Author(s): Arno Kumagai, M.D., 2009License: Unless otherwise noted, this material is made available under the terms of the...
Citation Key                            for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + A...
DIABETES MELLITUS                         M2 - Endocrine Sequence                            Arno K. Kumagai, M.D.        ...
DIABETES MELLITUS    Diabetes (fr. Ionian Greek):          To pass through Diabetes is a dreadful affliction, themelting d...
DIABETES MELLITUS     Mellitus (fr. Latin) = Sweet or Honey-like4th Cent. A.D. India: Susruta and Charaka•  Urine from pol...
DIABETES: THE GROWING EPIDEMIC        U.S. News Magazine June 25, 2001
Diabetes Mellitus: The Growing Epidemic       CDC Study of Diabetes in the United States: 1990-1998   !1990               ...
DIABETES MELLITUSApproximately 8% of the U.S. population, some     18 million individuals, have diabetes.                 ...
DIABETES MELLITUSDiabetes disproportionately affects ethnic minorities in the                      United States.         ...
DIABETES MELLITUS   Annually, 34,000 deaths are attributable todiabetes, making it the 6th leading cause of death.        ...
DIABETES MELLITUS                        Diabetes                      Mellitus is the                       #1 cause of: ...
DIABETES MELLITUS                         Diabetes                          Mellitus       ~2.5x   increased risk         ...
DIABETES MELLITUS:                The Socioeconomic Impact             HEATLH CARE              RESOURCESA. Kumagai
DIABETES MELLITUS:                 The Socioeconomic Impact                                $92 BILLION (direct) and       ...
DIABETES MELLITUS:                        Psychosocial Issues                               Once the diagnosis of diabetes...
DIABETES MELLITUS:                   Societal Issues                                          STOP!                       ...
Diabetes Mellitus:     IMPORTANT!                       Definition         Diabetes mellitus is a chronic disorder of     ...
IMPORTANT!                    Diabetes MellitusTYPE 1 or Insulin-Dependent Diabetes Mellitus (IDDM)•  Represents ~5-10% of...
IMPORTANT!                     Diabetes MellitusType 2 or Non-Insulin-Dependent Diabetes Mellitus                     (NID...
Diabetes Mellitus               Gestational Diabetes•  Occurs only in the setting of pregnancy•  Affects ~7% of all pregna...
Diabetes Mellitus Diabetes Associated with Other Medical Disorders•  Pancreatic Damage or Destruction: chronic pancreatiti...
Diabetes Mellitus        Atypical or Genetic Forms of DiabetesAtypical or Non-Autoimmune Diabetes•  Most cases seen in Afr...
Diabetes Mellitus:           DIAGNOSIS--New Criteria (1997)             Normal blood glucose: 80-100 mg/dL Diabetes is pre...
Diabetes Mellitus:           DIAGNOSIS          Remember:    Most of the time, diabetes isASYMPTOMATIC, or its symptoms ar...
Diabetes Mellitus   Pathogenesis
Type 1 DiabetesAlpha Cells:             Beta Cells:     Isolated islets stained for insulin (green)                       ...
Type 1 Diabetes: Pathogenesis                                                         Isolated islets stained for insulin ...
Type 2 Diabetes: Pathogenesis                         The pathogenesis of                          type 2 diabetes is     ...
DIABETES MELLITUS:                               Normal Glucose Metabolism    GLUCOSE SUPPLY                              ...
Type 2 Diabetes:                         Pathophysiology   Introducing the Players in Type 2 Diabetes….             Liver ...
Type 2 Diabetes:                         Pathophysiology                          Abnormally high hepatic                 ...
Type 2 Diabetes:                        Development and Progression                 DIET    COKE                          ...
Pathogenesis of Type 2 Diabetes: the Molecular                     Level      www.hanall.co.kr
Diabetes Mellitus: Points to RememberUnderstand:1.  The epidemiology of diabetes: the current     epidemic, high prevalenc...
Additional Source Information                               for more information see: http://open.umich.edu/wiki/CitationP...
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03.05.09(a): Introduction to Diabetes

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Slideshow is from the University of Michigan Medical School’s M2 Endocrine sequence

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03.05.09(a): Introduction to Diabetes

  1. 1. Author(s): Arno Kumagai, M.D., 2009License: Unless otherwise noted, this material is made available under the terms of theCreative Commons Attribution–Noncommercial–Share Alike 3.0 License:http://creativecommons.org/licenses/by-nc-sa/3.0/We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, andadapt it. The citation key on the following slide provides information about how you may share and adapt this material.Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, orclarification regarding the use of content.For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use.Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement formedical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions aboutyour medical condition.Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  2. 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation LicenseMake Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. DIABETES MELLITUS M2 - Endocrine Sequence Arno K. Kumagai, M.D. Division of Metabolism, Endocrinology & Diabetes Department of Internal Medicine University of Michigan Medical SchoolWinter 2009
  4. 4. DIABETES MELLITUS Diabetes (fr. Ionian Greek): To pass through Diabetes is a dreadful affliction, themelting down of flesh and limbs intourine. The patients never stopmaking water, and the flow isincessant, like the opening ofaqueducts. Life is short,unpleasant, and painful, and thirst,unquenchable, drinking excessive,and disproportionate to the largequantity of urine, for yet more urineis passed. Areteus of Capadocia 2nd Century A.D.
  5. 5. DIABETES MELLITUS Mellitus (fr. Latin) = Sweet or Honey-like4th Cent. A.D. India: Susruta and Charaka•  Urine from polyuric patients tasted like honey, was sticky to the touch and attracted ants.•  Two types of people with this disorder: old, obese people and young, thin people who did not survive very long.•  Madhumeh = honey disease•  Renaissance England: The Pissing Evile•  17th Cent. England. Thomas Willis: Diabetic urine contains sugar. Diabetes due to sadnesse and longe griefe.•  18th Cent. England. Matthew Dobson: Diabetic serum contains sugar.
  6. 6. DIABETES: THE GROWING EPIDEMIC U.S. News Magazine June 25, 2001
  7. 7. Diabetes Mellitus: The Growing Epidemic CDC Study of Diabetes in the United States: 1990-1998 !1990 ! 1994 1998! Pink >6%DM! by self-report! CDC Diabetes Care, 23:1278, 2000. (All Images)
  8. 8. DIABETES MELLITUSApproximately 8% of the U.S. population, some 18 million individuals, have diabetes. BUT, ONE THIRD of the people who have diabetes are unaware that they have the disease. Approximately 1.5 million people are diagnosed with diabetes mellitus each year in the US alone.
  9. 9. DIABETES MELLITUSDiabetes disproportionately affects ethnic minorities in the United States. 16 Non-Hispanic Whites 14 Blacks 12 % in 10 Adults > 21 8 Hispanic/Latino yo 6 American 4 Indian/Alaskan Native 2 0 ? Asian Pacific Islanders Currently, there are no nationwide prevalence data for Asian Americans. Based on regional studies, risk appears to be between 1.5-2 times higher than that for White Americans. NIDDK National Institutes of Health
  10. 10. DIABETES MELLITUS Annually, 34,000 deaths are attributable todiabetes, making it the 6th leading cause of death. BUT,Diabetes is a significant contributing factor in the deaths of 320,000 Americans each year. Approximately 65% of individuals with diabetes die of cardiovascular disease (MI and stroke).
  11. 11. DIABETES MELLITUS Diabetes Mellitus is the #1 cause of: New Adult Lower Blindness Extremity Amputations End-Stage Renal Disease Requiring DialysisA. Kumagai
  12. 12. DIABETES MELLITUS Diabetes Mellitus ~2.5x increased risk 2x increased risk of MI of congenital 3-5x increased abnormalities risk of strokeA. Kumagai
  13. 13. DIABETES MELLITUS: The Socioeconomic Impact HEATLH CARE RESOURCESA. Kumagai
  14. 14. DIABETES MELLITUS: The Socioeconomic Impact $92 BILLION (direct) and $39 BILLION (indirect) annually is spent on diabetes and its related ECONOMIC BURDEN problems* OF DIABETES $13, 243 spent annually per capita for those with diabetes HEALTH CARE versus $2,560 for those RESOURCES without * 2002 costs (American Diabetes Association)A. Kumagai
  15. 15. DIABETES MELLITUS: Psychosocial Issues Once the diagnosis of diabetes is made, the individual with diabetes and his or her family may be plagued by feelings of anxiety, guilt, shame, fear and a sense of loss of control over his/her life.Les Pauvres by Picasso, 1903 Pablo Picasso
  16. 16. DIABETES MELLITUS: Societal Issues STOP! EFFECTIVE! DIABETES CARE! Factors such as socioeconomic status and cultural andlinguistic differences may present obstacles to quality care.A. Kumagai
  17. 17. Diabetes Mellitus: IMPORTANT! Definition Diabetes mellitus is a chronic disorder of carbohydrate metabolism that is characterized by:•  Chronic hyperglycemia•  A RELATIVE or ABSOLUTE deficiency of insulin.•  The Three P s : Polyuria, Polydipsia and Polyphagia.•  The development of chronic microvascular and macrovascular complications.
  18. 18. IMPORTANT! Diabetes MellitusTYPE 1 or Insulin-Dependent Diabetes Mellitus (IDDM)•  Represents ~5-10% of individuals with diabetes in U.S.•  Absolute deficiency of endogenous insulin production and dependence on exogenous insulin for survival.•  Ketosis-prone.•  Onset generally at young age (<20-years-old). Older name is Juvenile Diabetes.•  Result of autoimmune destruction of pancreatic beta cells.•  Often appears in association with other autoimmune diseases, e.g, autoimmune thyroiditis, Addison s disease, etc.
  19. 19. IMPORTANT! Diabetes MellitusType 2 or Non-Insulin-Dependent Diabetes Mellitus (NIDDM): •  Represents 90-95% of diabetes in U.S. •  Presence of endogenous insulin; however, not effective. •  Not ketosis-prone under basal conditions. •  Onset usually older (>40-years-old) and MAY GO UNDETECTED FOR YEARS OR DECADES. •  High (>85%) correlation with obesity in most ethnic groups. •  Hereditary/genetic factors very strong.
  20. 20. Diabetes Mellitus Gestational Diabetes•  Occurs only in the setting of pregnancy•  Affects ~7% of all pregnancies in US.•  Higher risk: certain ethnic groups (African Americans, Hispanic/Latino, and Native Americans), obesity, and positive family history of diabetes.•  There is a 30-50% risk of developing type 2 diabetes within 5-10 years.
  21. 21. Diabetes Mellitus Diabetes Associated with Other Medical Disorders•  Pancreatic Damage or Destruction: chronic pancreatitis, hemachromatosis, cystic fibrosis.•  Endocrine Diseases: Acromegaly, Cushing s Syndrome.•  States of extreme physiological stress: e.g., infections, burns.•  Drugs: GLUCOCORTICOIDS, thiazide diuretics, niacin. Pink = important to remember
  22. 22. Diabetes Mellitus Atypical or Genetic Forms of DiabetesAtypical or Non-Autoimmune Diabetes•  Most cases seen in African Americans and Hispanic/ Latinos.•  Almost always associated with obesity.•  May present with diabetic ketoacidosis.•  Do not need insulin for survival.Genetic Syndromes. Example: MODY = Maturity Onset Diabetes of Youth•  Autosomal dominant inheritance pattern•  Non-insulin dependent diabetes occurs at very young age.•  Deletions or mutations in genes found to play role in regulating glucose metabolism.
  23. 23. Diabetes Mellitus: DIAGNOSIS--New Criteria (1997) Normal blood glucose: 80-100 mg/dL Diabetes is present with either: Two fasting blood glucose values of ! 126 mg/dL. or A random blood glucose of >200 mg/dL + symptoms. The Oral Glucose Tolerance Test (GTT): measurement of blood glucosevalues in a timed manner after ingestion of a standard amount of glucose.Used clinically on a regular basis only to detect diabetes developing during pregnancy.
  24. 24. Diabetes Mellitus: DIAGNOSIS Remember: Most of the time, diabetes isASYMPTOMATIC, or its symptoms are subtle and nonspecific.
  25. 25. Diabetes Mellitus Pathogenesis
  26. 26. Type 1 DiabetesAlpha Cells: Beta Cells: Isolated islets stained for insulin (green) and caspase-3 (pink).GLUCAGON INSULIN W. Moritz, Ph.D., Univ. of Zurich Dr. Thomas Caceci Type 1 diabetes involves selective autoimmune destruction of the insulin-secreting beta cells of the pancreatic islets.
  27. 27. Type 1 Diabetes: Pathogenesis Isolated islets stained for insulin (green) and caspase-3 (pink). W. Moritz, Ph.D., Univ. of Zurich•  A T cell-mediated autoimmune process causing inflammation and destruction of the b cells of the pancreas.•  Associated with the presence of autoimmune antibodies, including antibodies against islet cells, insulin and the 65 kDa form of glutamic acid decarboxylase (GAD65).•  Autoimmune antibodies play no apparent role in development of diabetes but serve as useful markers for those at high risk.•  Genetic factors play a role: association with specific HLA haplotypes.•  Concordance among identical twins: 30-50%.
  28. 28. Type 2 Diabetes: Pathogenesis The pathogenesis of type 2 diabetes is slightly more complex…obLiterated (Flickr) "
  29. 29. DIABETES MELLITUS: Normal Glucose Metabolism GLUCOSE SUPPLY GLUCOSE DEMAND DIET BRAIN COKE BLOOD Insulin-independent tissues GLUCOSE 70-120 mg/dL MUSCLE Liver Hepatic glucose production (+) (-) INSULIN INSULIN PANCREAS FAT CELL Insulin-dependent tissuesA. Kumagai
  30. 30. Type 2 Diabetes: Pathophysiology Introducing the Players in Type 2 Diabetes…. Liver MUSCLE PANCREAS FAT CELLA. Kumagai
  31. 31. Type 2 Diabetes: Pathophysiology Abnormally high hepatic glucose output Liver Peripheral insulin resistance BLOOD GLUCOSE MUSCLE PANCREAS INSULIN Abnormal pancreatic insulin secretion FAT CELLA. Kumagai
  32. 32. Type 2 Diabetes: Development and Progression DIET COKE Increasing peripheral insulin resistance leads to POSTPRANDIAL HYPERGLYCEMIA BLOOD Liver GLUCOSE MUSCLE INSULIN INSULIN PANCREAS Eventually, abnormal insulin FAT CELL secretion and progressive ! cell dysfunction leads to FASTINGA. Kumagai HYPERGLYCEMIA
  33. 33. Pathogenesis of Type 2 Diabetes: the Molecular Level www.hanall.co.kr
  34. 34. Diabetes Mellitus: Points to RememberUnderstand:1.  The epidemiology of diabetes: the current epidemic, high prevalence in minority populations, effects on individuals and society.2.  The differences between type 1 and type 2 diabetes.3.  The pathogenesis of type 1 and type 2 diabetes.
  35. 35. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicySlide 6: U.S. News Magazine June 25, 2001Slide 7: CDC Diabetes Care, 23:1278, 2000. (All Images)Slide 9: NIDDK National Institutes of HealthSlide 11: Arno KumagaiSlide 12: Arno KumagaiSlide 13: Arno KumagaiSlide 14: Arno KumagaiSlide 15: Pablo PicassoSlide 16: Arno KumagaiSlide 26: Dr. Thomas Caceci, Image from http://education.vetmed.vt.edu/Curriculum/VM8054/Labs/labtoc.htm; W. Moritz, Ph.D., Univ. of ZurichSlide 27: W. Moritz, Ph.D., Univ. of ZurichSlide 28: CC: BY-NC-SA obLiterated, http://www.flickr.com/photos/obliterated/2464032152/, Flickr, http://creativecommons.org/licenses/by-nc-sa/2.0/deed.enSlide 29: Arno KumagaiSlide 30: Arno KumagaiSlide 31: Arno KumagaiSlide 32: Arno KumagaiSlide 33: www.hanall.co.kr

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