REVIEW ON DIABETES MELLITUS

“REVIEW ON DIABETES MELLITUS”

A dissertation submitted to the University of Pune

For the partial fulfillment for the degree in

Bachelor of Pharmacy
Acadmic Year
2022-2023

Submitted by,
Ms.Komal Ananda Kamble

Under the supervision of

Dr. H. V. Kamble
(M. Pharm., Ph.D.)

Professor and Principal

Loknete Shri Dadapatil Pharate College of Pharmacy

A/P Mandavgan Pharata, Tal – Shirur, Dist – Pune. 412211

iv
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

CERTIFICATE
This is to certify that investigations incorporated in this thesis titled, Review on
Diabetes Mellitus submitted by miss. komal ananda kamble for the partial fulfillment
of requirements of degree in Bachelor of Pharmacy in the faculty of Pharmaceutical
Sciences, University of Pune. The research work was carried out in Loknete Dadapatil
Pharate College Of Pharmacy, affiliated to Savitribai Phule pune University, under
my guidance and supervision.

The thesis is now ready for examination. I hereby forward the same.

Date:

Place: Mandavgan Pharata

Guide
Prof. M.M.Garje
Prof. P.B.Sonawane
(M. Pharm.)
(Pharmaceutical Chemistry)

Loknete Shri Dadapatil Pharate College of Pharmacy

A/P Mandavgan Pharata, Tal – Shirur, Dist – Pune.

v
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

CERTIFICATE

This is to certify that investigations incorporated in this thesis titled, Review on

Diabetes Mellitus submitted by miss komal Ananda kamble for the partial fulfillment
of requirements of degree in Bachelor of Pharmacy in the faculty of Pharmaceutical
Sciences, University of Pune were carried out in Loknete Dadapatil Pharate College
Of Pharmacy under the guidance and supervision of Prof. M.M.Garje and Prof.
P.B.Sonawane (M.Pharm.).Professors (Pharmaceutical Chemistry), Loknete Shri
Dadapatil Pharate College of Pharmacy.

Date:

Place: Mandavgan Pharata

Dr. H. V. Kamble
Principal

Loknete Shri Dadapatil Pharate College of Pharmacy

A/P Mandavgan Pharata, Tal – Shirur, Dist – Pune. 412211

vi
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

STATEMENT BY CANDIDATE
I, the undersigned wish to state that the work presented in the current dissertation
titled,Review on Diabetes Mellitus is my own contribution to knowledge & research
carried out under the guidance of Prof. M.M.Garje and Prof. P.B.Sonawane
Professors, Loknete Shri Dadapatil Pharate College of Pharmacy, Mandavgan Pharata
and.This work has not been submitted for any other degree to any university. References
of prior research work have been cited and clearly indicated in the References.

Date:

Place: Mandavgan Pharata

Ms. Komal Ananda Kamble

Loknete Shri Dadapatil Pharate College of Pharmacy

A/P Mandavgan Pharata, Tal – Shirur, Dist – Pune. 412211

vii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

ACKNOWLEDGEMENT

I am overwhelmed in all humbleness and gratefullness to acknowledge my depth to all

those who have help me to put this ideas ,well above the level of simplycity and into
something concrete. I would like to express my special thanks of gratitude to my teacher
Mr . M .M .Garaje , Ms .Sonawane P.B as well as our principal Kamble H.V to gave me
the golden opportunity to do this wonderful project on the topic "DIABETES MELLITUS"
which also help me in doing a lot of research and I came to know about so many new
things . I am really thankful to them . Any attempt at any level can't be satisfactorily
completed with the support and guidence of my teachers and friends.I would like to thank
my friends who helped me a lot in gathering different information ,collecting data and
guiding me from time to time in making this project ,despite of their busy schedule they
gave me different ideas in making this project unique .

viii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

CONTENT

1)Abstract
2)Introduction
3)Types of diabeties mellitus
4)Risk factors
5)Causes of diabeties
6)Symptoms of diabeties
7)Complications of diabeties
8)Diagnosis
9)Tests for diabeties
10)Management
11)Treatment
12)Medication

ix
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

ABSTRACT

Diabetes mellitus is a group of physiological dysfunction characterized by hyperglycemia

resulting directly from insuline resistance ,inadequate insuline secreation ,or excessive
glucagon secretions.
Type 1 dibeties (TD 1) is an autoimmune disorder leading to the destruction of pancreatic
beta cells .
TYPE 2 DIABETES (T2D) which is much more common ,is primarily a problem of
progressively impaired glucose regulation due to a combination of dys functional
pancreatic beta cells and insuline resistance. The purpose of this article is to review the
basic science of type 2 diabetes and its complications ,and to discuss the most recent
treatment guidelines .

x
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

INTRODUCTION

Diabetes Mellitus’ happens when blood glucose/sugar becomes too high [1]. Blood glucose
is the main type of sugar found in blood and is the main source of energy. Glucose comes
from the food and is also made in the liver and muscles. The blood carries glucose to all of
the body’s cells to use for energy. Pancreas, an organ located between the stomach and
spine, releases a hormone called insulin into the blood which carries glucose to all body’s
cells. Sometimes the pancreas doesn’t make enough insulin or the insulin doesn’t work the
way it should, glucose then stays in the blood and doesn’t reach cells. Blood glucose levels
get too high and can cause diabetes [2]. The three main types of diabetes are Type 1, Type
2 & Gestational Diabetes. People irrespective of gender and age can develop diabetes.

xi
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

Risk factors for Type 1 diabetes include:

 Having a family history (parent or sibling) of Type 1 diabetes.

 Injury to the pancreas (such as by infection, tumor, surgery or accident).
 Presence of autoantibodies (antibodies that mistakenly attack your own body’s
tissues or organs).
 Physical stress (such as surgery or illness).
 Exposure to illnesses caused by viruses.

Risk factors for prediabetes and Type 2 diabetes include:

 history (parent or sibling) of prediabetes or Type 2 diabetes.

 Being Black, Hispanic, Native American, Asian-American race or Pacific Islander.
 Having overweight/obesity.
 Having high blood pressure.
 Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.
 Being physically inactive.
 Being age 45 or older.
 Having gestational diabetes or giving birth to a baby weighing more than 9 pounds.
 Having polycystic ovary syndrome.
 Having a history of heart disease or stroke.

xii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

 Being a smoker.

Risk factors for gestational diabetes include:

 Family history (parent or sibling) of prediabetes or Type 2 diabetes.

 Being African-American, Hispanic, Native American or Asian-American.
 Having overweight/obesity before your pregnancy.
 Being over 25 years of age.

xiii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

WHAT CAUSES DIABETES ?

The cause of diabetes, regardless of the type, is having too much glucose circulating in
your bloodstream. However, the reason why your blood glucose levels are high differs
depending on the type of diabetes.
Causes of Type 1 diabetes: This is an immune system disease. Your body attacks and
destroys insulin-producing cells in your pancreas. Without insulin to allow glucose to enter
your cells, glucose builds up in your bloodstream. Genes may also play a role in some
patients. Also, a virus may trigger the immune system attack.
Cause of Type 2 diabetes and prediabetes: Your body’s cells don't allow insulin to work
as it should to let glucose into its cells. Your body's cells have become resistant to insulin.
Your pancreas can’t keep up and make enough insulin to overcome this resistance. Glucose
levels rise in your bloodstream.
Gestational diabetes: Hormones produced by the placenta during your pregnancy make
your body’s cells more resistant to insulin. Your pancreas can’t make enough insulin to
overcome this resistance. Too much glucose remains in your bloodstream.

xiv
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

WHAT ARE THE SYMPTOMS OF DIABETES?

Symptoms of diabetes include:

 Increased thirst.
 Weak, tired feeling.
 Blurred vision.
 Numbness or tingling in the hands or feet.
 Slow-healing sores or cuts.
 Unplanned weight loss.
 Frequent urination.
 Frequent unexplained infections.
 Dry mouth.

xv
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

Other symptoms:

 In women: Dry and itchy skin, and frequent yeast infections or urinary tract
infections.
 In men: Decreased sex drive, erectile dysfunction, decreased muscle strength.

Type 1 diabetes symptoms: Symptoms can develop quickly – over a few weeks or

months. Symptoms begin when you’re young – as a child, teen or young adult. Additional
symptoms include nausea, vomiting or stomach pains and yeast infections or urinary tract
infections.
Type 2 diabetes and prediabetes symptoms: You may not have any symptoms at all or
may not notice them since they develop slowly over several years. Symptoms usually begin
to develop when you’re an adult, but prediabetes and Type 2 diabetes is on the rise in all
age groups.
Gestational diabetes: You typically will not notice symptoms. Your obstetrician will test
you for gestational diabetes between 24 and 28 weeks of your pregnancy.

xvi
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

WHAT ARE THE COMPLICATIONS OF DIABETES?

If your blood glucose level remains high over a long period of time, your body’s tissues
and organs can be seriously damaged. Some complications can be life-threatening over
time.
Complications include:

 Cardiovascular issues including coronary artery disease, chest pain, heart

attack, stroke, high blood pressure, high cholesterol, atherosclerosis (narrowing of
the arteries).
 Nerve damage (neuropathy) that causes numbing and tingling that starts at toes or
fingers then spreads.
 Kidney damage (nephropathy) that can lead to kidney failure or the need
for dialysis or transplant.
 Eye damage (retinopathy) that can lead to blindness; cataracts, glaucoma.
 Foot damage including nerve damage, poor blood flow and poor healing of cuts and
sores.

xvii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

 Skin infections.
 Erectile dysfunction.
 Hearing loss.
 Depression.
 Dementia.
 Dental problems.

Complications of gestational diabetes:

In the mother: Preeclampsia (high blood pressure, excess protein in urine, leg/feet
swelling), risk of gestational diabetes during future pregnancies and risk of diabetes later in
life.
In the newborn: Higher-than-normal birth weight, low blood sugar (hypoglycemia),
higher risk of developing Type 2 diabetes over time and death shortly after birth.

HOW IS DIABETES DIAGNOSED?

Diabetes is diagnosed and managed by checking your glucose level in a blood test. There
are three tests that can measure your blood glucose level: fasting glucose test, random
glucose test and A1c test.

 Fasting plasma glucose test: This test is best done in the morning after an eight
hour fast (nothing to eat or drink except sips of water).
 Random plasma glucose test: This test can be done any time without the need to
fast.
 A1c test: This test, also called HbA1C or glycated hemolglobin test, provides your
average blood glucose level over the past two to three months. This test measures
the amount of glucose attached to hemoglobin, the protein in your red blood cells
that carries oxygen. You don’t need to fast before this test.

xviii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

 Oral glucose tolerance test: In this test, blood glucose level is first measured after
an overnight fast. Then you drink a sugary drink. Your blood glucose level is then
checked at hours one, two and three.

HOW IS DIABETES MANAGED?

Diabetes affects your whole body. To best manage diabetes, you’ll need to take steps to
manage your risk factors, including:

 Keep your blood glucose levels as near to normal as possible by following a diet
plan, taking prescribed medication and increasing your activity level.
 Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as
near the normal ranges as possible.
 Manage your blood pressure. Your blood pressure should not be over 140/90
mmHg.

xix
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

You hold the keys to managing your diabetes by:

 Planning what you eat and following a healthy meal plan. Follow a Mediterranean
diet (vegetables, whole grains, beans, fruits, healthy fats, low sugar) or Dash diet.
These diets are high in nutrition and fiber and low in fats and calories. See a
registered dietitian for help understanding nutrition and meal planning.
 Exercising regularly. Try to exercise at least 30 minutes most days of the week.
Walk, swim or find some activity you enjoy.
 Achieving a healthy weight. Work with your healthcare team to develop a weight-
loss plan.
 Taking medication and insulin, if prescribed, and closely following
recommendations on how and when to take it.
 Monitoring your blood glucose and blood pressure levels at home.
 Keeping your appointments with your healthcare providers and having laboratory
tests completed as ordered by your doctor.
 Quitting smoking (if you smoke).

HOW IS DIABETES TREATED?

Treatments for diabetes depend on your type of diabetes, how well managed your blood
glucose level is and your other existing health conditions.

 Type 1 diabetes: If you have this type, you must take insulin every day. Your
pancreas no longer makes insulin.
 Type 2 diabetes: If you have this type, your treatments can include medications
(both for diabetes and for conditions that are risk factors for diabetes), insulin and

xx
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

lifestyle changes such as losing weight, making healthy food choices and being
more physically active.
 Prediabetes: If you have prediabetes, the goal is to keep you from progressing to
diabetes. Treatments are focused on treatable risk factors, such as losing weight by
eating a healthy diet (like the Mediterranean diet) and exercising (at least five days
a week for 30 minutes). Many of the strategies used to prevent diabetes are the
same as those recommended to treat diabetes (see prevention section of this article).
 Gestational diabetes: If you have this type and your glucose level is not too high,
your initial treatment might be modifying your diet and getting regular exercise. If
the target goal is still not met or your glucose level is very high, your healthcare
team may start medication or insulin.

WHAT INSULIN MEDICATIONS ARE APPROVED TO

TREAT DIABETES?
There are many types of insulins for diabetes. If you need insulin, you healthcare team will
discuss the different types and if they are to be combined with oral medications. To follow
is a brief review of insulin types.

 Rapid-acting insulins: These insulins are taken 15 minutes before meals, they peak
(when it best lowers blood glucose) at one hour and work for another two to four
xxi
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

hours. Examples include insulin glulisine (Apidra®), insulin lispro (Humalog®)

and insulin aspart (NovoLog®).
 Short-acting insulins: These insulins take about 30 minutes to reach your
bloodstream, reach their peak effects in two to three hours and last for three to six
hours. An example is insulin regular (Humulin R®).
 Intermediate-acting insulins: These insulins reach your bloodstream in two to four
hours, peak in four to 12 hours and work for up to 18 hours. An example in NPH.
 Long-acting insulins: These insulins work to keep your blood sugar stable all day.
Usually, these insulins last for about 18 hours. Examples include insulin glargine
(Basaglar®, Lantus®, Toujeo®), insulin detemir (Levemir®) and insulin degludec
(Tresiba®).

There are insulins that are a combination of different insulins. There are also insulins that
are combined with a GLP-1 receptor agonist medication (e.g. Xultophy®, Soliqua®).

CONCLUSION

Take Care of Diabetes Each Day Do four things each day to help blood glucose levels stay
in target range: I. Follow a healthy eating plan. II. Be physically active. III. Manage insulin
dosages. IV. Monitor diabetes. These things may seem like a lot to do at first. Make small

xxii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

changes until these steps become a normal part of day activity. Learn to balance insulin
dosage with each meal and exercise to avoid hypos. Set a target blood glucose range and
improve HbA1c (maintain it in between 6%-7%). Participate in marathons and attend
diabetic camps to meet and learn from the experiences of other Type 1 diabetic people.
Meditate, practice yoga and stay positive. Once learned to manage diabetes, people can
lead a normal life and do not have to be afraid of diabetic complications. The author
advices all those diagnosed with type 1 diabetes to be patient and stay strong.

REFERENCES
1. Richard Holt IG, Clive Cockram S, Allan Flyvbjerg, Barry J (2010) Textbook of
Diabetes. Wiley-Blackwell, a John Wiley & Son Ltd. publication, (4th edn.), UK.
2. Michael Parchman L, Marion J Franz (2013) Your Guide to Diabetes: Type 1 and Type
2. NIH publication, No. 14-4016,
xxiii
LSDP COLLAGE OF PHARMACY
 REVIEW ON DIABETES MELLITUS

3. Suresh Lal B (2016) Diabetes: causes, symptoms and treatments. In book: Public health
environment and social issues in India, (Chapter 5), (1st edn).
4. Rubio-Cabezas O, Hattersley AT, Njolstad PR (2014) The diagnosis and management
of monogenic diabetes in children and adolescents. Pediatric Diabetes 12: 33-42.
5. Michael Dansinger (2018) Diagnosis of diabetes, Webmd.
6. Melissa Conard Stoppler (2019) Diabetic ketoacidosis symptoms, causes, treatment and
complications. eMedicine health.
7. Will Dubois (2019) Beta cell resurrection with diabetes. Diabetes mine.
8. Kenneth Saladin (2018) How is insulin produced in a cell? Anatomy and Physiology:
The unity of form and function. (8th edn).
9. Peter Rentzepis (2019) Switching to afrezza inhaled insulin: tips from diabetes educator.
Diatribe Learn.
10. Barbara Brody (2018) Life with insulin injections. Webmd.
11. Lisa Leontis RN, Anp C (2016) Diabetes glossary. Endocrin Web.
12. Brian VSC (2019) The levemir and lantus burn. Diabetes forum.
13. McGill JB, Ahn D, Edelman SV, Kilpatrick CR, Santos Cavaiola T, et al. (2016)
Making insulin accessible: Does inhaled insulin fill an unmet need? Advances in Therapy
33(8): 1267-1278.
14. Boughton CK, Hovorka R (2019) Is an artificial pancreas (closed-loop system) for type
1 diabetes effective? Diabet Med 36(3): 279-286.
15. Brunilda Nazario (2018) Best and worst foods for diabetes. Webmd.
16. Kathlevn Zelman (2014) Treating the flu in people with health risk. Medcinenet.
17. Gary Scheiner (2016) Dealing with dawn phenomena. Diabetes daily.
18. Gaete X (2010) Menstrual irregularities linked to type 1 diabetes. Fertil Steril,
Endocrine Today. 19. Minesh Khatri (2017) Tips for travelling with diabetes. Webmd.

xxiv
LSDP COLLAGE OF PHARMACY