Diabetes mellitus

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physiology of diabetes mellitus, the clinical symtoms and commonly used treatments

physiology of diabetes mellitus, the clinical symtoms and commonly used treatments

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  • 1. Syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin or decreased sensitivity of tissues to insulin.
  • 2.  A small protein  Molecular weight of 5808  Contains 2 amino acid chains linked by disulfide bonds  Helps to store excess energy
  • 3.  TYPE I- IDDM (Insulin dependant Diabetes Mellitus) Caused by lack of insulin secretion.  TYPE II- NIDDM (Non Insulin Dependant Diabetes Mellitus. Caused by insulin resistance.
  • 4.  May develop abruptly or over a period of few days  3 important features of TYPE 1 DM: 1. Blood glucose 2. Utilization of fats for energy & formation of cholesterol by liver 3. Depletion of body proteins
  • 5. Blood glucose concentration rises to very high levels Increased blood glucose causes loss of glucose in urine Increased blood glucose leads to dehydration Chronic high glucose conc. causes tissue injury Increased utilization of fats and metabolic acidosis Depletion of body proteins
  • 6.  More common than TYPE I  Often between ages 50-60, thus called as adult-onset diabetes  Most important risk factor: Increasing prevalence of OBESITY
  • 7.  OBESITY  INSULIN RESISTANCE  METABOLIC SYNDROME which includes:  Accumulation of abdominal fat  Fasting hyperglycemia  Lipid abnormalities(eg; blood triglycerides)
  • 8.  POLYCYSTIC OVARY SYNDROME- Marked increase in ovarian androgen production and insulin resistance  CUSHING’S SYNDROME(excess formation of glucocorticoids) OR ACROMEGALY(excess formation of growth hormone)
  • 9.  URINARY GLUCOSE- glucose gets excreted in urine unlike in normal conditions where entire glucose is reabsorbed during tubular reabsorption.  FASTING BLOOD GLUCOSE AND INSULIN LEVELS-normal levels:80-90mg/100ml  ACETONE BREATH  GLUCOSE TOLERANCE TEST
  • 10.  Normal fasting person: 1 gm glucose/kg body wt. ingested Blood glucose rises from 90mg/100ml- 120mg/100ml-140mg/100ml Falls back to control value in abt 2 hours  Person with diabetes: Since blood glucose is already above 110mg/100ml Blood glucose rises higher on ingestion Falls back only after 4-6hours but still fails to fall below control value
  • 11.  SINGLE DOSE OF ONE OF THE LONGER ACTING INSULINS  SOMETIMES ADDITIONAL QUANTITIES ARE ALSO FIVEN IN TIMES WHEN BLOOD GLUCOSE RISES TOO HIGH
  • 12.  Dieting and exercises usually recommended  Drugs may be administered  EXOGENOUS INSULIN MUST BE USED TO REGULATE BLOOD GLUCOSE