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Dow University of Health Sciences

Institute of Nursing
Diabetic Mellitus

Badil Dass
1st April, 2013

By the end of this lecture, the students will
able to:
Define Diabetes Mellitus.
List the types of Diabetes Mellitus
Understand the pathophysiology of Type1 Diabetes Mellitus
Identify the clinical features of Type-1
Diabetes Mellitus
Describe the insulin interim of
Types, dose, peak hours and duration

Diabetes Mellitus
Diabetes mellitus is metabolic disorder of
carbohydrate, protein, and fat characterized
by elevated levels of glucose in the blood
(hyperglycemia) resulting from defects in insulin
secretion, insulin action, or both

Classification of Diabetes mellitus


-1 Diabetes (IDDM)
Type -2 Diabetes (NIDDM)
Gestational diabetes mellitus
Diabetes mellitus associated with other
conditions or syndromes/ secondary diabetes

Type -1 Diabetes (IDDM)


-1 (5%10% of all diabetes)

Type-1 Diabetes Mellitus is cased by destruction
of beta cells by autoimmune process.
It is thought that combined genetic,
immunologic, and possibly environmental (e.g.,
viral) factors contribute to beta cell destruction.
Virus are rubella, mumps, Coxsackievirus
DR3 and DR4 deficiency



the concentration of glucose in the blood

exceeds the renal threshold for glucose, usually
180 to 200 mg/dL (9.9 to 11.1 mmol/L).
The kidneys may not reabsorb all of the filtered
glucose; the glucose then appears in the urine
When excess glucose is excreted in the urine, it
is accompanied by excessive loss of fluids and
electrolytes. This is called osmotic diuresis.

Insulin normally inhibits glycogenolysis
(breakdown of stored glucose) and
Due to insulin deficiency the gluconeogenesis
process occurs that cause the fat breakdown.
The end product of fat breakdown is ketone.
Excessive ketones cause the DKA

( Diabetes Ketoacidosis)


bodies are acids that disturb the acid

base balance of the body when they accumulate
in excessive
The resulting DKA may cause signs and
symptoms such
as abdominal pain, nausea, vomiting,
hyperventilation, a fruity breath odor, and, if left
untreated, altered level of consciousness, coma,
and death.



of insulin treatment, along with fluid

and electrolytes needed, is essential to treat
hyperglycemia and DKA and rapidly improves
the metabolic abnormalities.

Clinical characteristics and implications

Onset any age, but usually young (<20 yrs)
Usually thin at diagnosis
Recent weight loss
Etiology includes genetic, immunologic, or

environmental factors (e.g., virus).

Often have islet cell antibodies
Little or no endogenous insulin
Need insulin to preserve life
Ketosis-prone when insulin absent
Acute complication of hyperglycemia: diabetic

The Discovery of Insulin


a German medical student, Paul

Langerhans, found pancreatic cells named
the islets of Langerhans
Beta cells produce insulin
Functions was unknown


1889 in Germany, physiologist Oskar Minkowski

and physician Joseph von Mering, showed that if the
pancreas was removed from a dog, the animal got
But if the duct through which the pancreatic juices
flow to the intestine was ligated - surgically tied off so
the juices couldn't reach the intestine - the dog
developed minor digestive problems but no diabetes.
So it seemed that the pancreas must have at least two
To produce digestive juices
To produce a substance that regulates the sugar glucose

Banting's Idea

October 1920 in Toronto, Canada, Dr.

Frederick Banting, surgeon with a bachelor's
degree in medicine, had the idea that the
pancreatic digestive juices could be harmful to
the secretion of the pancreas produced by the
islets of Langerhans.
ligate the pancreatic ducts in order to stop the
flow of nourishment to the pancreas.
This would cause the pancreas to degenerate,
making it shrink and lose its ability to secrete
the digestive juices.


in 1921, Banting took his idea to

Professor John Macleod at the University
of Toronto, who was a leading figure in
the study of diabetes in Canada

The Experiment Begins
Banting and Best began their experiments
by removing the pancreas from a dog.
This resulted in the following:
It's blood sugar rose.
It became thirsty, drank lots of water, and
urinated more often.
It became weaker and weaker.
The dog had developed diabetes

Experimenting on another dog
Banting and Best surgically ligated the pancreas,
stopping the flow of nourishment, so that the
pancreas degenerated.
sliced it up, and froze the pieces in a mixture of
water and salts. When the pieces were half frozen,
they were ground up and filtered. The isolated
substance was named "isletin."
The extract was injected into the diabetic dog. Its
blood glucose level dropped, and it seemed
healthier and stronger. By giving the diabetic dog a
few injections a day, Banting and Best could keep it
healthy and free of symptoms.


1922 in Toronto, Canada, a 14-yearold boy, Leonard Thompson, was chosen as

the first person with diabetes to receive
The test was a success.
The Nobel Prize
The news of the successful treatment of
diabetes with insulin rapidly spread outside
of Toronto, and in 1923 the Nobel Committee
decided to award Banting and Macleod the
Nobel Prize in Physiology or Medicine.