3. *
Diabetes mellitus (DM), is a group of metabolic diseases in which there are
high blood sugar levels over a prolonged period.
Symptoms of high blood sugar include frequent urination, increased
thirst, and increased hunger.
If left untreated, diabetes can cause many complications
4. Acute complications can include diabetic ketoacidosis, nonketotic
hyperosmolar coma, or death.
Serious long-term complications include heart disease, stroke, chronic
kidney failure, foot ulcers,and damage to the eyes.
Diabetes is due to either the pancreas not producingenough insulin or the
cells of the body not responding properly to the insulin produced.
There are three main types of diabetes mellitus:
Type 1 DM
Type 2 DM
Gestational Diabetes
6. Type 1 DM
Results from the pancreas's failure to produce enoughinsulin.
This form was previously referred to as "insulin- dependent diabetes mellitus"
(IDDM) or "juvenilediabetes".
. .
Type 1 Diabetes Mellitus is a syndrome characterized by hyperglycemia and
insulin deficiency resulting from the loss of beta cells in pancreatic islets
(occurs secondary to other diseases and is much less common than
autoimmune (type 1A).
The destruction of beta cells in Type 1A diabetes results from the interaction
of both genetic and environmental factors.
Although the genetic susceptibility is not well understood, type 1 diabetes is
most strongly associated with major histocompatibility complex (MHC),
specifically histocompatibility leukocyte antigen (HLA) class II alleles (HLA-
DQ and HLA-DR).
(Type 1 diabetes is less hereditary than type 2 but 7-13% of patients also
have a first degree relative with type 1 diabetes, Environmental factors
include viral infections (especially enteroviruses), exposure to infectious
microorganisms (such as Helicobacter pylori), exposure to cow’s milk proteins
and a lack of vitamin D
7. The destruction of insulin-producing beta cells in the pancreas starts with the
formation of autoantigens. These autoantigens are ingested by antigen-presenting
cells which activate T helper 1 (Th1) and T helper 2 (Th2) lmphocytes. Activated
Th1 lymphocytes secrete interluekin-2 (IL-2) and interferon.
IL-2 activates autoantigen-specific T cytotoxic lymphocytes which destroy islet
cells through the secretion of toxic perforins and granzymes.
Interferon activates macrophages and stimulates the release of inflammatory
cytokines (including IL-1 and tumor necrosis factor [TNF]) which further destroy
beta).
Activated Th2 lymphocytes produce IL-4 which stimulates B lymphocytes to
proliferate and produce islet cell autoantibodies (ICAs) and anti-glutamic acid
decarboxylase (antiGAD65) antibodies.
AntiGAD65 is an enzyme that helps control the release of insulin from beta cells
and can be used to determine the cause of diabetes .
Insulin autoantibodies [IAAs]) and zinc transporter 8 (Znt8) protein are also
associated with type 1 diabetes mellitus.
8. . Despite it’s complicated pathophysiology, it is important to understand the
destruction of beta cells in type 1 diabetes because it leads to a lack of insulin
and amylin. Without insulin or amylin the body cannot promote glucose
disappearance or limit glucose appearance from the bloodstream, respectively,
resulting in hyperglycemia.
13. The classic symptoms of
untreated diabetes are
weight loss
polyuria (increased urination)
polydipsia (increased thirst) and
polyphagia (increased hunger).
Blurry vision
Headache
Fatigue
Slow healing of cuts and
Itchy skin.
Prolonged high blood glucose
can cause glucose absorption in
the lens of the eye, which leads to
changesin its shape, resulting in
vision changes.
A number of skin rashes that can
occur in diabetes are collectively
known as diabetic dermadromes
14. *
All forms of diabetes increase the risk
of long-term complications. These
typically develop after many years
(10–20)
The major long-term complications
relate to damage to blood vessels.
tcardiovascular disease
About 75% of deaths in diabetics are
due to coronary artery disease.
Other "macrovascular"diseases
(stroke)
peripheral vascular disease.
15. The primary complications of diabetes due to damage in
small blood vessels include damage to the eyes, kidneys,
and nerves.
Damage to the eyes, known as diabetic retinopathy,
is caused by damage to the blood vessels in the retina
of
the eye, and can result in gradual vision loss and
blindness.
Damage to the kidneys, known as diabetic nephropathy,
can lead to tissue scarring, urine protein loss, and
eventually chronic kidney disease, sometimes requiring
dialysis or kidney transplant.
Damage to the nerves of the body, known as diabetic
neuropathy, is the most common complication of
16. The symptoms can include
numbness, tingling, pain, and altered
pain sensation, which can lead to
damage to the skin.
Diabetes-related foot
problems (such as diabetic foot
ulcers) may occur, and can be
difficult to treat, occasionally
requiring amputation.
Additionally, proximal diabetic
neuropathy causes painful muscle
wasting and weakness – Diabetic
Amyotrophy.
17. *
Insulin plays a critical role in balancing glucose
levels in the body:
It can inhibit the breakdown of glycogen or the
process of gluconeogenesis.
It can stimulate the transport of glucose into
fat and muscle cells.
It can stimulate the storage of glucose in the
form of glycogen.
18. When the glucose concentration in the blood remains
high over time, the kidneys will reach a threshold
of reabsorption Glycosuria.
This increases the osmotic pressure of the urine
polyuria increased fluid loss
Lost blood volume will be replaced osmotically from
water held in body cells and other body compartments
dehydration polydipsia
19. *
If the amount of insulin available is insufficient
If cells respond poorly to the effects of insulin
If the insulin itself is defective
Then glucose will not be absorbed properly by the
body
cells
The net effect is persistently high levels of blood
glucose, poor protein synthesis, and break down
of fat storage
Acidosis.
21. *
No specific oral lesions associated with diabetes. However,
there are a number of problems by presence of hyperglycemia.
Periodontal disease:
Microangiopathy alters antigenic challenge.
Altered cell-mediated immune response and impaired
of neutrophil chemotaxis.
Increased Ca+ and glucose lead to plaque
formation.
23. *
Salivary glands
Xerostomia is common, but reason is unclear.
Tenderness, pain and burning sensation of tongue.
May cause secondary enlargement of parotid glands with sialosis.
Dental caries
Increase caries prevalence in adult with diabetes. (xerostomia,
increase saliva glucose)
Hyperglycemia state shows a positive association with dental
caries.
24. TREATMENT FOR AUTOIMMUNE DISESES
Autoimmune disorders in general cannot be cured, but the condition can be
controlled in many cases. Historically, treatments include:
• anti-inflammatory drugs – to reduce inflammation and pain
• corticosteroids – to reduce inflammation. They are sometimes used to treat an
acute flare of symptoms.
• pain-killing medication – such as paracetamol and codeine
• immunosuppressant drugs – to inhibit the activity of the immune system
• physical therapy – to encourage
• mobilitytreatment for the deficiency – for example, insulin injections in the
case of diabetessurgery – for example, to treat bowel blockage in the case of
Crohn's disease
25. TYPES OF AUTOIMMUNE DISORDERS
Autoimmune disorders can affect nearly every organ and system of the body. Some
autoimmune disorders include:
Diabetes (Type I) – affects the pancreas. Symptoms include thirst, frequent
urination, weight loss and an increased susceptibility to infection.
Graves' disease – affects the thyroid gland. Symptoms include weight loss, elevated
heart rate, anxiety and diarrhoea.
Inflammatory bowel disease – includes ulcerative colitis and possibly, Crohn's
disease. Symptoms include diarrhoea and abdominal pain.
Multiple sclerosis – affects the nervous system. Depending on which part of the
nervous system is affected, symptoms can include numbness, paralysis and vision
impairment.
Psoriasis – affects the skin. Features include the development of thick, reddened
skin scales.
26. Rheumatoid arthritis – affects the joints.
Symptoms include swollen and
deformed joints. The eyes, lungs and
heart may also be targeted.
Scleroderma – affects the skin and
other structures, causing the formation
of scar tissue. Features include
thickening of the skin, skin ulcers and
stiff joints.
Systemic lupus erythematosus – affects
connective tissue and can strike any
organ system of the body. Symptoms
include joint inflammation, fever, weight
loss and a characteristic facial rash
27. • high dose immunosuppression – the use of immune system suppressing drugs
(in the doses needed to treat cancer or to prevent the rejection of
transplanted organs) have been tried recently, with promising results.
• Particularly when intervention is early, the chance of a cure with some of
these conditions seems possible
28. CURRENT TREATMENTS FOR AUTOIMMUNE DISEASES
include physical therapy,
non-steroidal anti-inflammatory drugs (NSAIDs),
corticosteroids, disease-modifying anti-inflammatory drugs (DMARDs),
anticytokine therapies, inhibition of intracellular-signaling pathways,
costimulation inhibition, biological inhibitors of T cell function, B-cell anergy
and depletion
regulatory T cells, stem cell transplantion.
New biologic drugs that target specific cells or cytokines involved in the
early inflammatory response started because of their improved efficacy and
limited toxicity.
The hematopoietic stem cell transplantation represents a possible
therapeutic strategy for autoimmune diseases resistant to available
treatmen
