Diabetes mellitus

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Diabetes mellitus

  1. 1. Diabetes Mellitus By Malek Abidkhan M. Luqmaan Jinnah
  2. 2. <ul><li>What is diabetes mellitus? </li></ul>
  3. 3. <ul><li>Diabetes Mellitus is a syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of the tissues to insulin . </li></ul>
  4. 4. Insulin <ul><li>Hormone secreted by β cells of pancreas. </li></ul><ul><li>Binds on enzyme link receptor of target cells. </li></ul><ul><li>Acts as a primary messenger and activates tyrosine kinase </li></ul><ul><li>This promotes glucose transport in the cells. </li></ul><ul><li>It effects CHO, lipid and protein metabolisms and growth and gene expression. </li></ul>
  5. 5. Types of Diabetes Mellitus
  6. 6. <ul><li>Type I </li></ul><ul><li>Also called insulin-dependent diabetes mellitus (IDDM), is caused by lack of insulin secretion . </li></ul><ul><li>Type II </li></ul><ul><li>Also called non-insulin-dependent diabetes mellitus (NIDDM), is caused by decrease sensitivity of target tissue to the metabolic effect of insulin . </li></ul>
  7. 7. Symptoms <ul><li>The same for types one and two </li></ul><ul><li>excessive secretion of urine, thirst, weight loss, and tiredness </li></ul>
  8. 8. Type 1 Diabetes Mellitus – lack of insulin production by beta cells of the pancreas
  9. 9. <ul><li>Injury to beta cells of pancreas or diseases that impair insulin prodution can lead to type I diabetes. </li></ul><ul><li>Reason for injury: </li></ul><ul><li>Viral infection </li></ul><ul><li>Autoimmune disorders </li></ul><ul><li>Hereditary tendency for beta cell degenration </li></ul>
  10. 10. <ul><li>The usual onset of diabetes occures at about 14 years of age in USA, and for this reason it is often called juvenile diabetes mellitus . </li></ul><ul><li>It develop very abruptly over period of a few days or weeks, with three principle sequelae: </li></ul><ul><li>increased blood glucose </li></ul><ul><li>Increased utilization of fats for energy and for formation of cholesterol by the liver </li></ul><ul><li>Depletion of body’s proteins </li></ul>
  11. 11. Increased blood glucose level <ul><li>Normal blood glucose level is approximately 80 – 110 mg/ 100 ml. </li></ul><ul><li>In diabetes is increase up to 300 – 1200 mg/100 ml. </li></ul><ul><li>Increased blood glucose causes; </li></ul><ul><li>(i) Loss of glucose in urine </li></ul><ul><li>(ii) dehydration </li></ul><ul><li>(iii) tissue injury </li></ul>
  12. 12. Other effects of type I <ul><li>Diabetes mellitus causes increased utilization of fats and “ Metabolic acidosis ” </li></ul>
  13. 13. <ul><li>NO Insulin in blood </li></ul><ul><ul><li>Glucose cannot enter cells </li></ul></ul><ul><li>Therefor cells metabolize fats for energy </li></ul><ul><li>Release keto acids (acetoacetate) </li></ul><ul><li>Metabolic acidosis </li></ul>
  14. 14. <ul><li>Metabolic acidosis Dehydration ( polyuria) </li></ul><ul><li>Severe Acidosis </li></ul><ul><li>Diabetic COMA </li></ul>
  15. 15. <ul><li>Excess Fat utilization in the liver for long time </li></ul><ul><li>Release large amounts of cholesterol in blood </li></ul><ul><li>Increased deposition of cholesterol in arterial walls </li></ul><ul><li>ARTERIOSCLEROSIS </li></ul>
  16. 16. Type 2 Diabetes Mellitus <ul><li>Far more common than type I. </li></ul><ul><li>Accounts for ≈ 90% of all cases of diabetes mellitus. </li></ul><ul><li>Onset occurs after age 30, often between 50 and 60 years. </li></ul><ul><li>Therefore, syndrome is often referred to as adult - onset diabetes. </li></ul><ul><li>Obesity is the most important risk factor for type II. </li></ul>
  17. 17. <ul><li>Less sensitivity of receptors for insulin </li></ul><ul><li> secretion of insulin by pancreas </li></ul><ul><li> plasma insulin – hyperinsulinemia. </li></ul><ul><li>Due to insulin resistance </li></ul>
  18. 18. <ul><li>Insulin Resistance </li></ul><ul><li>“ Diminished sensitivity of target tissues to the metabolic effects of insulin.” </li></ul>
  19. 19. <ul><li>When cell becomes resistance to insulin </li></ul><ul><li>Less glucose uptake/utilization by cells </li></ul><ul><li> plasma glucose </li></ul><ul><li> Type II Diabetes </li></ul>
  20. 20. <ul><li>Other factors that cause insulin resistance and type II diabetes </li></ul><ul><li>Acquired or genetic conditions that impair insulin signaling in peripheral tissues. </li></ul><ul><li>Polycystic ovary syndrome (PCOS). </li></ul><ul><li>Cushing’s syndrome. </li></ul>
  21. 21. Diagnosis <ul><li>Urinary glucose </li></ul><ul><li>Fasting blood glucose level </li></ul><ul><li>Insulin level </li></ul><ul><li>Glucose tolerance test </li></ul><ul><li>Acetone breath </li></ul>
  22. 22. Fasting blood glucose level <ul><li>Normal blood glucose level is 80-90 mg/100 ml. </li></ul><ul><li>110 mg/100ml is upper limit of normal. </li></ul><ul><li>More than that is diabetic. </li></ul>
  23. 23. Glucose tolerance test <ul><li>Normal fasting person is given 1g of glucose per kg of body weight. </li></ul><ul><li>Blood glucose level rises from 90mg/100ml to 120 – 140mg/100ml and falls back to below normal in 2hrs. </li></ul><ul><li>But in diabetics, it is always above 110mg/100ml. </li></ul>
  24. 24. <ul><li>Type I diabetes </li></ul><ul><li>Administration of insulin . </li></ul>Treatment
  25. 25. Treatment <ul><li>Type II diabetes </li></ul><ul><li>Dieting and exercise to reduse weight and to reverse insulin resistance. </li></ul><ul><li>In severe cases, insulin administration </li></ul><ul><li>Drugs: </li></ul><ul><li>To increase insulin sensitivity to cells, thiazolidinediones and metformins . </li></ul><ul><li>To increase insulin release, sulfonylureas . </li></ul>
  26. 26. Complications <ul><li>Diabetic retinopathy: a leading cause of blindness and visual disability </li></ul><ul><li>Kidney failure </li></ul><ul><li>Heart disease </li></ul><ul><li>Diabetic neuropathy </li></ul><ul><li>Diabetic foot disease </li></ul>
  27. 27. Insulin shock <ul><li>High dose of insulin to diabetics </li></ul><ul><li>Blood glucose level falls below normal </li></ul><ul><li>(50 – 70mg/100ml) (20-50 mg/100ml ) (below 20) </li></ul><ul><li>Hypoglycemia, Clonic seizures Hypoglycemic </li></ul><ul><li>Excites CNS, and loss of coma </li></ul><ul><li>Hallucinations consciousness </li></ul>

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