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Diabetes mellitus yashwant kumar.


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  • 1. Diabetes Mellitus TYPE 1 BY YASHWANT KUMAR GROUP -8.
  • 2. Diabetes MellitusThe disease is characterized by an absolutedeficiency of insulin caused by anautoimmune attack on the β cells of thepancreas.About 10% of the ten million diabetics inUSA has type 1 diabetes, only (2/3)isdiagnosed.Complication: stroke, heart attack, kidneydisease, eye disease and nerve damage.
  • 3. Diabetes – Insulin(synthesis, storage, secretion) insulin mRNA is translated as a single chain precursor called preproinsulin removal of signal peptide during insertion into the endoplasmic reticulum generates proinsulin Zn Produced within the pancreas by β cells  islets of Langerhans Within the endoplasmic reticulum, proinsulin is exposed to several specific endopeptidases which excise the C peptide, thereby generating the mature form of insulin Stored as β granules
  • 4. Diabetes – Insulin(Biochemical Role)-Tyrosine Kinase receptors are thelocks in which the insulin key fits- Involved in signal transduction(insulin hormonebeing 1st messenger)
  • 5. ALTERED CHO METABOLISM Insulin Glucose Utilization + Glycogenolysis Hyperglycemia Glucosuria (osmotic diuresis) Polyuria* (and electrolyte imbalance) Polydipsia** Hallmark symptoms of diabetes
  • 6. ALTERED PROTEIN METABOLISM Insulin Protein Catabolism Gluconeogenesis (amino acids glucose) Hyperglycemia Weight Loss and Fatigue
  • 7. ALTERED FAT METABOLISM Insulin Lipolysis Free fatty acids + ketones Acidosis + Weight Loss
  • 8. Type 1 Diabetes MellitusFormerly known as “juvenile onset” or“insulin dependent” diabetesMost often occurs in people under 30years of agePeak onset between ages 11 and 13
  • 9. Type 1 Diabetes MellitusEtiology and PathophysiologyProgressive destruction of pancreaticcellsAuto antibodies cause a reduction of80% to 90% of normal cell functionbefore manifestations occur
  • 10. Type 1 Diabetes MellitusEtiology and Pathophysiology Causes: – Genetic predisposition – Exposure to a virus
  • 11. Type 1 Diabetes Mellitus Onset of DiseaseManifestations develop when thepancreas can no longer produce insulin – Rapid onset of symptoms – Present at ER with impending or actual ketoacidosis
  • 12. Type 1 Diabetes Mellitus Onset of DiseaseWeight lossPolydipsia (excessive thirst)Polyuria (frequent urination)Polyphagia (excessive hunger)Weakness and fatigueKetoacidosis
  • 13. Type 1 Diabetes Mellitus Onset of DiseaseDiabetic ketoacidosis (DKA)– Life-threatening complication of Type 1 DM– Occurs in the absence of insulin– Results in metabolic acidosis
  • 14. Clinical ManifestationsType 1 Diabetes MellitusPolyuriaPolydipsiaPolyphagiaWeight loss
  • 16. Type 1 Diabetes MellitusDiagnostic Studies Fasting plasma glucose level 7 mmol/L Random plasma glucose level 11.1 mmol/L plus symptoms mmol/L 2 hr post challenge Hemoglobin A1C test (glycosylated Hgb) – Reflects amount of glucose attached to Hgb over life of RBC – Indicates overall glucose control over previous 90 – 120 days Impaired Glucose Tolerance Test – patient is “challenged” with glucose load. Patient should be able to maintain normal BG. Diabetes if BG > 11.1
  • 17. Diabetes MellitusDrug Therapy: Insulin Exogenous insulin: – Required for all patient with type 1 DM. Types of insulin – Human insulin • Most widely used type of insulin • Cost-effective • Likelihood of allergic reaction
  • 18. Diabetes MellitusDrug Therapy: Insulin – Insulins differ in regard to onset, peak action, and duration – Different types of insulin may be used for combination therapy – Rapid-acting: Lispro – *Short-acting: Regular – *Intermediate-acting: NPH or Lente – Long-acting: Ultralente, Lantus
  • 19. Injection Sites Fig. 47-5
  • 20. Diabetes MellitusDrug Therapy: Insulin Insulin delivery methods – Ordinary SQ injection – Insulin pen • preloaded with insulin; “dial” the dose – Insulin pump • Continuous “basal” infusion. At mealtime, user programs to deliver “bolus” infusion that correlates with amount of CHOs ingested. Allows tight control and greater flexibility with meals and activity
  • 21. Diabetes MellitusDrug Therapy: Insulin Insulin delivery methods – Intensive insulin therapy • Multiple daily injects and frequent SMBG Problems with insulin therapy – Hypoglycemia (BS < 3.9 mmol/L) • Due to too much insulin in relation to glucose availability – Allergic reactions • Local inflammatory reaction – Lipodystrophy
  • 22. Diabetes MellitusNutritional Therapy Exercise – Essential part of diabetes management – Increases insulin sensitivity – Lowers blood glucose levels – Decreases insulin resistance
  • 23. Diabetes MellitusPancreas Transplantation Used for patients with type 1 DM who have end-stage renal disease and who have had or plan to have a kidney transplant Eliminates the need for exogenous insulin Can also eliminate hypoglycemia and hyperglycemia
  • 24. Diabetes – Oral Medications 6 Classes : Sulfonylureas Biguanides Sulfonylureas and biguanide combination drugs Thiazolidinediones Alpha-glycosidase inhibitors Meglitinides
  • 25. Thank You