common form of diabetes. In the case of insulin resistance, the body is
producing the insulin, but insulin sensitivity is reduced and it does not do the job as
well as it should do.[7] The glucose is not entering the body's cells properly, causing
two problems:
A build-up of glucose in the blood.
The cells are not getting the glucose they need for
energy and growth.

RISK FACTORS FOR TYPE 2 DMRISK FACTORS FOR TYPE 2 DM
 Obesity:- The number one risk factor for type 2 diabetes is obesity. Greater weight
means a higher risk of insulin resistance because fat interferes with the body's ability
to use insulin. The number of children being diagnosed with type 2 diabetes has also
risen.[8]
 Sedentary lifestyle:- A sedentary lifestyle is damaging to health and bears
responsibility for the growing obesity problems." Inactivity and being overweight go
hand in hand towards a diagnosis of type 2.[9] Muscle cells have more insulin
receptors than fat cells, so a person can decrease insulin resistance by exercising.
Being more active also lowers blood sugar levels by helping insulin to be more
effective.
 Unhealthy eating habit:- People who have been diagnosed with type 2 diabetes are
overweight. Unhealthy eating contributes largely to obesity. Too much fat, not
enough fiber and too many simple carbohydrates all contribute to a diagnosis of
diabetes.[10] Eating right is can turn the diagnosis around and reverse or prevent
Type 2.
 Family history and genetics:- If you have a relative who has/had diabetes your risk
might be greater. The risk increases if the relative is a close one - if your father or
mother has/had diabetes your risk might be greater than if your uncle has/had it

GESTATIONAL DIABETES MELLITUSMELLITUS
 Gestational diabetes only happens during pregnancy. It means you have high blood
sugar levels, but those levels were normal before you were pregnant. If you have it,
you can still have a healthy baby with help from your doctor and by doing simple
things to manage your blood sugar also called blood glucose. After your baby is born,
gestational diabetes usually goes away. Gestational diabetes makes you more likely
to develop type 2 diabetes, but it won’t definitely happen.[11]

CAUSES OF GESTATIONAL DMCAUSES OF GESTATIONAL DM
 During pregnancy, the placenta (responsible for supplying oxygen and nutrients from
mother to the developing baby) makes hormones that can lead to a buildup of
glucose in your blood.
Usually, your pancreas can make enough insulin to handle that. If not, your blood
sugar levels will rise and can cause gestational diabetes.[12]
Risk factors for gestational diabetes mellitus
 Age:- Women older than age 25 are at increased risk.
 Family or Personal History:- Your risk increases if you have prediabetes -a
precursor to type 2 diabetes — or if a close family member, such as a parent or
sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes
during a previous pregnancy, if you delivered a very large baby or if you had an
unexplained stillbirth.
 Weight: -Being overweight before pregnancy increases your risk.
 Race:- For reasons that aren't clear, women who are black, Hispanic, American
Indian or Asian are more likely to develop gestational diabetes.

OTHER TYPES OF DMOTHER TYPES OF DM
 Maturity onset diabetes of the young (MODY) :- MODY is a rare form
of diabetes which is different from both Type 1 and Type 2 diabetes, and runs
strongly in families. MODY is caused by a mutation (or change) in a single gene. If a
parent has this gene mutation, any child they have, has a 50 per cent chance of
inheriting it from them.[13] If a child does inherit the mutation they will generally go on
to develop MODY before they’re 25, whatever their weight, lifestyle, ethnic group etc.
 Neonatal diabetes:- Neonatal diabetes is a form of diabetes that is diagnosed
under the age of nine months.[14] It’s a different type of diabetes than the more
common Type 1 diabetes as it’s not an autoimmune condition (where the body has
destroyed its insulin producing cells).

DIAGNOSE TEST FOR DIABETES
MELLITUS
 Tests for type 1 and type 2 diabetes
 Glycated hemoglobin (A1C) test
This blood test, which doesn't require fasting, indicates your average blood sugar
level for the past two to three months. It measures the percentage of blood sugar
attached to hemoglobin, the oxygen-carrying protein in red blood cells.
The higher your blood sugar levels, the more hemoglobin you'll have with sugar
attached. An A1C level of 6.5 percent or higher on two separate tests indicates that
you have diabetes.[15] An A1C between 5.7 and 6.4 percent indicates prediabetes (A
condition in which blood sugar is high but not high enough to be type 2 diabetes)
Below 5.7 is considered normal.

If the A1C test results aren't consistent, the test isn't available, or you have certain
conditions that can make the A1C test inaccurate — such as if you're pregnant or have an
uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use
the following tests to diagnose diabetes:
Random blood sugar test.
A blood sample will be taken at a random time. Regardless of when you last ate, a
random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimeters per
liter (mmol/L) — or higher suggests diabetes.[16]
Fasting blood sugar test.
A blood sample will be taken after an overnight fast. A fasting blood sugar level less
than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL
(5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two
separate tests, you have diabetes.
Oral glucose tolerance test.
For this test, you fast overnight, and the fasting blood sugar level is measured. Then you
drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than
200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and
199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.[17]

TESTS FOR GESTATIONALTESTS FOR GESTATIONAL
DIABETES MELLITUSDIABETES MELLITUS
Your doctor will likely evaluate your risk factors for gestational diabetes early in your
pregnancy:
 Initial glucose challenge test :- You'll begin the glucose challenge test by drinking a
syrupy glucose solution. One hour later, you'll have a blood test to measure your blood
sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered
normal on a glucose challenge test, although this may vary at specific clinics or labs.
If your blood sugar level is higher than normal, it only means you have a higher risk of
gestational diabetes. [18]
 Follow-up glucose tolerance testing:- For the follow-up test, you'll be asked to fast
overnight and then have your fasting blood sugar level measured. Then you'll drink another
sweet solution — this one containing a higher concentration of glucose — and your blood
sugar level will be checked every hour for a period of three hours.
If at least two of the blood sugar readings are higher than the normal values established
for each of the three hours of the test, you'll be diagnosed with gestational diabetes.[19]

TREATMENT FOR ALL TYPES OF
DIABETES
Healthy eating :- Contrary to popular perception, there's no specific diabetes diet.
You'll need to center your diet on more fruits, vegetables, lean proteins and whole grains
— foods that are high in nutrition and fiber and low in fat and calories — and cut down on
saturated fats, refined carbohydrates and sweets.[20] In fact, it's the best eating plan for
the entire family. Sugary foods are OK in a while, as long as they're counted as part of
your meal plan.
Physical activity :- Everyone needs regular aerobic exercise, and of the three hours
of the test, you'll be diagnosed with gestational diabetes.[21]
people who have diabetes are no exception. Exercise lowers your blood sugar level by
moving sugar into your cells, where it's used for energy. Exercise also increases your
sensitivity to insulin, which means your body needs less insulin to transport sugar to your
cells.

TREATMENTS FOR TYPE 1 DIABEESTREATMENTS FOR TYPE 1 DIABEES
MELLITUSMELLITUS
 Insulin :- People with type 1 diabetes need insulin therapy to survive. Many people with type 2
diabetes or gestational diabetes also need insulin therapy.
Insulin is usually given subcutaneously either by injections or by an insulin pump Research of other
routes of administration is underway. In acute-care settings, insulin may also be given intravenously. In
general, there are three types of insulin, characterized by the rate which they are metabolized by the
body. They are rapid acting insulin's, intermediate acting insulin's and long acting insulin's.[22]
TYPES OF INSULIN USED IN THE TREATMENT OF THE TYPE 1 DMTYPES OF INSULIN USED IN THE TREATMENT OF THE TYPE 1 DM
INSULIN PREPARATION
SHORT ACTING INTERMEDIATE ACTING LONG ACTING
REGULAR INSULIN
INSULIN ZINC SUSPENSION
ISOPANE INSULIN
INSULIN GLARGIN
INSULIN DETEMIR

ACTIONS OF NSULIN
 It helps in the transportation of glucose across the cell membrane.
 Insulin activate GLUT-4 (Transporter of glucose) as a result of that glucose
transportation occur across the cell.[22]
 It helps in the formation of glycogen;
insulin stimulate Glycogen synthase enzyme
Glucose Glycogen
 Insulin inhibit the phosphorylase enzyme which convert the glycogen into glucose.
Phosphorylase Insulin
Glucose Glycogen Glucose

MECHANISM OF ACTION OF INSULIN
(IDDM)

TREATMENT FOR TYPE 2 DM (NIDDM)
Oral diabetes medications are used in the treatment of type 2 diabetes Medicines within this
category fall within one of several classes, including;[23]
A) Enhance insulin secretion
1) sulfonylureas (KATP channel blocker)
First generation- Tolbutamide
Second generation- Glibenclamide,Glipizide
2) Meglitinide/Phenylalanine analogues
Repaglinide,Nateglinide
3) Glucagon like pepetide -1 (GLP1) Receptor Agonist (Injectable Drugs)
Excenatide, Liraglutide
4) Dipeptidyl Peptidase -4 (DPP4) Inhibitors
Sitagliptin , vildagliptin
B) Overcome insulin resistance
1) Biguanide (Ampk Activator)
Metformin
2)Thiazolidinediones (PPARalpha Activator
Pioglitazine
C) Miscellaneous Antidiabetic Drugs
1) Alpha glucosidase inhibitors
Acarbose , Miglitol
2) Amylin Analogue
Pramlintide
3 )Dopamine D2 Receptor Agonist
Bromocriptine
4) Sodium Glucose Cotransport 2 Inhibitors
Dopagliflozin

MECHANISM OF ACTION
1)Sulphonyl urease:- Sus SU Drugs
SU receptor
Closure of ATP dependant Potassium channel
cause depolarisation
increase calcium inside the cell
stimulate release of insulin
2) Meglitinide Analogues:- Sus Meglitinide drugs
SU receptor
Closure of ATP dependant Potassium channel
cause depolarisation
increase calcium inside the cell
stimulate release of insulin

 GLP1 Receptor Agonist:- Food in GIT Glucose GLP1 liraglutide
Act on beta cell
Increase the insulin release
 DPP4 Inhibitors :- sitagliptin
DPP 4
GLP1 Inactivate peptide (Degrade)

HERBAL DRUG TREATMENT FORHERBAL DRUG TREATMENT FOR
DIABETESDIABETES
 Acacia arabica
 Achyranthes aspera
 Allium sativum (garlic)
 Allium cepa: (onion)
 Azadirachta indica
 Tinospora cordifolia: (Guduchi)
 Cinnamon
 Bitter Melon
 Fenugreek
 Gymnema

NEW ANTI DIABETIC DRUGS
 New Drug Treatments for Type 1 and Type 2 Diabetes
NN1250/Insulin Degludec/Tresiba
NN1250/Insulin Degludec is being developed by Novo Nordisk and has reached
phase 3 clinical trials. This is a completely neutral, soluble, and subcutaneous ultra-
long-acting new-generation insulin that lasts for over 24 hours. This insulin is
designed for basal insulin treatment of both type 1 and type 2 diabetes mellitus.[25]
LY2405319
LY2405319 is a new drug being developed by Eli Lilly. The drug is in a new class of
treatments known as FGF21 analogues. FGF21 stands for fibroblast growth factor 21,
which is a hormone in the body that stimulates glucose uptake of adipose cells (fat
cells). In initial phase 1 human studies, the drug has shown beneficial effects on
blood lipid levels, blood glucose levels and reduction in body weight. [26]

LIFESTYLE FOR TYPE 1 AND TYPE 2LIFESTYLE FOR TYPE 1 AND TYPE 2
DMDM
 Identify yourself:- Wear a tag or bracelet that says you have diabetes. Keep a
glucagon kit nearby in case of a low blood sugar emergency — and make sure your
friends and loved ones know how to use it.[27]
 Pay attention to your feet:-Wash your feet daily in lukewarm water. Dry them
gently, especially between the toes. Moisturize with lotion, but not between the toes.
Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your
doctor if you have a sore or other foot problem that doesn't start to heal on its own.
[28]
 Keep your blood pressure and cholesterol under control:- Eating healthy
foods and exercising regularly can go a long way toward controlling high blood
pressure and cholesterol. Medication may be needed, too.
 Take care of your teeth:- Diabetes may leave you prone to gum infections.
Brush and floss your teeth at least twice a day. And if you have type 1 or type 2
diabetes, schedule dental exams at least once a year. Consult your dentist right away
if your gums bleed or look red or swollen.

REFERENCE
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27) Patra SR, Jahnavi G (2011) An Improvement in Compliance for Foot Care in Persons with Type 2 Diabetes
with a Teaching Session

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Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUS