Diabetes Mellitus Concept Map: An Overview
Definition
The map
starts with Diabetes Mellitus (DM) definition which is a syndrome that is caused by absolute or
relative lack of insulin, resistance to the action of insulin, or both. It is characterized by hyperglycemia and
alteration in lipid and protein metabolism.
This definition is linked with the normal physiology of insulin and
glucagon secretion in response to blood glucose level (BGL). From DM definition, there are also links to
symptoms of hyperglycemia and DM complications (including micro- and
macrovascular complications).
Diagnosis
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| Diabetes Mellitus - Criteria for diagnosis and diagnostic tests |
Symptoms of hyperglycemia are written under
(DIAGNOSIS), where DM diagnostic criteria.
DM is diagnosed by demonstrating any one of the following a long with symptoms of DM:
- Symptoms of hyperglycemia or
hyperglycemic crisis plus casual plasma glucose ≥ 200 mg/dL
(11.1 mmol/L)
- Fasting plasma glucose ≥ 126 mg/dL
(7.0 mmol/L)
- 2-hour postload glucose ≥ 200mg/dL
(11.1 mmol/L) during OGTT
- HbA ≥ 6.5%.
From these
criteria, there are links to DM diagnostic tests including: Random Blood
Glucose Test, Fasting Blood Glucose Test, Oral Glucose Tolerance Test (OGTT)
/2-Hour Postprandial Test, and Glycosylated Hemoglobin (HbA1C), with a
comparison of their relevant values of blood glucose level in cases of normal
BGL, Impaired glucose tolerance (IGT), Impaired fasting glucose (IFG), Increased
risk of diabetes mellitus, and values in case of DM.
Monitoring
Although
(MONITORING) part is usually mentioned in any reference at the end of the
topic, it is mentioned in this map close to (Diagnosis) part to show
differences between all tests used in diabetes and to clarify which ones that
are used for diagnosis and/or monitoring.
Tests that are used in DM monitoring are: Self / Home Monitoring of
Blood Glucose (SMBG /HMBG), Glycosylated Hemoglobin (HbA1C), and Serum
Fructosamine. Each one is explained and
followed by normal values of BGL and values that indicate DM or inadequate
glucose control. (Monitoring) part is
also followed by explanations of screening tests that are usually used by
diabetic patients. The first one is
screening for glucose in urine, a condition that is called (Glucosuria) and the
second is to screen for ketones in urine, a conditions that is called (Ketonuria).
The other
part of (Monitoring) is related to DM complications, when to start monitor for
these complications and what monitoring tests are used.
Types of Diabetes mellitus
A
comparison between diabetes mellitus type 1 and type 2 is included within the
map. This comparison covers the
following points:
Age of
onset - Onset - Risk Factors -Pancreatic Function - Pathophysiology - Clinical
Presentation – Obesity – Complications – Treatment.
Treatment
of DM type 1 includes : insulin, diet, and exercise, while treatment of type 2
includes: diet, exercise, oral antidiabetics (OAD), insulin.
 |
| Type 1 Diabetes Mellitus vs Type 2 |
Treatment
A mind map
of diabetes mellitus treatment is included under (TREATMENT). The main function
of this map is to differentiate between the sites of action of medications used
in the management of DM, i.e. to show whether this medicine acts to stimulate
pancreatic insulin secretion (Insulin secretagogues), decrease peripheral insulin resistance (Thiazolidinediones),
decrease hepatic glucose production (Biguanides), or slow digestion and
absorption of carbohydrates (α-Glucosidase inhibitors (AGIs)) …etc. Medications used in the management of
diabetes mellitus are discussed in comparisons that involve their mechanisms of
action, adverse effects, drug interactions, precautions, and contraindications
if any.
 |
Diabetes Mellitus - Pathophysiology and treatment map
(abbreviations are mentioned in the map) |
The
pharmacological treatment of diabetes mellitus includes:
- Insulin
- Glucagon-Like Peptide 1 (GLP-1 )
Agonists (Incretin mimetics )
- Oral Antidiabetics (OAD)
1) Sulfonylureas
(SU' s) / Long-acting insulin secretagogues
2) Meglitinides
/ Short-acting insulin secretagogues
1) Biguanides
2) Thiazolidinediones
(TZDs) / Glitazones / PPARγ Agonists
- Intestinal enzyme inhibitors
α-Glucosidase
inhibitors (AGIs)
- Dipeptidyl peptidase - 4 inhibi tors
-
Amylin analogue
-
Dopamine Agonists
-
Bile Acid Sequestrants
Diabetes Complications
 |
Diabetes Mellitus Complications - Diabetic ketoacidosis (DKA)
Click to enlarge |
Lifelong insulin
is required in all type 1 DM patients and it should be started immediately
after diagnosis, unless patient probably will experience an acute complication
of diabetes which is called “Diabetic Ketoacidosis” – DKA. It is a diabetic emergency that is caused by absolute
or relative insulin deficiency. A
separate concept map for diabetic ketoacidosis is included to give an overview
of DKA definition, pathophysiology, diagnosis, and management. Next to DKA map, there is an overview of
another diabetic complication called “Hyperosmolar Hyperglycemic State” – HHS
which mainly occurs in type 2 DM patients.
Differences between DKA and HHS are highlighted with dotted boxes.
Patient
education icon is scattered at different sites within the map to indicate the
importance of patient education in those particular areas for example:
- Risk factors of diabetes mellitus 2
including “insulin resistance syndrome” or “metabolic syndrome"
- Self / Home Monitoring of Blood Glucose
(SMBG /HMBG)
- Monitoring using (SMBG) and (HbA1c)
for insulin dosage adjustment
- Importance of insulin therapy in order
to avoid DKA
Diabetes mellitus
concept map also includes:
Non pharmacological
treatment of DM:
Modifications
in diet and exercise should be adjusted individually, with different diet
requirements for both types of DM.
Adjunctive
treatment
Treatment
and prevention of complications and recommendations of using ACEIs, ARBs,
aspirin, and/or lipid-lowering agents according to patient’s case.
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| Diabetes Mellitus Folded Map |
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Diabetes Mellitus Concept Map, version no. 2.0, by Maha Atef, B Pharm
Last updated on: 31 October 2012
References
"American Diabetes Association Treatment Algorithm for Type 2 Diabetes." Pharmacist's Letter. November 2006. 11 May 2009.
"Diabetic Ketoacidosis (DKA)." The Merck Manuals for Healthcare Professionals. May 2007. Merck Medicus. 29 April 2009
DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach. 8th. The McGraw-Hill Companies , 2011.
Fauci, Anthony S., et al. Harrison's Online. 17th Edition ed. The McGraw-Hill Companies, 2008. Merck Medicus. 2008. 17 Feb. 2009 <http://www.merckmedicus.com/pp/us/
hcp/frame_textbooks.jsp?pg=http://www.accessmedicine.com/resourceTOC.aspx? resourceID=4>
