Integrated Teaching Curriculum On Diabetes should ideally cover topics ranging from: 1.

Anatomy of the pancreas: location, shape, size, parts, blood supply, islets of Langerhans- nerve supply 2. Physiology: Endocrine functions of the pancreas- source, synthesis, mode of action of Insulin and Glucagon; Role of Liver, Insulin, Glucagon and other hormones in the maintenance of blood sugar level; hypoactivity-DM, hyperactivity-hyperinsulinism 3. Biochemistry: factors maintaining blood glucose, normal plasma glucose level, effects of hormones on glucose level, Oral Glucose Tolerance Test, Diagnostic criteria for DM, Impaired glucose tolerance, renal threshold, reducing substances in urine, Benedicts test, structure of insulin, factors influencing insulin secretion, mechanism of action of insulin (receptors, signal transduction, gene transcription, enzyme activation, glucose uptake), metabolic effects of insulin, hyperglycemic hormones (glucagon, adrenaline, ACTH, glucocorticoids, thyroxine, GH), DM-types, cardinal signs and symptoms, metabolic derangements in DM 4. Pathology: DM definition, pathogenesis type 1 and 2, pathologic changes in islets, pathogenesis of complications, diagnosis- (urine, blood sugar estimation, OGTT, glycosylated Hb, other tests) 5. Pharmacology: Approaches to drug therapy in type 1 and type 2 DM, role of insulin to produce hypoglycemia, conventional preparations of insulin, human insulin, insulin analogues, reactions to insulin, drug interactions, uses of insulin (DM, DKA,hyperosmolar coma), insulin resistance; oral hypoglycemics-mechanism of action, indications 6. Medicine: Spectrum of glucose hemostasis and DM, etiologic classification of DM, Risk factors for type 2 DM. Long Term treatment- Treatment Goals, patient education, Medical Nutrition Therapy (nutritional recommendations for adults with diabetes), monitoring of blood glucose (self monitoring as well). Type 1 treatment: general aspects, intensive management, insulin preparations, regimens. Type 2 treatment: general aspects, oral hypoglycemic agents, insulin secretagogues). Side effects of therapy, guidelines for ongoing medical care for patients with diabetes, psychosocial aspects, management in hospitalized patients, preparation of diabetic patients during surgery. Major acute complications: Diabetic ketoacidosis (Clinical signs and symptoms, laboratory diagnosis and management); Hyperglycemic Hyperosmolar State (Clinical signs and symptoms, lab diag and management). 7. Chronic Complications: Microvascular (Diabetic nephropathy, Diabetic retinopathy, macular edema, diabetic neuropathy), Macrovascular (Coronary arterial Disease, Peripheral Arterial Disease, Cerebrovascular Disease, immunocompromised state (opportunistic infections like candidiasis, recurrent UTI, pneumonia, tuberculosis,

malignant otitis externa, carbuncle, delayed wound healing, diabetic ulcer foot), Cataracts, Glaucoma in Diabetics, gastrointestinal symptoms (diarrhea). 8. Obstetrics: Diabetes mellitus in Pregnancy, Gestational DM, Whites classification, effects of pregnancy on DM, effects of DM on pregnancy- maternal and fetal complications, management- antenatal care, labor vs CS, fetal monitoring, puerperium, neonatal care 9. Community Medicine: Epidemiology- Indian vs global trend, National Programme for Prevention and Control of Diabetes (NPPCDCDS)

Distribution of Sessions: Subject Anatomy +Physiology Biochemistry Pathology Pharmacology Medicine Chronic Complications Obstetrics Community Medicine TOTAL SESSIONS Number of sessions 1 2 2 2 1 2 1 1 12