MANAGEMENT OF

DIABETES
MELLITUS

1) Diet and lifestyle

management
Aims:
Achieve good glycaemic control
Reduce hyperglycaemia and avoid
hypoglycaemia
Assist with weight management
Reduce risk of micro and
macrovascular complication
Ensure adequate nutritional intake

a) Carbohydrate
b)Fat
c) Weight management
d)Alcohol
e) Salt
f) Sweet food

2) Anti-Diabetic Drugs
a) Sulfonylureas
glyburide, glipizade
b) Biguanides
metformin
c) alpha-Glucosidase inhibitor
acarbose,miglitol

d) Thiazolidinediones
pioglitazone,rosiglitazone
e) Incretin mimetics
exenatide,liraglutide

3) Insulin
Produced by beta cells of islet of
langerhans
Because it is a polypeptide, it will be
degrade in the git if taken orally
Administered by subcutaneous
injection:
anterior abdominal wall,upper
arms,outer thighs,buttocks

 Short-acting insulin
Pre-meal injection in multiple dose
regimens. Dissociate more rapidly
following injection without altering
biological effect. Enter circulation more
rapidly than human soluble insulin and
also disappear more rapidly.
Longer-acting insulin
Addition of zinc or protamine derived from
fish sperm. Most widely used form is NPH
(isophane insulin). Structure modified to
delay absorption or to prolong their
duration of action.

 Inhaled insulin
Alternative but withdrawn from market
in 2007 (limited clinical demand) Main
limitation: only about 10% of inhaled
dose reaches the circulation

Insulin is administered using

Disposable plastic stringe with fine
needle
Pen injectors with insulin cartridge
Continuous subcutaneous insulin
infusion (CSII) devices

Insulin
syringe
Insulin pen

Adverse effect observed with insulin

Headache
Anxiety
Symptoms
Tachycardia
caused by
hypoglycaemia
Confusion
Vertigo
Diaphoresis local atrophy or hypertrophy
of
subcutaneous fatty
Lipodystrophy tissue at the site of injection
hypersensitivity

Diabetic foot:classification
Wagner ulcer classification system, which is
based on the depth of penetration, the presence
of osteomyelitis or gangrene, and the extent of
tissue necrosis

 The University of Texas diabetic wound classification

system assesses the depth of ulcer penetration, the presence of
wound infection, and the presence of clinical signs of lowerextremity ischemia.This system uses four grades of ulcer depth (0
to 3) and four stages (A to D), based on ischemia or infection, or
both

Management for diabetic

foot
education
Antibiotics
Half shoe is recommended (front
covered)
Hygiene and personal care: Must cut
toe nails (not by patient)
Regular foot examination
Wound debridement
Amputation

Wound
debridement

Diabetic
dermopathy

Thank you