Diabetes is a hormonal disorder where the body isn’t able to

properly use/produce a hormone called insulin which helps

break glucose in our food to convert it to energy.
High levels of unregulated glucose in the bloodstream can
damage the kidneys, eyes, nerves, even cause cardiac arrests.
Depending on the inability to use or produce insulin, diabetes
has been divided into two types:
Type I and Type II.
There is also another condition called prediabetes, where an
individual’s blood sugar levels are higher than the normal
level, however, these raised levels are not enough to diagnose
a patient with diabetes.
However, a person at this stage is at risk of developing
diabetes in due course.
Types of Diabetes:
As mentioned earlier the diagnosis of a
certain type of diabetes depends on the
patient’s inability to produce or properly
utilize the insulin produced by the body.
2. Type II Diabetes:
The more common type of diabetes is
generally characterized by the
patient’s inability to properly use the
insulin produced in the body. At the
later stages of type II diabetes, the
patient’s body loses the ability to
produce insulin altogether.
While Type I and Type II Diabetes look similar,
their causes are their differentiating points.
• Type I diabetes is caused by an autoimmune
disorder where the immune system mistakes
normal body functions as hostile.
• Type II diabetes is caused because the body
develops a resistance to insulin and therefore
doesn’t respond adequately to the hormone.
•While the two types of diabetes have some
common symptoms, they also display some
unique symptoms, which help in differentiating
the two.
• There is also the fact that people with type II
diabetes, develop symptoms over a period of
years while the development rate of type I
diabetes is very fast in comparison to the former.
• It should also be noted that if detected in time,
type II diabetes can be prevented, but type I
diabetes cannot be prevented.
Diabetes: Data At a Glance -

Diabetes along with Heart Disease is the most common chronic

disease in India.
Thus, it is not really surprising that by 2008 India held 21% of the
world’s share of diabetic patients and that by 2017 with 70
million registered cases of diabetes, India because of the 2nd
country in the world with the most number of diabetic patients.
however, may come as a little surprise that diabetes is the
underlying cause behind 50% adult deaths and that the age
range of diabetic patients is the largest with patients being as
young as 20 years to as old as 79 years.
• The projected data for 2037 states that the number of diabetic
patients in India would rise to 120 million.
 BE PHYSICAL ACTIVE.
 EAT HEALTHY DIET
 ABCS ( KNOW AND CONTROL) - AIC,BLOOD PRSSURE ,
CHOLESTROL ,SMOKING
 TAKE YOUR MEDICATION
Treatment for Diabetes
Successful treatment makes all the difference to long-term
health, and achieving balanced diabetes treatment can be
the key to living with both type 1and type 2 diabetes.
Treatment varies for each individual, not simply on the type
of diabetes that they have, but also more individual-specific
MEDICINES
diabetic treatment differences.
Treating your diabetes
Your diabetes treatment and management strategy should
be agreed between you and your health care team.
The aim of diabetes treatment is to keep, within
reason, blood glucose levels as near to normal as possible. INJECTIONS
Training in self management of diabetes forms an essential
part of diabetes management. Treatment should be agreed
on an individual basis and address medical, psychosocial
and lifestyle .
TRANSPLANT HERBAL REMEDIES
Balanced diabetes treatments
A variety of different factors have a role to play in treating diabetes,
but the importance of balanced, co-ordinated diabetes treatment for
all diabetics cannot be underestimated.
Regular and successful treatment decreases the risk of each
patient developing diabetes complications.
The basics of diabetes treatment are broken down into each
diabetic type below.
Treatment of Type 1 diabetes
Type 1 diabetes treatment is a daily task. Lack of insulin production
by the pancreas makes Type 1 diabetes is particularly difficult to
control.
Treatment requires a strict regimen that typically includes a
carefully calculated diet, planned physical activity, multiple daily
Treatment of Type 1 diabetes
Type 1 diabetes treatment is a daily task. Lack
of insulin production by the pancreas makes Type 1
diabetes is particularly difficult to control.
Treatment requires a strict regimen that typically
includes a carefully calculated diet, planned physical
activity, multiple daily insulin injections and
home blood glucose testing a number of times

Treatment of Type 2 diabetes

Treatment typically includes diet control, exercise,
home blood glucose testing, and in some cases,
oral medication and/or insulin. Approximately 40%
of people with type 2 diabetes require insulin
injections.
FreeStyle Libre
Available to diabetics in the UK, FreeStyle
Libre consists of a small sensor patch that
is placed on the arm and can be worn for
up to 14 days. Developed by Abbott
Diabetes Care, the patch measures
glucose levels in the interstitial fluid
between the cells right under the skin.
Although the measurements are not as
accurate as using a blood test, the device
allows patients to monitor their glucose
levels continuously and wirelessly, either
using a reading device or downloading an
app on their phones.
GlucoTrack
Developed by Integrity Applications in Israel, GlucoTrack can
measure blood sugar levels through a combination of
ultrasonic, electromagnetic and thermal waves.
To provide a readout, the sensor is clipped on
the ear.
The device is indicated for adults with type 2 diabetes and is
currently approved in Europe, where the company has just
recently started to commercialize the glucose monitor.
Eversense
Developed by Senseonics, Eversense is a subcutaneous
implant that can last for up to 3 months. The device can
measure glucose in the interstitial fluid under the skin of the
arm by using a polymer that fluoresces in response to the
levels of glucose. The data is then sent to a transmitter that
displays the glucose levels in real time.
The device recently received FDA approval and the company
struck a deal with Roche to distribute the sensor.
Diet and preventing type 2
diabetes
Diet is the most important part of lifestyle change. The adage
that you can’t outrun a bad diet is true.
It is much easier to lose weight on a good diet even if you are
struggling to do exercise, than it is through exercise if you’re eating a
poor diet.
Effective diets to prevent type 2 diabetes are those that do not cause
your body to produce a lot of insulin. Carbohydrate has the biggest
demand on insulin and so any diet that helps reduce carbohydrate
intake will help towards reducing your risk of type 2 diabetes.
Cutting out sugary food and drink and refined grains such as white
bread and white rice is a good first step.
Modern research has shown that low-fat diets are not as healthy as
they were once believed to be. It is more important to avoid
processed food rather than trying to avoid fat in foods such as dairy.
Aim to have a balanced diet by basing meals around vegetables and
include healthy sources of fat such as unsalted tree nuts (walnuts,
almonds, hazelnuts), olive oil, avocado, oily fish, meat and full fat
dairy.
Overview Prevention of diabetes
When people talk about prevention of diabetes, it is usually
about preventing type 2 diabetes. In the majority of cases, type
2 diabetes is brought on by lifestyle factors which can often be
prevented.
These include an unbalanced diet, lack of activity, lack of sleep,
stress, smoking and alcohol.
By making lifestyles changes, you can decrease your risk of
developing type 2 diabetes.

Type 2 diabetes prevention overview

Leading doctors and researchers point to excessive levels of insulin as the likely
reason why insulin resistance and type 2 diabetes develops.
Strategies such as low-carb diets and exercise help to reduce levels of insulin and
are therefore effective for preventing type 2 diabetes from developing.
There are a number of risk factors for diabetes, some of which are preventable,
such as weight gain around the middle (central obesity), high cholesterol/triglyceride
levels and high blood pressure.
Losing weight, adopting more activity into your day, stopping smoking and reducing
alcohol intake can also help towards lowering the risk of developing type 2 diabetes
mellitus and improving your all-round healt
 ANTIDIABETIC DRUGS (April 2017)

Gliclazide (Diamicron®) Gliclazide (Diamicron® MR)

Sulfonylureas
Glimepiride (Amaryl®) Glyburide (Diaβeta®)

• Meglitinides Nateglinide Repaglinide (GlucoNorm )

• Biguanides Metformine (Glucophage )
• Metformine extended-release (Glumetza)
• Thiazolidinediones (TZD)
• Pioglitazone (Actos)
• Rosiglitazone (Avandia )
• Pioglitazone :
 Future Treatments

Oral Insulin
• Current type 2 diabetes management entails an attempt to slow progression of the
condition, while reserving insulin as a medication for the last stages, when a person’s
pancreas will stop producing insulin.
• This is generally, not the greatest approach because one of the best ways of
slowing down progression of diabetes is by introducing insulin early in order to give
the pancreas a rest, and delaying a full dependency on insulin.
• An oral insulin medication would eliminate the need for injections in persons with
type 2, be able to be introduced much earlier in the treatment, and possibly greatly
reduce injection needs for patients with type 1 diabetes.
• Oral insulin has one obstacle: our stomach’s digestive juices.

However, there are several giants in the race to bring us Oral insulin, and at various
trial stages, with Israeli pharmaceutical, Oramed, claiming to be at Phase 2 clinical
trials.
Brown Fat Power
• People apparently make two kinds of fat, your
regular ol’ white fat, which can be bad for us,
especially when accumulated around our mid
section, and brown fat.
• brown fat apparently has a lot of wonderful,
useful purposes, such as body temperature
regulation which necessitates that it process
glucose and burn it as fuel.
• In fact, brown fat can produce 10 times the
amount of glucose transporters than insulin.
Finding treatments that activate brown fat could
lead to better management of obesity, cardiac
health, and help manage glucose levels without
need for insulin.
Amylin Toxic Clump Therapy
• Extensive research is beginning to show that type 1
and type 2 diabetes are both the result of the formation
of toxic clumps of a hormone called amylin. Normally
amylin works together with insulin order to regulate the
body’s response.
• But when some of this amylin that IS produced starts
to clump up around beta cells (which are the cells that
produce insulin), these clumps can be toxic to the beta
cells, and result in diabetes.
• Researchers expect to have potential medicines in
clinical trials to target this toxicity in the next few years.
Autoimmune Therapy – anti-CD20:
•Some research is showing that more than a metabolic
disorder, type 2 diabetes is also an autoimmune condition
which occurs resulting out of the inflammation caused
from the dying of adipose tissue and its auto immune-
inhibited ability to handle insulin.

• Some autoimmune therapies such use of the antibody

anti-CD20 have shown promise in eliminating diabetes in
laboratory mice, and the advantage is that this
medication is already approved for use in humans to treat
some types of blood cancers and autoimmune disorders.
Management of Type-2 Diabetes

Diet
Exercise
OHA ( Oral Hypoglycemic Agents )
Monotherapy
Increase the dose of OHAs
Combination of OHAs

BIDS
Insulin injections
 Classification of OHAs

1. Sulphonylureas Glibenclamide , Glipizide ,

Gliclazide , Glimepiride

2. Biguanides Metformin , Phenformin

3. Glitazones Rosiglitazone , Pioglitazone

4. Glinides Repaglinide , Nateglinide

5. Alpha - glucosidase inhibitors Acarbose

 Action of OHA s

•Sulphonylureas Pancreatic - beta-cell ID

•Biguanides Extra-pancreatic IR
esp:hepatic cells
•Glitazones Extra-pancreatic IR
esp: peripheral cells
•Glinides Pancreatic - B - cells ID
•Alpha - glucosidase inhibitors Gut
 Insulin Secretagogues
Sulfonylureas And Meglitinides
Advantages Disadvantages
 Improve insulin  Hypoglycemia
secretion  High long-term failure
 High initial response rate
rate  Need caution in patients
 Fast onset of action with hepatic and/or renal
 Flexible dosing dysfunction
schedule possible
 A comparison of SUs
No Drug Half- Duration Dosage Contraindications
Life of action
(hrs) (hrs)
1. Glibenclamid 4-6 18 - 24 Adult-2.5mg –20 Severe or life threatening
e mg /day hyperglycemia, liver disease,
severe renal failure,
adrenocortical insufficiency,
2. Gliclazide 8 - 20 12 - 24 Adult—40-80 diabetes complicated
mg/day& increased with ketosis and acidosis,
upto320mg /day in unstable diabetes, severe renal
divided doses & hepatic impairment
3. Glipizide 3-5 12 - 18 Adult --- 5-20 mg Ketoacidosis, impaired
adrenocortical function,
stress, pre-coma & coma,
severe renal
insufficiency
4. Glimipiride 5-9 More than Adult --1-2 mg OD Hypersensitivity, ketoacidosis,
24 hrs. Maintenance Dose- severe renal & hepatic
1-4 mg impairment
 Dosing of SUs

Molecule Daily Dose No. of Doses/Day

Second- Glibenclamide 1.25 - 20 mg 1-2
generation
agents
Glipizide 2.5 - 40 mg 1-2

Glipizide SR 5 - 20 mg 1

Glimepiride 1 - 8 mg 1
 Biguanides: Metformin
Advantages
 Unique mechanism of action
 “Insulin-sparing” with rare
hypoglycemia
 High initial response rate
 Established safety profile
 Favorable lipid profile
 Decreased macrovascular
complications with monotherapy
as observed in UKPDS
Disadvantages
 Risk of lactic acidosis
 GI side effects in up to 50% of
patients
 Not tolerated in up to 4% of
patients
 Contraindicated in patients with
impaired renal function,
congestive heart failure requiring
 Thiazolidinediones
Advantages Disadvantages
 True insulin sensitizers by targeting  Delayed onset of action
PPAR
 Potential weight gain
 Improvements in estimates of -cell
function  Potential fluid retention/
 Efficacy as monotherapy and in edema/congestive heart failure
combination with metformin or  Liver monitoring required
sulfonylureas
 Unique mechanism
of action
 Glycemic control with low risk of
hypoglycemia as monotherapy
 Positive effects on HDL and free
fatty acids
 Can be used in patients with renal
insufficiency and the elderly
 HbA1c in Combination Therapy
Studies: Oral Medications
(Difference from Placebo, Separate Studies)
0

-0.5 -0.8
-1.0
-1 -1.2 -1.2
-1.3
-1.5
-1.5

-2 2.2 -3.5 -2.2

-2.5

-3
Glib/ Rep+ SU+ Tolb+ Met+ Met+ Met/Rosi Met/Glip
Met Met Pio Acarb Pio Rosi
Lifestyle Changes to Control Your Diabetes

• Eat healthy.
• Exercise.
• Get checkups.
• Manage stress.
food groups
Some people believe that a diabetes diagnosis
means “goodbye” to good food. Not so. Having
diabetes does not mean that you can no longer
enjoy good food, or that you have to give up your
favorite foods.
Living with diabetes means eating regular, healthy
meals from the following five food groups:

• Grains and starches

• Vegetables
• Fruits
• Milk & alternatives
• Meat & alternatives
some guidelines for healthy eating
Healthy eating for diabetes is healthy eating for the whole family.
Enjoy having regular meals, starting with breakfast first, then lunch and
dinner.
Space meals no more than 6 hours apart.
Eat a variety of foods in each meal, including healthy fats, lean meats or
proteins, whole grains and low-fat dairy.
Choose fiber rich foods such as fruits, vegetables and whole grains as
much as possible, like brown bread, bran cereals, whole wheat pasta
and brown rice.
Explore alternatives to meat such as lentils, beans or tofu.
Choose calorie-free liquids such as unsweetened tea, coffee or water.
Choose sugar substitutes.
At present, India is considered as the diabetic capital of the world. There are
approximately 3.5 crore diabetics in India, and this figure is expected to
increase up to 5.2 crore by 2025.
Every fifth patient visiting a consulting physician is a diabetic and every seventh
patient visiting a family physician is a diabetic. Keeping in view the alarming
increase in the incidence and prevalence of diabetics in India, the World Health
Organization (WHO) has declared India as the ‘Diabetic Capital’ of the world.
(1) Studies have shown that increasing patient knowledge regarding disease
and its complications has significant benefits with regard to patient
compliance to treatment and to decreasing complications associated with
the disease.
(2) Considering this, we sought to quantify in a population of diabetics visiting
our clinic, the level of knowledge with respect to different areas pertaining
to the prevention and treatment of associated complications.
 Knowledge of Diabetes, its Treatment
and Complications Amongst Diabetic
Preventive measures Number of patients identifying
the preventive measures (%)
(N = 101)

Regular blood sugar testing 88 (87.1)

Regular inspection of feet 42 (41.6)
Losing excess weight 31 (30.7)

Table
Knowledge of measures that can be taken for preventing complications in diabetes
Of the 101 diabetic patients 50 (50.5%) did not know that kidney function tests should be performed in diabetes. Ninety-four (94.1%) patients did not know about
glycosylated hemoglobin (HbA1c).
Of the 101 diabetic patients, 48 (48.5%) did not know about the symptoms of hypoglycemia. Yet, 77 (76.2%) knew that sweets should be consumed if they were
hypoglycemic. Of the 101 patients, 11 (10.9%) said that they would definitely have taken preventive measures seriously had they known earlier that diabetes could
be prevented. Sixty (59.4%) patients said that they would probably have taken preventive measures seriously.
Total knowledge scores for each patient were calculated by cumulating the scores for correct answers. The maximum score attainable was 37. The mean score in
men was 2.84 points higher than that in women and the difference was found to be statistically significant (t -statistic = 2.44, P = 0.016). On applying multiple
linear regression, this difference was found to be statistically significant after controlling for age, duration of disease, type of diabetic and whether the patient was
private or general (P = 0.018). Duration of disease was also found to be significantly associated with higher knowledge score after controlling for these factors (P =
0.001).
Patients' knowledge regarding the treatment and complications of diabetes showed serious
deficiencies, more so among women, even though most had been diabetic for years.
A significant predictor for lower knowledge scores was female gender. In this study, the mean
score of the women was 2.84 points lower than that of men (t = 2.44, P = 0.016).
This finding was similar to that reported by Vishwanathan et al, who conducted a study on the
knowledge of diabetic subjects regarding foot problems and care of feet.
(3) They demonstrated that a low knowledge score was more common among women than in
men. In a study conducted in Chandigarh, it was again shown that knowledge concerning the
prevention of diabetes complications was partial amongst diabetics, with only 63.3% of the
diabetics taking care of their feet through regular washing.
(4) The fact that 51 (50.5%) patients thought that diabetes is curable, and that only 64 (63.4%)
patients correctly said that the treatment continues throughout the life, may reflect a mentality
of patients that once the blood sugars are controlled, they can stop taking their medicines. Only
47 (46.5%) correctly said that diabetes is preventable and only 29 (28.7%) were aware of the
causes of diabetes.
This indicates a significant lack of the knowledge of primary and primordial prevention of
diabetes in the population. This fact along with that 71 of the 101 (70.3%) patients said that
they would either definitely or probably have taken preventive measure seriously had they
known that diabetes was preventable means that imparting knowledge regarding prevention
should be a major thrust in the future.
MADE BY :
NEHAL JAIN