THE UNIVERSITY OF LAHORE

Practical Assignment

GROUP MEMBERS : Umair Hanif, IKram,

Shabir Hussain, Javaid joiya
Obaid-ur-rehman, Samdhani,
Suleman Malik.

SUBMITTED TO : Sir Waqar

SUBMITTED DATE : 7-Dec-2010

COURSE TITLE : Pharm-D-V

SUBJECT : Pathology

TOPIC : Diabetes
Diabetes Mellitus:
Diabetes mellitus is a group of metabolic diseases characterized by high
blood sugar (glucose) levels that result from defects in insulin secretion, or action, or
both.
Diabetes mellitus, commonly referred to as diabetes because it was first identified as a
disease associated with "sweet urine,”

Normal Blood Glucose Level:

In most humans this varies from about 80 mg/dl to 110 mg/dl except
shortly after eating when the blood glucose level rises temporarily up to maybe 140 mg/dl
or a bit more in non-diabetics.

Diagnosis & Testing:

Diabetes is diagnosed with the following tests:

• Fasting blood glucose level

Diabetes is diagnosed if it is higher than 126 mg/dL on two occasions
• Random (no fasting) blood glucose level
Diabetes is suspected if it is higher than 200 mg/dL, and the patient has
symptoms such as increased thirst, urination, and fatigue (this must be confirmed with a
fasting test)
• Oral glucose tolerance test
Diabetes is diagnosed if the glucose level is higher than 200 mg/dL after 2
hours.

Ketone testing:
Ketone testing is also used in type 1 diabetes. Ketones are produced by the
breakdown of fat and muscle. They are harmful at high levels. The Ketone test is done
using a urine sample. Ketone testing is usually done at the following times:

• When the blood sugar is higher than 240 mg/dL

• During an illness such as pneumonia, heart attack, or stroke
• When nausea or vomiting occur
• During pregnancy

The following tests will help you and your doctor monitor your diabetes and prevent
complications of diabetes:

• Check the skin and bones on your feet and legs.

• Check the sensation in your feet.
• Have your blood pressure checked at least every year (blood pressure should be
130/80 mm/Hg or lower).
TYPE 1 Diabetes Mellitus:

Diabetes mellitus type 1 also called Insulin-Dependent-Diabetes-

Mellitus (IDDM), or juvenile diabetes, is a form of diabetes mellitus that results
from autoimmune destruction of insulin producing beta cells of the islets of
Langerhans in the pancreas. The subsequent lack of insulin leads to increased blood and
urine glucose.

Type 1 diabetes can affect children or adults but was traditionally termed
"juvenile diabetes" because it represents a majority of the diabetes cases in children.

Sign & Symptoms of IDDM:

Major Symptoms are
• Polyuria.
• Polydypsia.
• Polyphagia.
• There is gradual weight loss.
• There is a sense of weakness along with it Lassitude or lethargy to do any work.
• Pruritis.
• Balanitis or inflammation of tip of penis in males and also vaginitis in females.
• There is often compliant of leg cramps,
• There is often blurring of vision.

Causes of IDDM:
No one knows exactly what causes IDDM (idiopathic). What is clear is
that the body's own immune or disease-fighting system for some reason turns against the
body's own tissues. Certain substances formed by the immune system attack the beta cells
of the pancreas, destroying their ability to make insulin.

Treatment of IDDM:

• Treatment for IDDM includes a daily routine of insulin shots or use of an insulin
pump.
• Transplantation of Pancreas in some cases.

• A person with IDDM needs to time meals with insulin doses to keep blood
glucose from getting too high or low. The foods you choose can play a role in
controlling blood glucose levels. Increasing the proportion of fiber and complex
carbohydrates in your diet and avoiding refined sugar may aid in reducing drastic
changes in blood glucose and in some people it may permit lowering of insulin
dose.
 • Reducing fats and cholesterol can help reduce the risk of heart disease, which
affects people with diabetes more often than those with normal glucose
metabolism.

• Exercise carefully, strenuous exercise increases the muscles' use of glucose, so it

can lower glucose in the blood. At the same time, exercise also stimulates the
body to release glucose and fats for use as energy. This stimulus can have the
effect of raising blood glucose. In order to exercise safely, you should balance
insulin dose, meals, and the timing of exercise to keep blood glucose levels from
getting too high or too low.

TYPE 2 Diabetes Mellitus:

Diabetes mellitus type 2 formerly called Non-Insulin-Dependent Diabetes

Mellitus (NIDDM), or adult-onset diabetes, it is a disorder that is characterized by high
blood glucose in the context of insulin resistance and relative insulin deficiency.
Although type 2 diabetes mellitus typically affects individuals older than 40
years, but it has been diagnosed in children as young as 2 years of age who have a family
history of diabetes.

Sign & Symptoms of NIDDM:

People with type 2 diabetes may not have symptoms for years or decades, but as the
disease progresses, symptoms develop.

People with type 2 diabetes may have the following signs and symptoms:
• Polyuria.
• Polydypsia.
• Polyphagia.
• There is gradual weight loss.
• Decreased sensation or numbness in the hands and feet.
• Frequent bladder and vaginal infections.
• Male impotence (erectile dysfunction).
• Slow healing of cuts or sores.
• Muscle fatigue, tiredness.
• Pruritis.
• Blurred vision.

Causes of NIDDM:
In type 2 diabetes, either the pancreas does not make enough insulin or body cells
unable to respond insulin properly (insulin resistance). No one knows the exact cause of
type 2 diabetes, but it's more likely to occur in people who are:
• Over 45 years of age.
• Are overweighting (obesity).
• Have a family history of diabetes (genetics).
• Chronic pancreatitis
• Gestational diabetes
• Insulin resistance
• Haemochromatosis
(Iron overload causes pancreas damage that can cause Type 1 or
Type 2 diabetes).
• Polycystic ovary syndrome (PCOS) - ovary cysts inhibit natural female hormones
causing insulin resistance.
• Frequent use of Steroids
• Metabolic syndrome - a syndrome with 4 key features (diabetes, hypertension,
obesity/overweight, and high cholesterol).

Treatment of NIDDM:

• Reducing insulin resistance and managing insulin deficiency.

• Diet is the cornerstone of treatment and should be used first-line before drug
treatment.
• Metformin is the drug of choice in obese NIDDM patients and Sulphonylureas
in non-obese patients.
• Daily Exercise
• Many NIDDM patients (30%) will eventually require insulin therapy.