PHAR 1008: Comprehensive Report on Diabetes Mellitus Management

This report provides a detailed overview of diabetes mellitus, differentiating it from diabetes insipidus, and classifying diabetes mellitus into Type 1 and Type 2. It discusses the diagnosis and management strategies including non-pharmacological treatments, medication, and surgical options. The pathophysiology of insulin deficiency and its impact on glucose and fat metabolism are explained, along with the symptoms of diabetes mellitus such as glycosuria, polyuria, polydipsia, and weight loss. A graphical analysis of blood glucose levels in patients is presented, followed by a discussion of the long-term complications of diabetes mellitus, including diabetic retinopathy, kidney and heart disease, and diabetic foot disease. The report emphasizes the importance of considering these complications in designing effective management and treatment plans.

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Health Professional Essentials
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Health Professional Essentials
1. Definition
Diabetes mellitus is a chronic condition caused by inability of the pancrease to secret
sufficient insulin or the insensitivity of the body cells to insulin produced by the pancrease
characterized by high concentration of blood sugar (WHO 2014, P.2). On the other hand,
diabetes insipidus is a condition caused by lack of secretion of Antideuretic Hormone by the
pituitary gland leading to inability of the kidney nephron to reabsorb water characterized by
production of large volumes of dilute urine.
2. Types of Diabetes Mellitus
Individuals with diabetes mellitus are categorized as Type 1 and Type 2 diabetic persons.
The basis of classification of diabetes mellitus is insulin dependence. That is, type 1 diabetes id
caused by failure of the pancrease to secret insulin while type 2 diabetes is caused by inability of
the body cells to respond to insulin secreted by the pancrease (WHO 2014, P.3).
3. Diagnosis and Management of Diabetes Mellitus
Diagnosis of diabetes mellitus is based o WHO recommendations. An individual is
diagnosed as diabetic when the two consecutive glucose measurements are established to be
above 126mg/dl (WHO 2016, p.6). Diabetes mellitus is a chronic condition that has no cure.
Instead, the condition is managed by maintaining blood glucose levels close to normal. The
condition has three main routes of treatment. Firstly, non-pharmacological treatment involves
physical exercise and proper nutrition (Haw, Galaviz, and Straus 2017, p.1811). Physical
exercise assists in breakdown of excess glucose while proper nutrition entails management of

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level of cholesterol intake in the diet. Diabetes mellitus can also be treated through medication.
Particularly, type 1 diabetes is treated through injection of insulin which stimulates the
absorption of excess glucose from the blood to body cells (Rotella, Pala, and Mannucci, p.141).
On the other hand, type 2 diabetes mellitus is treated through oral medication such as
administration of metformin. Finally, diabetes mellitus is treated through surgical operation
especially for type 2 diabetic individuals who are suffering from obesity (Picot, Jones, Colquitt,
and Clegg 2016, p.227)
4. Pathophysiology
Insulin is the principal hormone that controls metabolism of glucose and fats. As a result,
insulin deficiency or insensitivity to secreted insulin causes impairment in the metabolism of fats
and glucose causing increase in concentration of blood sugar to abnormal levels (American
Diabetes Association 2014, p.131). There are three principal sources of blood including intestinal
absorption, breakdown of glycogen, and breakdown of non-carbohydrates such as fats (Shoback
and Gadner 2015, p.335). Increase in the level of glucose arising from any of the highlighted
sources causes stimulation of the beta cells of pancrease to secrete insulin hormone. The
secretion of this hormone results in the absorption of blood glucose into body cells as well as
conversion of excess glucose into glycogen and fats for storage. Insufficient insulin or intensity
of the pancreatic cells causes failure of absorption of glucose from the blood. As a consequence,
the concentration of blood glucose increases to abnormal levels. Metabolism of fats is also
significantly impaired as a result of deficiency in insulin. Particularly, insufficient insulin causes
a failure in absorption and consequent conversion of glucose into fats.

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The symptoms of diabetes mellitus are attributed to inability of the body to absorb blood
glucose. Firstly, deficiency in insulin and insensitivity of the body to secreted insulin causes
persistent high levels of glucose. Reabsorption of blood glucose occurs in the kidneys. When the
levels of blood glucose is persistently high, the kidneys reach a point where they can no longer
reabsorb glucose leading to secretion of glucose in urine, a condition known as glycosuria
(Murray 2015, p.49). The nest symptom of diabetes mellitus is polyuria. Secretion of glucose in
urine increases the osmotic pressure of urine above that of blood in the kidney nephron. The high
osmotic pressure of urine results in inability of the kidney nephron to reabsorb water into the
blood. This condition causes production of large quantities of urine. In addition, diabetes mellitus
leads to weight loss due to loss of glucose in urine as opposed to conversion into glycogen and
storage. Finally, increase in concentration of glucose in blood increases the osmotic pressure of
blood causing body cells to lose water into by osmosis. Consequently, diabetic individuals feel
consistently dehydrated and thirsty, a condition described as polydipsia as a result of the body
needing constant replenishing of water lost from the body cells. As highlighted, the symptoms of
diabetes mellitus include secretion of glucose in urine, production of large quantities of urine,
dehydration and thirst, and weight loss.
5. Graphical Analysis
The levels of blood glucose for two overnight fasting patients were recorded against time
following ingestion with 75g of glucose. The procedure for the determination of glucose levels
included addition of 5.0ml of assay reagent followed by addition of 0.1ml of glucose standards to
each test tube. Finally, 0.1ml of each test serum was added to each test tube, the contents shaken
and absorbance read at 625nm. The results are tabulated as shown below.

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Table 1: Standards
Glucose standard (mmol/L) Absorbance @ 625nm
0 0.02
3 0.21
6 0.43
9 0.65
12 0.83
Figure 1: A Graph of Absorbance against Glucose Concentration.
0 2 4 6 8 10 12 14
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
f(x) = 0.0704444444444444 x
R² = 0.999293953858393
Glucose Concentration (mmol/L)
Absorbance

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Table 2: Patients Results
Time (min) Absorbance – Patient A Absorbance – Patient B
0 0.26 0.47
30 0.51 0.63
60 0.25 0.80
90 0.23 0.76
120 0.24 0.63
240 0.30 0.58
Using the regression equation Abs = 0.070C obtained from the graph of absorbance and glucose
concentration and the patients results in table 2, the concentration of glucose in each patient
serum sample were determined and tabulated in table 3 as shown below.
Table 3: Glucose concentration in patient serum sample
Time (min) Glucose Concentration
(mmol/L) – Patient A
Glucose Concentration
(mmol/L) – Patient B
0 3.71 6.71
30 7.29 9.00
60 3.57 11.43
90 3.29 10.86
120 3.43 9.00
240 4.29 8.29
The results indicate that patient A secrets sufficient insulin that initiates absorption of ingested
glucose within 30 minutes as shown in figure 2 while patient B is diabetic.

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Figure 2: A Graph of Glucose Concentration against Time
0 50 100 150 200 250 300
0
2
4
6
8
10
12
14
Series2
Series4
Time (min)
Glucose Concentration
(mmmol/L)
6. Complications of Diabetes Mellitus
Treatment of diabetes mellitus is associated with long term risks and complication that a
pharmacists need to take into account when advising a diabetic client. To begin with, high level
of blood glucose causes damage of retina blood vessels leading to diabetic retinopathy. Diabetic
retinopathy results in loss of vision. The onset and progression of retinopathy can be delayed
through effective control of metabolism of glucose such as good nutrition and lifestyle changes.
In addition, high blood sugar levels causes failure of the kidney and heart disease. Kidney and
heart failure are accelerated by smoking, high levels of blood cholesterol, and high bold pressure
(WHO 2014, P.2). A pharmacist should therefore take these risk factors into consideration when
planning a diabetic management plan. Another complication of diabetes is diabetic foot disease
which often leads to ulceration and even limb amputation. Taken into consideration these
complications are vital in designing effective management and treatment plans.

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References
American Diabetes Association. Insulin Basics. London: American Diabetes Association; 2014.
Haw JS, Galaviz KI, and Straus AN. Long-term sustainability of diabetes prevention approaches:
A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Internal
Medicine, 177(3); 2017: 1808-1817.
Murray RK. Harper’s illustrated biochemistry. New York: McGraw-Hill Medical; 2015.
Picot, J., Jones, J., Colquitt J.L,, and Clegg A.J. The clinical effectiveness and cost-effectiveness
of bariatric surgery for obesity: A systematic review and economic evaluation. Health
Technology Assignment, 13 (7); 2016: 215-357.
Rotella, M., Pala, L., Mannucci, E. Role of insulin in type 1 diabetes therapy. International
Journal of Endocrinology and Metabolism, 11(3); 2013: 137-144.
Shoback DG, and Gadner, D. Greenspan’s basic and clinical endocrinology. New York:
McGraw-Hill Medical; 2015.
World Health Organization. Diabetes Mellitus Fact Sheet N0 138. Geneva: World Health
Organization; 2014.
World Health Organization. Definition and diagnosis of diabetes mellitus. A report of WHO.
Geneva: World Health Organization; 2016.