Diabetes Mellitus Concept Map | DM type 1 | DM type 2 | Insulin | Oral Antidiabetics | Diabetic Ketoacidosis

Diabetes Mellitus Concept Map: An Overview

diabetes mellitus concept map from Zoom out - Pharmacotherapy
Diabetes Mellitus Concept Map
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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

Diabetes Mellitus - Criteria for diagnosis and diagnostic tests
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 - comparison
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
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)
  • Insulin secretagogues:
 1) Sulfonylureas (SU' s) / Long-acting insulin secretagogues
 2) Meglitinides / Short-acting insulin secretagogues

  • Insulin sensitizers
 1) Biguanides
 2) Thiazolidinediones (TZDs) / Glitazones / PPARγ Agonists

  • Intestinal enzyme inhibitors
 α-Glucosidase inhibitors (AGIs)

  • Dipeptidyl peptidase - 4 inhibi tors

  • New therapies:
-          Amylin analogue
-          Dopamine Agonists
-          Bile Acid Sequestrants

Diabetes Complications

Diabetes Mellitus Complications - Diabetic ketoacidosis (DKA) - diagram
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.

Diabetes Mellitus Concept Map Folded Poster
Diabetes Mellitus Folded Map

We hope you find Diabetes Mellitus Concept Map helpful and we are looking forward to hearing your opinionThis map is available in the following formats: 


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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>

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