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1. Unit Eight: Metabolic Disorders
Samara University
Department of Biomedical Sciences
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Chapter 8: Metabolic Disorders
DR. MYM
Dr. Mohammed. Y (MD, Lecture)

2. Objectives
 At the end of this session the student will be able to:
 Describe Diabetes Mellitus
 Disorder of calcium and uric acid metabolism
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3. Definition of Diabetes
A heterogeneous disorder characterized by
abnormal carbohydrate, fat and protein
metabolism, secondary to resistance to the
action of insulin, absolute or relative
insufficient insulin secretion, or both resulting
in hyperglycaemia
Chapter 8: Metabolic disorder
DR. MYM

4. Diabetes = “siphon”or “running
through”
Large urine volume
Mellitus = sweet(Glucose in urine)
Chapter 8: Metabolic disorder
DR. MYM
Definition of Diabetes Cont…

5.  Most important NCD
 382 million people have diabetes
 80% live in LMICs
 Most affected age group – 40 to 59 years
 175 million people are undiagnosed
 5.1 million deaths in 2013 (1 death every 6 seconds)
 Health care expenditure USD 548 billion ( 11% )
 80% spent in rich countries
 79,000 children developed type 1 diabetes in 2013
Chapter 8: Metabolic disorder
DR. MYM
Key Points on Diabetes

6. 2000 2013 2035
177 million 382 million 592 million
World Diabetes prevalence
Chapter 8: Metabolic disorder
DR. MYM

7. 2000 2013 2035
7.1 million 20 million 42 million
Diabetes prevalence in Africa
Chapter 8: Metabolic disorder
DR. MYM

8. 1982 2013 2035
0.34% 1.9 million 2.6 million
Diabetes prevalence in Ethiopia
Chapter 8: Metabolic disorder
DR. MYM

9.  Most Common Metabolic Disease
 Heterogeneous Disorders
 Multiple Etiology
 Disturbance Of Carbohydrate, Protein And Fat Metabolism
 Hyperglycemia - Common Feature
 Defects In Insulin Secretion, Action Or Both
 Symptomatic & Asymptomatic Presentation
 Prone to Acute & Chronic Complications
General Features of Diabetes
Chapter 8: Metabolic disorder
DR. MYM

10.  Symptoms
 Polydypsia
 Polyuria
 Polyphagia
 Nocturia
 Weight loss
 Fatigue
 Pruritus vulvae
Clinical Features
 Amenorrhea
 Slowly Healing Infections
 Visual Problems
 Pain in the Legs
 Erectile Dysfunction
 Signs
 No Characteristic Features
 Wasting & Dehydration
 Evidence Of Complications
Chapter 8: Metabolic disorder
DR. MYM

11. Diagnosis A1C
%
Fasting
Glucose
mg/dL
Random
Glucose*
mg/dL
2-hour
75g OGTT
mg/dL
Normal < 5.7 < 100 - < 140
Prediabetes 5.7–6.4 100–125 - 140–199
Diabetes > 6.5 > 126 > 200 +
symptoms
> 200
* Random glucose cannot be used to diagnose prediabetes
Diagnosis of Diabetes
Chapter 8: Metabolic disorder
DR. MYM

12.  Central obesity (Waist circumference  94 cm for men and  80
cm for women)
Plus
 any two of the following four factors
1. TG 150 mg/dl, or specific treatment for this lipid abnormality
2. HDL <40 mg/l in males and <50 mg/l in females, or specific
treatment for this lipid abnormality
3. Systolic BP 130 or diastolic BP 85 mmHg, or treatment of
previously diagnosed hypertension
4. Fasting plasma glucose 100 mg/dl, or previously diagnosed
type 2 diabetes.
The Metabolic Syndrome Criteria
Chapter 8: Metabolic disorder
DR. MYM

13. Measure midway between lower costal margin & iliac crest
Sex IDF ATP
Males 94 102
Females 80 88
Waist Circumference (cm)
Chapter 8: Metabolic disorder
DR. MYM

14. Risk Factors for Diabetes
 Age > 40 years
 Strong Family History
 Obesity (Diabesity)
 Ethnicity (Blacks/Asians)
 Previous GDM
 Women Who Delivered Babies > 4
Kg
 In Utero Under- & Over Nutrition
 Previous IGT/IFG
 Hypertension
 Dyslipidemia
Chapter 8: Metabolic disorder
DR. MYM

15. Types Of Diabetes Mellitus
 Type 1
 Autoimmune – Type 1A
 Idiopathic – Type 1B
 Type 2
 Predominantly Insulin Resistance
 Predominantly Insulin Secretory Defects
 Gestational Diabetes Mellitus
 Other Specific Types
Chapter 8: Metabolic disorder
DR. MYM

16. Other Specific Types Of Diabetes
1. Genetic Defect Of Beta Cells e.g. MODY
2. Genetic Defects In Insulin Action e.g. Type A Insulin Resistance
3. Diseases Of The Exocrine Pancreas e.g. FCPP, Tumors
4. Endocrinopathies e.g. Acromegaly
5. Drug- Or Chemical Induced e.g. Steroids
6. Infections e.g. Congenital Rubella
7. Rare Immune-mediated Diabetes e.g. "Stiff-man" Syndrome
8. Other Genetic Syndromes e.g. Down's Syndrome
Chapter 8: Metabolic disorder
DR. MYM

17. Type 1A Diabetes Mellitus
 Cellular Mediated Autoimmune Destruction Of Beta Cells
 Markers Of Autoimmunity: ICA, IAA, Anti GAD Antibodies
 Variable Rate Of Beta Cell Destruction
Acute Onset And Profound Symptoms
 Age < 30 Years
 Non-obese (Obesity Not Incompatible)
 Ketonuria &/or Metabolic Acidosis
 Immediate & Permanent Need For Insulin
 No Microvascular Complications at Diagnosis
 Prone to Other Autoimmune Diseases: Graves’, Hashimoto’s,
Addison’s Diseases, etc.
Chapter 8: Metabolic disorder
DR. MYM

18. Pathogenetic Progression of Type 1 Diabetes
B
Cell
Mass
Age yrs
Genetic
Predisposition
N insulin
secretion
Precipitating Event
Antibody +
N FBS
Overt Diabetes
C Peptide
Present C Peptide
Absent
Chapter 8: Metabolic disorder
DR. MYM

19. Chapter 8: Metabolic disorder
DR. MYM

20. Chapter 8: Metabolic disorder
DR. MYM

21. Type 1B Diabetes Mellitus
 Young Patients
 Abrupt Onset (Mean Duration Of Symptoms – 4 Days)
 Prone To DKA Soon After Onset
 No Insulitis on Biopsy/Autopsy
 No Hyper-expression Of MHC Class I Molecules In Islets
 No Diabetes-related Antibodies
 Highly Elevated Serum Pancreatic Enzymes
 Lymphocytic Infiltration Of The Exocrine Pancreas
No Classic Features of Acute/Chronic Pancreatitis
Chapter 8: Metabolic disorder
DR. MYM

22. Type 2 Diabetes Mellitus
 Insulin Resistance
 Relative Insulin Deficiency
 Most are Obese/Abdominal Obesity
 Symptomatic/Asymptomatic
 Age > 40 Years
 Positive Family History
 Hyperosmolar Hyperglycemic State, DKA Very Rarely
 Risk Increases With Age, Obesity, Sedentary Life Style, Prior GDM
 Microvascular Complications May be Present at Diagnosis
 Major Morbidity & Mortality From Macrovascular Disease
 More Frequent in Persons With HPN & Dyslipidemias
Chapter 8: Metabolic disorder
DR. MYM

23. Pathogenesis of Type 2 Diabetes
β-cell Failure
Insulin
Resistance
Environment
Ageing
Pancreas
Muscle &
Adipose Tissue
IGT
Type 2 Diabetes
Genes
NGT or
Metabolic
Syndrome
80%
20%
Impaired
Incretin
Effect

24. Gestational Diabetes
 Glucose intolerance which is first recognized in pregnancy
 Complicates 3-7% of pregnancies
 Onset usually at 24 - 28 weeks
 97% disappears after delivery
 Cause
 Insulin resistance due to increased weight in pregnancy and
hormones
 Complications:
 Fetal death, HTN, UTI, premature birth, macrosomia,
hypoglycemia
 Higher risk of type 2 DM later in life
Chapter 8: Metabolic disorder
DR. MYM

25. Differences B/n Type 1 & Type 2 DM
Type 1 Type 2
Prevalence 1% 5%
Onset Age Yrs. < 40 40
Symptoms Rapid &
Marked
Slow/ No
Genetics: 1st Degree
Monozygotic Concordance
< 10%
50 %
> 20%
90-100%
HLA Yes No
Autoimmunity Yes No
Body Build Lean Obese Or Normal
Metabolism DKA HHS
Treatment Insulin Tablets + Insulin
Chapter 8: Metabolic disorder
DR. MYM

26. Management Components
 Education
 Establish Targets
 Diet
 Exercise
 Reduction of Risk Factors
 Medications
 Oral agents - Type 2
 Insulin – Type 1 & Type 2
Chapter 8: Metabolic disorder
DR. MYM

27. Disorder of calcium and uric acid metabolism
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28. Quiz2
1. Diabetes is a disturbance of carbohydrate metabolism that does not
affect the metabolism of lipids and proteins(T or F)
2. A family history of diabetes is more common in patients affected by
type 1diabetes than type 2(T or F)
3. One of the following is not a micro vascular complication of DM
A. Stroke C. Nephropathy
B. Retinopathy D. Neuropathy
4. DKA is more common is
A. Type 1 DM C. Gestational DM
B. Type 2 DM D. A&B
5. One of the following is diagnostic for DM
A. A random blood glucose e level 200mg /dl with profound
hyperglycemia(poly symptom)
B. A fasting glucose level of 110 mg /dl
C. A RBS level of 126 mg /dl
D. None
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29. Reading Assignment
 Disorder of calcium and uric acid metabolism
6. Elaborate Pathogenesis of severe complicated Malaria
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30. The End
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