Diabetes Mellitus Concept Map: An Overview

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Diabetes Mellitus (DM) Concept Map

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 to 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 stated under (DIAGNOSIS), where DM diagnostic criteria are mentioned.  DM is diagnosed by demonstrating any one of the following along 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 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 of the map is also followed by explanations of screening tests that are usually used by diabetic patients.  The first one is screening for glucose in the urine, a condition that is called (Glucosuria), and the second is screening for ketones in urine, a condition that is called (Ketonuria). 
The other part of (Monitoring) is related to; DM complications, when to start to monitor for these complications, and what monitoring tests are used.

Types of Diabetes Mellitus

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.

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Type 1 Diabetes Mellitus vs Type 2

Treatment of Diabetes Mellitus

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 include their mechanisms of action, adverse effects, drug interactions, precautions, and contraindications if any.

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Diabetes Mellitus – Pathophysiology and treatment map (abbreviations are mentioned in the map)

Pharmacological treatment

  • 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:
    1. Amylin analogue
    2. Dopamine Agonists
    3. Bile Acid Sequestrants

Diabetes Complications

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Lifelong insulin is required in all type 1 DM patients and it should be started immediately after diagnosis otherwise the patient probably will experience an acute complication of diabetes 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 the DKA map, there is an explanation of another diabetic complication called “Hyperosmolar Hyperglycemic State” – HHS which mainly occurs in type 2 DM patients.  Differences between DKA and HHS are highlighted in the map.

You’ll find the patient education icon at different sites in the map to indicate the importance of patient education in some particular areas like:

  • 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 to avoid DKA.

Diabetes mellitus concept map also includes:

Non pharmacological treatment

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.

Order the map

You can order the diabetes mellitus concept map in any of the following forms according to your preference. Our maps are comprehensive in a way that can benefit both students and clinicians.

This map is available in two forms;
1. Printable version.
2. Whole map version.

Check them out below to know the difference, so that you can choose what is suitable for you. And please feel free to leave your feedback, comments, or questions in the comments section below.

Diabetes Mellitus Concept Map by Maha Atef, B Pharm, PGDip (ClinPharm), PGDip (TQM)
Last updated on 31 October 2012.

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