Diabetes mellitus yashwant kumar.

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Diabetes mellitus yashwant kumar.

  1. 1. Diabetes Mellitus TYPE 1 BY YASHWANT KUMAR GROUP -8.
  2. 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. 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. 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. 5. ALTERED CHO METABOLISM Insulin Glucose Utilization + Glycogenolysis Hyperglycemia Glucosuria (osmotic diuresis) Polyuria* (and electrolyte imbalance) Polydipsia** Hallmark symptoms of diabetes
  6. 6. ALTERED PROTEIN METABOLISM Insulin Protein Catabolism Gluconeogenesis (amino acids glucose) Hyperglycemia Weight Loss and Fatigue
  7. 7. ALTERED FAT METABOLISM Insulin Lipolysis Free fatty acids + ketones Acidosis + Weight Loss
  8. 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. 9. Type 1 Diabetes MellitusEtiology and PathophysiologyProgressive destruction of pancreaticcellsAuto antibodies cause a reduction of80% to 90% of normal cell functionbefore manifestations occur
  10. 10. Type 1 Diabetes MellitusEtiology and Pathophysiology Causes: – Genetic predisposition – Exposure to a virus
  11. 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. 12. Type 1 Diabetes Mellitus Onset of DiseaseWeight lossPolydipsia (excessive thirst)Polyuria (frequent urination)Polyphagia (excessive hunger)Weakness and fatigueKetoacidosis
  13. 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. 14. Clinical ManifestationsType 1 Diabetes MellitusPolyuriaPolydipsiaPolyphagiaWeight loss
  15. 15. DIFFERENCE
  16. 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. 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. 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. 19. Injection Sites Fig. 47-5
  20. 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. 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. 22. Diabetes MellitusNutritional Therapy Exercise – Essential part of diabetes management – Increases insulin sensitivity – Lowers blood glucose levels – Decreases insulin resistance
  23. 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. 24. Diabetes – Oral Medications 6 Classes : Sulfonylureas Biguanides Sulfonylureas and biguanide combination drugs Thiazolidinediones Alpha-glycosidase inhibitors Meglitinides
  25. 25. Thank You
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