Type 1 and type 2 DM and the management of the acute and chronic DM

1. DIABETES MELLITUS
KISUMU HEART CENTRE CME
PRESENTER: DR. AJWANG

2. OUTLINE
• Introduction
• Classification
• Type 1 DM
• Type 2 DM
• Diagnosis of DM
• Complications of DM
• Management

3. INTRODUCTION
• Diabetes Mellitus (DM) is a clinical syndrome characterized by
hyperglycemia cause by absolute or relative deficiency of
insulin.
• According to WHO, about 422million people worldwide have
diabetes, with the majority living in low and middle income
countries
• Diabetes contributes to 1.5 million deaths direactly each year

4. CLASSIFICATION AND ETIOLOGY
• Broadly categorzed into 2 major types and a miscellaneous
group
- Type 1 DM
-Type 2 DM
- Etiology-specific DM eg Gestational DM & Maturity
Onset Diabetes of the Young (MODY)

5. TYPE 1 DM
• Constitutes about 10% of the cases of DM
• further subdivided into 2:
- Subtype 1A- aka immune mediated; characterized by
autoimmune destruction of beta cells leading to insulin
deficiency.
-Subtype 1B - aka idiopathic; characterized by insulin
deficiency and tendency to develop ketosis but are
negative for autoimmune markers

6. TYPE 1 DM PRESENTATION
• Manifest at an early, usually below 35 yerars
• polyuria, polydipsia, polyphagia and progressive weight loss
• acutely may present with ketoacidosis or hypoglycemic
episodes

7. TYPE 2 DM
• Comprises about 80% of DM cases
• the basic metabolic defect is either ;
1. delayed insulin secretion relative to the glucose load (impaired
insulin secretion) OR
2. Peripheral tissues unable to respond to the insulin produced (Insulin
resistance)
• usually part of the metabolic syndrome that comprises;
-hyperinsulinemia
-type 2 DM or impaired glucose tolerance
-hypertension
-Dyslipidemia
-Central/visceral obesity

8. TYPE 2 DM PRESENTATION
• Usually manifests above the age of 40
• symptoms are usually slow and insidious
• usually asymptomatic at diagnosis or may present with
polydipsia and/or polyuria.
• Ketoacidosis is very rare

9. Summary of type 1 vs type 2 DM

10. signs and symptoms of uncontrolled DM

11. Diagnosis
• urinalysis- glucose, ketones and
proteins
• Random blood sugar
• Glycated hemoglobin- HbA1c gives an
estimate of the sugar control in the last
3 months
• Oral glucose tolerance test- to
differentiate impaired glucose tolerance
(Pre-DM) from DM

12. Complications of DM
• Acute complications- hypoglycemia, Diabetic Ketoacidosis
(DKA), Hyperosmolar non-ketotic coma(HONK)
• Long term complications:
-Macrovascular
-Microvascular

13. r
Macrovascular complications
• cerebrovascular incidents-
stroke
• coronary artery disease- may
present with heart attack
• Peripheral vascular disease-
may present with chronic leg
ulcers or gangrene
Microvascular complication
• retinopathy/ Cataracts
• Nephropathy- Renal failure
• Peripheral neuropathy- sensory
loss, paraesthesias, pain,
weakness
• Autonomic neuropathy-

14. MANAGEMENT
• Diet and lifestyle modification
• Pharmacotherapy:
-biguanides eg metformin-incereases insulin sensitivity,
is euglycemic.
-sulfonylureas- eg glibenclamide, glyclazide; stimulate
insulin production.
-DPP4 inhibitors- Sitagliptin, vildagliptin
-thiazolidineziones- pioglitazone, Rosiglitazone
• Managing complications

15. INSULIN THERAPY