This is an integrated and evidence based presentation on Diabetes Mellitus covering all the aspects of its pathology,clinical features,classification,complications,diagnosis,treatment and recent advances.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
This document provides information about diabetes mellitus, including its definition, classification, risk factors, diagnostic criteria, clinical presentation, management, complications, and special patient populations. Diabetes is a chronic condition characterized by hyperglycemia due to insulin deficiency or insulin resistance. It is classified into type 1, type 2, and gestational diabetes. Lifestyle modifications including diet and exercise are the primary management approach. Oral medications and insulin therapy may also be used. Complications can include hypoglycemia, retinopathy, nephropathy, neuropathy, and foot ulcers if not properly managed.
This document discusses diabetes mellitus, including its causes, symptoms, diagnosis, and complications. It defines diabetes as a group of metabolic disorders characterized by high blood sugar levels over a prolonged period. The main types are type 1, where the body cannot produce enough insulin, and type 2, where tissues do not respond well to insulin. Complications of long-term high blood sugar levels include damage to small blood vessels (retinopathy, nephropathy), nerves (neuropathies), and increased risk of infections that can require amputation in severe cases of diabetic foot. The document also outlines risk factors, diagnostic tests, and the roles of insulin and other hormones in regulating blood sugar levels.
The document discusses the role of genes in the HLA region and insulin gene in determining risk of type 1 diabetes, prevention of both type 1 and type 2 diabetes, and future expectations such as pancreas transplants, islet cell transplants to the liver, and use of seaweed-derived housing to protect transplanted islet cells from immune system rejection. It also examines causes of type 2 diabetes including metabolic syndrome and findings from the Diabetes Prevention Program on preventing progression from pre-diabetes to type 2 diabetes through lifestyle changes and metformin.
This document discusses the challenges of managing diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD progression and that CKD increases mortality risk in diabetes patients. Managing glucose levels in CKD patients is difficult due to risks of hypoglycemia from insulin clearance issues and need to adjust oral medications for kidney function. The CARMELINA trial demonstrated the renal safety of the DPP-4 inhibitor linagliptin in high cardio-renal risk patients, showing no increase in sustained decrease in eGFR or other renal outcomes compared to placebo over 2 years.
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
This document summarizes key findings from the IDF Diabetes Atlas 2021:
1) An estimated 537 million adults aged 20-79 have diabetes globally in 2021, representing 1 in 10 adults. 6.7 million deaths are attributed to diabetes each year.
2) The top 10 countries for number of adults with diabetes are China, India, USA, Brazil, Pakistan, Indonesia, Mexico, Egypt, Italy, and Bangladesh. The top countries for diabetes healthcare expenditure are USA, China, Japan, Germany, and India.
3) Diabetes prevalence is increasing worldwide, with the majority (75%) of people with diabetes living in low and middle income countries. Cardiovascular disease is the leading cause of death for people
Diabetes is a disease where the body cannot properly use and store glucose, causing blood glucose levels to rise too high. There are two major types of diabetes: type 1 where the body stops producing insulin and type 2 which results from not producing enough insulin or being unable to use insulin properly. Diabetes can occur in anyone but some factors like family history, obesity, and inactivity increase risk. Diabetes is treated through lifestyle changes like weight control, nutrition, exercise and medication including tablets or injections to manage blood sugar levels.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
This document provides information about diabetes mellitus, including its definition, classification, risk factors, diagnostic criteria, clinical presentation, management, complications, and special patient populations. Diabetes is a chronic condition characterized by hyperglycemia due to insulin deficiency or insulin resistance. It is classified into type 1, type 2, and gestational diabetes. Lifestyle modifications including diet and exercise are the primary management approach. Oral medications and insulin therapy may also be used. Complications can include hypoglycemia, retinopathy, nephropathy, neuropathy, and foot ulcers if not properly managed.
This document discusses diabetes mellitus, including its causes, symptoms, diagnosis, and complications. It defines diabetes as a group of metabolic disorders characterized by high blood sugar levels over a prolonged period. The main types are type 1, where the body cannot produce enough insulin, and type 2, where tissues do not respond well to insulin. Complications of long-term high blood sugar levels include damage to small blood vessels (retinopathy, nephropathy), nerves (neuropathies), and increased risk of infections that can require amputation in severe cases of diabetic foot. The document also outlines risk factors, diagnostic tests, and the roles of insulin and other hormones in regulating blood sugar levels.
The document discusses the role of genes in the HLA region and insulin gene in determining risk of type 1 diabetes, prevention of both type 1 and type 2 diabetes, and future expectations such as pancreas transplants, islet cell transplants to the liver, and use of seaweed-derived housing to protect transplanted islet cells from immune system rejection. It also examines causes of type 2 diabetes including metabolic syndrome and findings from the Diabetes Prevention Program on preventing progression from pre-diabetes to type 2 diabetes through lifestyle changes and metformin.
This document discusses the challenges of managing diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD progression and that CKD increases mortality risk in diabetes patients. Managing glucose levels in CKD patients is difficult due to risks of hypoglycemia from insulin clearance issues and need to adjust oral medications for kidney function. The CARMELINA trial demonstrated the renal safety of the DPP-4 inhibitor linagliptin in high cardio-renal risk patients, showing no increase in sustained decrease in eGFR or other renal outcomes compared to placebo over 2 years.
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
This document summarizes key findings from the IDF Diabetes Atlas 2021:
1) An estimated 537 million adults aged 20-79 have diabetes globally in 2021, representing 1 in 10 adults. 6.7 million deaths are attributed to diabetes each year.
2) The top 10 countries for number of adults with diabetes are China, India, USA, Brazil, Pakistan, Indonesia, Mexico, Egypt, Italy, and Bangladesh. The top countries for diabetes healthcare expenditure are USA, China, Japan, Germany, and India.
3) Diabetes prevalence is increasing worldwide, with the majority (75%) of people with diabetes living in low and middle income countries. Cardiovascular disease is the leading cause of death for people
Diabetes is a disease where the body cannot properly use and store glucose, causing blood glucose levels to rise too high. There are two major types of diabetes: type 1 where the body stops producing insulin and type 2 which results from not producing enough insulin or being unable to use insulin properly. Diabetes can occur in anyone but some factors like family history, obesity, and inactivity increase risk. Diabetes is treated through lifestyle changes like weight control, nutrition, exercise and medication including tablets or injections to manage blood sugar levels.
The document provides an overview of the Standards of Care in Diabetes - 2023 guidelines. It includes 17 sections that cover various aspects of diabetes care, treatment goals, and quality evaluation tools. The sections include classification and diagnosis of diabetes, prevention or delay of type 2 diabetes, medical evaluation and assessment of comorbidities, facilitating positive health behaviors, glycemic targets, pharmacologic treatment approaches, management of cardiovascular disease and other complications, and more. The guidelines are intended to provide clinicians, patients, and other stakeholders with an evidence-based framework for diabetes care and management.
A 56-year-old woman presents with increased urinary frequency and thirst. Her blood glucose is elevated at 223 mg/dL and hemoglobin A1c is 9.2, consistent with diabetes. She is obese and eats an unhealthy diet. The document defines diabetes mellitus and the differences between type 1 and type 2 diabetes. It discusses common symptoms, diagnostic tests including blood glucose and hemoglobin A1c levels, and treatment options including lifestyle changes, oral medications, and insulin. Complications like diabetic ketoacidosis are also reviewed.
There are three main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes occurs when the pancreas does not produce enough insulin and usually affects children and young adults. Type 2 diabetes is the most common form and is marked by high blood sugar levels. Gestational diabetes develops during pregnancy. The symptoms of diabetes can include fatigue, thirst, frequent urination, and blurred vision. Diabetes is diagnosed through blood tests measuring glucose levels. Treatment involves monitoring blood sugar levels, following a diet and exercise regimen, and sometimes taking medication like insulin. While there is no cure for diabetes, controlling blood sugar levels can prevent or delay complications to organs.
This presentation covers the main types of diabetes, how the body processes sugar normally and abnormally, diagnosis, treatment, and lifestyle management of diabetes. Type 1 diabetes occurs when the immune system attacks the pancreas, limiting insulin production. Type 2 diabetes is caused by insulin resistance or insensitivity, preventing cells from absorbing glucose. Gestational diabetes occurs during pregnancy due to hormonal changes. The presentation emphasizes lifestyle changes like diet, exercise, weight control and medication adherence to manage diabetes and reduce complications.
This document provides an overview of diabetes mellitus (DM), including the main types, signs and symptoms, complications, risk factors, and treatments. It discusses type 1 DM, type 2 DM, and gestational DM. Type 1 is characterized by a lack of insulin production and usually develops in childhood. Type 2 is caused by insulin resistance and relative insulin deficiency, accounting for 90% of DM cases. Gestational DM occurs during pregnancy. The document also reviews insulin mechanisms, oral hypoglycemic drugs used to treat DM, and potential impacts of gestational DM on children.
This document provides information about diabetes mellitus including the pathophysiology, types, diagnostic tests, treatment, and complications. It discusses that diabetes results from insulin deficiency or resistance leading to high blood sugar. There are three main types - type 1 is insulin dependent, type 2 is related to insulin resistance, and type 3 is linked to Alzheimer's disease. Treatment involves lifestyle changes, oral medications, and insulin therapy depending on the type of diabetes. Complications can be acute like ketoacidosis or chronic like damage to organs and tissues over time if not managed well.
My Nephrology Registrar Seminar Talk from September 2013
Topics Covered
Pathogenesis of Diabetic Nephropathy
Other Renal Disease in Diabetes
Treatment of Diabetic Kidney Disease + The Joint Renal Diabetic Clinic
This document summarizes a clinical presentation on the basal insulin degludec and barriers to achieving optimal glycemic control. It discusses that hypoglycemia and glucose variability are barriers, and that current basal insulins have limitations like needing to be dosed at the same time daily and intra-patient variability. Insulin degludec was developed to address these barriers with properties like an ultra-long half-life of over 25 hours, very low day-to-day variability in glucose-lowering effect, and the ability to reach steady-state in 3 days. Large clinical trials showed degludec was as effective as glargine at reducing A1c and had a similar or lower risk of hyp
This document defines and describes the two main types of diabetes - type 1 and type 2. Type 1 results from the body's failure to produce insulin and accounts for 5-10% of cases, often developing in children/young adults. Type 2 is much more common at 90-95% of cases and results from the body becoming resistant to insulin over time. The nursing focus for both types is monitoring blood glucose levels, assessing for complications, and educating patients on lifestyle modifications and medication management.
Recent studies have highlighted the growing global burden of type 2 diabetes, with over 600 million people projected to have the disease by 2045. In particular, Egypt will face explosive growth in cases. While control of blood sugar levels is important for reducing complications, most patients do not achieve treatment goals. Intensifying treatment in a timely manner when blood sugar is poorly controlled can reduce cardiovascular risks. Inertia on the part of both physicians and healthcare systems often limits timely treatment changes needed to improve outcomes for patients with type 2 diabetes.
SR is a 29-year-old woman recently diagnosed with type 1 diabetes based on her symptoms of dizziness, fatigue, frequent urination, excessive thirst and hunger, and electrolyte disturbances. Her blood glucose levels were very high at 720 mg/dL and her A1C was 8.5%, indicating her insulin levels were too low and she was not producing enough insulin. Her meal plan needs to be modified using carbohydrate counting to better manage her blood sugar levels, with the goal of keeping her A1C below 7% and blood glucose levels within normal ranges. She should monitor her blood glucose levels before and after exercise and meals to determine how activities and food affect her levels.
This is a presentation describing the management principles of a newly diagnosed diabetic patient, including, diet therapy, medical treatment and exercise
This document provides an overview of diabetes management guidelines from the American Diabetes Association. It defines diabetes, classifies the different types, and outlines diagnostic criteria. It discusses the major components of treatment including medical nutrition therapy, physical activity, smoking cessation, comprehensive medical evaluation, glycemic targets, glucose monitoring, and pharmacological therapies. Glycemic goals and treatment approaches are presented for both type 1 and type 2 diabetes in adults and children.
1) The document provides guidelines for healthcare professionals on managing diabetes patients who wish to fast during Ramadan. Fasting is an important religious practice in Islam that occurs during the month of Ramadan.
2) For diabetes patients, fasting can increase the risk of hypoglycemia, hyperglycemia, dehydration and other issues. The guidelines help clinicians evaluate a patient's risk level, provide advice on medication adjustments, blood glucose monitoring and other self-management techniques to minimize health risks from fasting.
3) Key recommendations include individualizing care plans based on a patient's diabetes type, medications, medical history and social circumstances. Patients at very high risk of health complications should not fast, while others may fast
This document discusses the complications of diabetes mellitus. It begins by defining diabetes and describing the different types. It then explains the acute and chronic complications that can occur, including microvascular complications affecting the eyes, kidneys, and nerves, as well as macrovascular complications increasing the risk of cardiovascular disease. The document outlines the main mechanisms behind these complications, such as the accumulation of sorbitol and the glycation of proteins, which can cause tissue damage. Finally, it discusses the importance of glycemic control through diet, exercise and medication in managing diabetes and preventing associated health issues.
Glucagon-like peptide 1 (GLP-1) is an incretin hormone that enhances glucose-dependent insulin secretion from pancreatic beta cells. GLP-1 levels are reduced in patients with type 2 diabetes. Therapeutic strategies that augment the GLP-1 pathway include GLP-1 receptor agonists such as exenatide and liraglutide, as well as dipeptidyl peptidase-4 (DPP-4) inhibitors which prevent the breakdown of endogenous GLP-1. These incretin-based therapies lower blood glucose levels with a low risk of hypoglycemia and promote weight loss, offering an important treatment option for patients with type 2 diabetes.
The document discusses the role of incretins in the management of diabetes. It describes how incretins like GLP-1 and GIP are released after eating to stimulate insulin production and suppress glucagon levels. However, in type 2 diabetes patients, incretin levels and effects are reduced. DPP-4 inhibitors are discussed as a treatment approach that blocks the breakdown of incretins, thereby increasing their levels and effects. Studies show that DPP-4 inhibitors like sitagliptin prolong the levels and actions of incretins, lowering glucose levels and being weight neutral. They represent a new class of diabetes drugs that mimic the normal incretin response.
Empagliflozin is an SGLT2 inhibitor that has shown cardiovascular benefits in clinical trials. SGLT2 inhibitors work by inhibiting glucose reabsorption in the kidneys, leading to increased glucose excretion and reduced blood glucose levels. Empagliflozin in particular has demonstrated reductions in cardiovascular death and hospitalization for heart failure. However, SGLT2 inhibitors also carry risks like genitourinary infections and volume depletion that require monitoring. Overall, SGLT2 inhibitors provide an additional treatment option for type 2 diabetes that can help lower glucose levels while also reducing cardiovascular outcomes.
This document provides information about type 2 diabetes mellitus. It defines diabetes as a group of metabolic disorders resulting in hyperglycemia due to defects in insulin secretion or action. Type 2 diabetes is characterized as adult-onset and non-insulin dependent, involving both insulin resistance where insulin does not bind properly to cells and impaired insulin secretion. Symptoms include frequent urination, increased thirst and hunger, weight loss, and vision changes. Without proper management, type 2 diabetes can lead to long-term complications affecting the heart, blood vessels, eyes, kidneys, and nerves.
Based on the information provided:
- Betty should receive her usual Lantus dose as scheduled since it is a basal insulin that works continuously to control her blood sugar throughout the day and night. Missing the dose could lead to hyperglycemia.
- She should not receive any Humulin R (regular insulin) since she is NPO for surgery and regular insulin requires food to avoid hypoglycemia.
- She may receive her usual Humalog dose if her blood sugar is elevated, as Humalog is a rapid-acting insulin used to control post-meal blood sugars. However, since her current blood sugar of 130mg/dL is in a reasonable range, the Humalog dose can be held until after her surgery when she
The document provides an overview of the Standards of Care in Diabetes - 2023 guidelines. It includes 17 sections that cover various aspects of diabetes care, treatment goals, and quality evaluation tools. The sections include classification and diagnosis of diabetes, prevention or delay of type 2 diabetes, medical evaluation and assessment of comorbidities, facilitating positive health behaviors, glycemic targets, pharmacologic treatment approaches, management of cardiovascular disease and other complications, and more. The guidelines are intended to provide clinicians, patients, and other stakeholders with an evidence-based framework for diabetes care and management.
A 56-year-old woman presents with increased urinary frequency and thirst. Her blood glucose is elevated at 223 mg/dL and hemoglobin A1c is 9.2, consistent with diabetes. She is obese and eats an unhealthy diet. The document defines diabetes mellitus and the differences between type 1 and type 2 diabetes. It discusses common symptoms, diagnostic tests including blood glucose and hemoglobin A1c levels, and treatment options including lifestyle changes, oral medications, and insulin. Complications like diabetic ketoacidosis are also reviewed.
There are three main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes occurs when the pancreas does not produce enough insulin and usually affects children and young adults. Type 2 diabetes is the most common form and is marked by high blood sugar levels. Gestational diabetes develops during pregnancy. The symptoms of diabetes can include fatigue, thirst, frequent urination, and blurred vision. Diabetes is diagnosed through blood tests measuring glucose levels. Treatment involves monitoring blood sugar levels, following a diet and exercise regimen, and sometimes taking medication like insulin. While there is no cure for diabetes, controlling blood sugar levels can prevent or delay complications to organs.
This presentation covers the main types of diabetes, how the body processes sugar normally and abnormally, diagnosis, treatment, and lifestyle management of diabetes. Type 1 diabetes occurs when the immune system attacks the pancreas, limiting insulin production. Type 2 diabetes is caused by insulin resistance or insensitivity, preventing cells from absorbing glucose. Gestational diabetes occurs during pregnancy due to hormonal changes. The presentation emphasizes lifestyle changes like diet, exercise, weight control and medication adherence to manage diabetes and reduce complications.
This document provides an overview of diabetes mellitus (DM), including the main types, signs and symptoms, complications, risk factors, and treatments. It discusses type 1 DM, type 2 DM, and gestational DM. Type 1 is characterized by a lack of insulin production and usually develops in childhood. Type 2 is caused by insulin resistance and relative insulin deficiency, accounting for 90% of DM cases. Gestational DM occurs during pregnancy. The document also reviews insulin mechanisms, oral hypoglycemic drugs used to treat DM, and potential impacts of gestational DM on children.
This document provides information about diabetes mellitus including the pathophysiology, types, diagnostic tests, treatment, and complications. It discusses that diabetes results from insulin deficiency or resistance leading to high blood sugar. There are three main types - type 1 is insulin dependent, type 2 is related to insulin resistance, and type 3 is linked to Alzheimer's disease. Treatment involves lifestyle changes, oral medications, and insulin therapy depending on the type of diabetes. Complications can be acute like ketoacidosis or chronic like damage to organs and tissues over time if not managed well.
My Nephrology Registrar Seminar Talk from September 2013
Topics Covered
Pathogenesis of Diabetic Nephropathy
Other Renal Disease in Diabetes
Treatment of Diabetic Kidney Disease + The Joint Renal Diabetic Clinic
This document summarizes a clinical presentation on the basal insulin degludec and barriers to achieving optimal glycemic control. It discusses that hypoglycemia and glucose variability are barriers, and that current basal insulins have limitations like needing to be dosed at the same time daily and intra-patient variability. Insulin degludec was developed to address these barriers with properties like an ultra-long half-life of over 25 hours, very low day-to-day variability in glucose-lowering effect, and the ability to reach steady-state in 3 days. Large clinical trials showed degludec was as effective as glargine at reducing A1c and had a similar or lower risk of hyp
This document defines and describes the two main types of diabetes - type 1 and type 2. Type 1 results from the body's failure to produce insulin and accounts for 5-10% of cases, often developing in children/young adults. Type 2 is much more common at 90-95% of cases and results from the body becoming resistant to insulin over time. The nursing focus for both types is monitoring blood glucose levels, assessing for complications, and educating patients on lifestyle modifications and medication management.
Recent studies have highlighted the growing global burden of type 2 diabetes, with over 600 million people projected to have the disease by 2045. In particular, Egypt will face explosive growth in cases. While control of blood sugar levels is important for reducing complications, most patients do not achieve treatment goals. Intensifying treatment in a timely manner when blood sugar is poorly controlled can reduce cardiovascular risks. Inertia on the part of both physicians and healthcare systems often limits timely treatment changes needed to improve outcomes for patients with type 2 diabetes.
SR is a 29-year-old woman recently diagnosed with type 1 diabetes based on her symptoms of dizziness, fatigue, frequent urination, excessive thirst and hunger, and electrolyte disturbances. Her blood glucose levels were very high at 720 mg/dL and her A1C was 8.5%, indicating her insulin levels were too low and she was not producing enough insulin. Her meal plan needs to be modified using carbohydrate counting to better manage her blood sugar levels, with the goal of keeping her A1C below 7% and blood glucose levels within normal ranges. She should monitor her blood glucose levels before and after exercise and meals to determine how activities and food affect her levels.
This is a presentation describing the management principles of a newly diagnosed diabetic patient, including, diet therapy, medical treatment and exercise
This document provides an overview of diabetes management guidelines from the American Diabetes Association. It defines diabetes, classifies the different types, and outlines diagnostic criteria. It discusses the major components of treatment including medical nutrition therapy, physical activity, smoking cessation, comprehensive medical evaluation, glycemic targets, glucose monitoring, and pharmacological therapies. Glycemic goals and treatment approaches are presented for both type 1 and type 2 diabetes in adults and children.
1) The document provides guidelines for healthcare professionals on managing diabetes patients who wish to fast during Ramadan. Fasting is an important religious practice in Islam that occurs during the month of Ramadan.
2) For diabetes patients, fasting can increase the risk of hypoglycemia, hyperglycemia, dehydration and other issues. The guidelines help clinicians evaluate a patient's risk level, provide advice on medication adjustments, blood glucose monitoring and other self-management techniques to minimize health risks from fasting.
3) Key recommendations include individualizing care plans based on a patient's diabetes type, medications, medical history and social circumstances. Patients at very high risk of health complications should not fast, while others may fast
This document discusses the complications of diabetes mellitus. It begins by defining diabetes and describing the different types. It then explains the acute and chronic complications that can occur, including microvascular complications affecting the eyes, kidneys, and nerves, as well as macrovascular complications increasing the risk of cardiovascular disease. The document outlines the main mechanisms behind these complications, such as the accumulation of sorbitol and the glycation of proteins, which can cause tissue damage. Finally, it discusses the importance of glycemic control through diet, exercise and medication in managing diabetes and preventing associated health issues.
Glucagon-like peptide 1 (GLP-1) is an incretin hormone that enhances glucose-dependent insulin secretion from pancreatic beta cells. GLP-1 levels are reduced in patients with type 2 diabetes. Therapeutic strategies that augment the GLP-1 pathway include GLP-1 receptor agonists such as exenatide and liraglutide, as well as dipeptidyl peptidase-4 (DPP-4) inhibitors which prevent the breakdown of endogenous GLP-1. These incretin-based therapies lower blood glucose levels with a low risk of hypoglycemia and promote weight loss, offering an important treatment option for patients with type 2 diabetes.
The document discusses the role of incretins in the management of diabetes. It describes how incretins like GLP-1 and GIP are released after eating to stimulate insulin production and suppress glucagon levels. However, in type 2 diabetes patients, incretin levels and effects are reduced. DPP-4 inhibitors are discussed as a treatment approach that blocks the breakdown of incretins, thereby increasing their levels and effects. Studies show that DPP-4 inhibitors like sitagliptin prolong the levels and actions of incretins, lowering glucose levels and being weight neutral. They represent a new class of diabetes drugs that mimic the normal incretin response.
Empagliflozin is an SGLT2 inhibitor that has shown cardiovascular benefits in clinical trials. SGLT2 inhibitors work by inhibiting glucose reabsorption in the kidneys, leading to increased glucose excretion and reduced blood glucose levels. Empagliflozin in particular has demonstrated reductions in cardiovascular death and hospitalization for heart failure. However, SGLT2 inhibitors also carry risks like genitourinary infections and volume depletion that require monitoring. Overall, SGLT2 inhibitors provide an additional treatment option for type 2 diabetes that can help lower glucose levels while also reducing cardiovascular outcomes.
This document provides information about type 2 diabetes mellitus. It defines diabetes as a group of metabolic disorders resulting in hyperglycemia due to defects in insulin secretion or action. Type 2 diabetes is characterized as adult-onset and non-insulin dependent, involving both insulin resistance where insulin does not bind properly to cells and impaired insulin secretion. Symptoms include frequent urination, increased thirst and hunger, weight loss, and vision changes. Without proper management, type 2 diabetes can lead to long-term complications affecting the heart, blood vessels, eyes, kidneys, and nerves.
Based on the information provided:
- Betty should receive her usual Lantus dose as scheduled since it is a basal insulin that works continuously to control her blood sugar throughout the day and night. Missing the dose could lead to hyperglycemia.
- She should not receive any Humulin R (regular insulin) since she is NPO for surgery and regular insulin requires food to avoid hypoglycemia.
- She may receive her usual Humalog dose if her blood sugar is elevated, as Humalog is a rapid-acting insulin used to control post-meal blood sugars. However, since her current blood sugar of 130mg/dL is in a reasonable range, the Humalog dose can be held until after her surgery when she
There are four main types of diabetes: type 1, type 2, gestational diabetes, and pre-diabetes. Type 1 is usually diagnosed in childhood and requires daily insulin injections. Type 2 is the most common type and is often linked to obesity. Gestational diabetes occurs during pregnancy, and pre-diabetes means blood sugar levels are higher than normal but not high enough to be classified as type 1 or 2. Common symptoms of diabetes include frequent urination, thirst, hunger, and fatigue. Testing involves fasting plasma glucose tests and oral glucose tolerance tests. Managing diabetes involves diet, exercise, medication and monitoring blood sugar levels. Long-term complications can affect the heart, kidneys, eyes, nerves and skin if diabetes is
This document discusses the different types of diabetes, their causes and symptoms. It covers Type 1 diabetes which occurs when the pancreas does not produce enough insulin, and Type 2 diabetes which happens when the pancreas does not make enough insulin or cells become insulin resistant. Symptoms of high and low blood sugar are explained. Treatment recommendations are provided for hypoglycemia and hyperglycemia. Normal blood sugar ranges are listed for different age groups. Lifestyle factors like diet, exercise and medication adherence are noted as important for diabetes management.
This document provides an overview of diabetes mellitus including its definition, classification, clinical features, investigations, treatment, and complications. It begins with defining the objectives of the lecture which are to define DM, classify its types, list predisposing factors and clinical features, and discuss drugs used in treatment. It then covers epidemiology, the main types of DM including type 1, type 2, and gestational diabetes. Key aspects of diagnosis and management are summarized such as diagnostic criteria, goals of treatment, and approaches including non-pharmacologic, pharmacologic, and surgical options.
Diabetes and various types have been discussed in detail as regard for Pg entrance and with various images, tables .....
Topics discussed: 1) introduction
2) types of diabetes
3) comp0lication of diabetes
4) DKA
5) NKHOC
6) Diabetic nephropathy
7) skin diseases in diabetes
Este documento resume los principales aspectos de la diabetes, incluyendo sus tipos (tipo 1, tipo 2 y gestacional), causas, síntomas, tratamientos, complicaciones y factores de riesgo. Explica que la diabetes se produce cuando el páncreas no produce suficiente insulina o cuando el cuerpo no la usa eficazmente, resultando en niveles elevados de azúcar en la sangre. También destaca la importancia de la prevención a través de una dieta saludable, ejercicio y controles médicos regulares.
The document discusses diabetes, including:
- Diabetes is a group of metabolic disorders characterized by hyperglycemia due to defects in insulin secretion or action.
- India currently has 63 million people with diabetes, the second highest number after China.
- There are two main types of diabetes - type 1 caused by beta cell destruction leading to insulin deficiency, and type 2 caused by insulin resistance and relative insulin deficiency.
- Treatment involves diet, exercise, oral medications like metformin and sulfonylureas, and sometimes insulin therapy. The goal is to control blood sugar levels and prevent complications like damage to eyes, kidneys, nerves, and blood vessels.
El documento proporciona una definición y clasificación de la diabetes mellitus. Explica que la diabetes tipo 1 es causada por la destrucción autoinmune de las células beta del páncreas que producen insulina, mientras que la diabetes tipo 2 se debe a la resistencia a la insulina. Describe las manifestaciones clínicas, complicaciones agudas y crónicas de ambos tipos, así como los tratamientos con insulina y medicamentos hipoglucemiantes. También cubre la diabetes gestacional.
This document provides information on tumours of the oral cavity, including:
- The oral cavity extends from the lips to the junction of the hard and soft palate, and tumors have a high incidence in India and France.
- Tumors are classified as benign, premalignant, or malignant. Benign tumors include solid tumors like fibromas and cystic lesions like mucoceles and ranulas.
- Premalignant lesions include leukoplakia and erythroplakia. Malignant lesions include squamous cell carcinoma, minor salivary gland tumors, and sarcomas.
- Risk factors for oral cavity cancers include smoking, tobacco chewing, alcohol, and
This document discusses various endocrine disorders that can cause short stature in children, including hypothyroidism, Cushing's syndrome, and delayed puberty. It provides details on symptoms, causes, diagnostic tests, and treatment options for each condition. The document also covers other endocrine-related topics such as acromegaly, diabetes insipidus, juvenile diabetes, goiter, hypo- and hyperparathyroidism. Management involves addressing the underlying endocrine abnormality through medications, hormone replacement, and surgery when necessary.
This document discusses diabetes mellitus, including the different types of diabetes, their causes and symptoms, treatment goals, and potential complications. It describes type 1 diabetes as an autoimmune disease where the body destroys insulin-producing cells, while type 2 diabetes involves insulin resistance where the body does not use insulin properly. Emergency conditions like diabetic ketoacidosis are also summarized. The document outlines screening recommendations and emphasizes lifestyle modifications like diet and exercise as well as medication management to control blood sugar levels and minimize health risks.
The document summarizes guidelines from the American Diabetes Association (ADA) regarding standards of medical care for diabetes in 2017. It discusses recommendations for classifying and diagnosing different types of diabetes, including prediabetes, type 1 diabetes, type 2 diabetes, and gestational diabetes. The ADA recommends screening for prediabetes and type 2 diabetes in asymptomatic adults starting at age 45 or earlier for those with risk factors. It also provides criteria for diagnosing diabetes based on hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests.
Diabetes mellitus is a disease characterized by high blood sugar levels. There are two main types: Type 1 occurs when the body does not produce insulin, while Type 2 occurs when the body does not produce enough insulin or the insulin it produces does not work properly. Long-term complications of diabetes include damage to blood vessels and nerves, which can lead to conditions affecting the eyes, kidneys, heart, and feet. The pancreas normally regulates blood sugar levels through the hormones insulin and glucagon.
Este documento define la diabetes, sus causas, tipos y tratamiento. La diabetes es una enfermedad caracterizada por altos niveles de glucosa en la sangre debido a una falta de insulina o resistencia a la insulina. Existen dos tipos principales de diabetes: tipo 1 causada por una falta de producción de insulina, y tipo 2 relacionada con factores genéticos y ambientales como la dieta y falta de ejercicio. El tratamiento de la diabetes tipo 1 implica la administración de insulina, mientras que la tipo 2 se trata generalmente con medicamentos
This document provides information about diabetes, including the different types, symptoms, causes, treatment, and complications. It discusses how diabetes occurs when the body does not produce enough insulin or the cells do not respond properly to insulin. The main types are type 1, type 2, and gestational diabetes. Treatment focuses on diet, exercise, weight control, and insulin as needed. Complications can include eye, foot, heart and kidney problems if diabetes is not well managed. Ways to support diabetes prevention and management in schools are also outlined.
This document discusses various disorders of the pituitary gland caused by hyperactivity or hypoactivity of the anterior and posterior pituitary. It describes gigantism, acromegaly, Cushing's disease caused by hyperactivity of the anterior pituitary and their symptoms. Hypoactive conditions like dwarfism, Simmond's disease are also explained. Disorders involving both anterior and posterior pituitary like SIADH and diabetes insipidus are mentioned along with their causes and features. Treatment options for different conditions are briefly outlined.
This document provides information on diabetes mellitus (DM), including its classification, differences between type 1 and type 2 DM, etiology, pathophysiology, and genetics. It discusses that DM is classified based on the pathogenic process causing hyperglycemia into type 1 and type 2. Type 1 DM results from beta cell destruction leading to insulin deficiency, while type 2 DM ranges from insulin resistance with relative deficiency to a secretory defect with resistance. The document outlines the etiology and pathophysiology of both types of DM in detail. It also addresses the genetic considerations for type 1 DM.
Este documento resume la historia, causas, tipos y complicaciones de la diabetes mellitus. Explica que la diabetes se caracteriza por niveles altos de glucosa en la sangre debido a bajos niveles de insulina o resistencia a la insulina. Describe los tipos principales de diabetes (tipo 1, tipo 2 y gestacional), sus síntomas, factores de riesgo y complicaciones agudas y crónicas. También resume los diferentes tipos de insulina y su función en la regulación de los niveles de glucosa.
1. Diabetes is a heterogeneous group of syndromes characterized by elevated blood glucose caused by relative or absolute deficiency of insulin.
2. It was first described in ancient Egypt and India, and the term "diabetes" was first used by Greeks in the 3rd century BCE. Type 1 and type 2 diabetes were first distinguished by Indian physicians.
3. The worldwide prevalence of diabetes has risen dramatically from an estimated 30 million cases in 1985 to 388 million cases in 2015.
Diabetes mellitus (DM):- It is a metabolicdisorder characterized by hyperglycaemia, (fasting plasma glucose ≥ 126 mg/dl and/or ≥ 200 mg/dl 2 hours after 75 g oral glucose),glycosuria, hyperlipidaemia, negative nitrogen balance and sometimes ketonaemia.
Diabetes mellitus, one of the major public health problems worldwide, is a metabolic disorder of multiple etiologies distinguished by a failure of glucose homeostasis with disturbances of carbohydrate, fat and protein metabolism as a result of defects in insulin secretion and/or insulin action.
According to International Diabetes Federation (IDF) report, elevated blood glucose is the third uppermost risk factor for premature mortality, following high blood pressure and tobacco use globally
Cardiovascular diseases, neuropathy, nephropathy, and retinopathy are among the major risks that are associated with diabetes.
These chronic complications may lead to hardening and narrowing of arteries (atherosclerosis) that could advance to stroke, coronary heart disease, and other blood vessel diseases, nerve damage, kidney failure, and blindness with time
Two major types of diabetes mellitus are
1. Insulin-dependent diabetes mellitus (IDDM) / juvenile onset diabetes mellitus
2. Noninsulin-dependent diabetes mellitus (NIDDM) / maturity onset diabetes mellitus
Insulin-dependent diabetes mellitus (IDDM) / juvenile onset diabetes mellitus
There is β cell destruction in pancreatic islets; majority of cases are autoimmune (type 1A) antibodies that destroy β cells are detectable in blood, but some are idiopathic (type 1B)-no βcell antibody is found.
2.Noninsulin-dependent diabetes mellitus (NIDDM) / maturity onset diabetes mellitus
Type 2 diabetes mellitus (T2DM) is the most prevalent metabolic disease worldwide.
There is no loss or moderate reduction in β cell mass: insulin in circulation is low. normal or even high. no anti-β -cell antibody is demonstrable: has a high degree of genetic predisposition: generally has a late onset (past middle age). Over 90% cases of diabetes are type 2 DM
Abnormality in gluco-receptor of β cells so that they respond at higher glucose concentration or relative β cell deficiency. In either way. insulin secretion is impaired: may progress to β cells failure.
Reduced sensitivity of peripheral tissues to insulin: reduction in number of insulin receptors, “down regulation” of insulin receptors.
Excess of hyperglycemic hormones (glucagon, ete. ) obesity: ; cause relative insulin deficiency the β cells Tag behind
Insulin history:
Insulin was discovered in 1921 by Banting and Best who demonstrated the hypoglycaemic action of an extract of pancreas prepared after degeneration of the exocrine part due to ligation of pancreatic duct.
It was first obtained in pure crystalline form in 1926 and the chemical structure was fully worked out in 1956 by Sanger.
Insulin is a two chain polypeptide having 51 amino acids and MW about 6000.
The A-chain has 21 while B-chain has 30 amino acids.
Diabetes mellitus (DM):- It is a metabolicdisorder characterized by hyperglycaemia, (fasting plasma glucose ≥ 126 mg/dl and/or ≥ 200 mg/dl 2 hours after 75 g oral glucose),glycosuria, hyperlipidaemia, negative nitrogen balance and sometimes ketonaemia.
Diabetes mellitus, one of the major public health problems worldwide, is a metabolic disorder of multiple etiologies distinguished by a failure of glucose homeostasis with disturbances of carbohydrate, fat and protein metabolism as a result of defects in insulin secretion and/or insulin action.
According to International Diabetes Federation (IDF) report, elevated blood glucose is the third uppermost risk factor for premature mortality, following high blood pressure and tobacco use globally
Cardiovascular diseases, neuropathy, nephropathy, and retinopathy are among the major risks that are associated with diabetes.
These chronic complications may lead to hardening and narrowing of arteries (atherosclerosis) that could advance to stroke, coronary heart disease, and other blood vessel diseases, nerve damage, kidney failure, and blindness with time
Two major types of diabetes mellitus are
1. Insulin-dependent diabetes mellitus (IDDM) / juvenile onset diabetes mellitus
2. Noninsulin-dependent diabetes mellitus (NIDDM) / maturity onset diabetes mellitus
Insulin-dependent diabetes mellitus (IDDM) / juvenile onset diabetes mellitus
There is β cell destruction in pancreatic islets; majority of cases are autoimmune (type 1A) antibodies that destroy β cells are detectable in blood, but some are idiopathic (type 1B)-no βcell antibody is found.
2.Noninsulin-dependent diabetes mellitus (NIDDM) / maturity onset diabetes mellitus
Type 2 diabetes mellitus (T2DM) is the most prevalent metabolic disease worldwide.
There is no loss or moderate reduction in β cell mass: insulin in circulation is low. normal or even high. no anti-β -cell antibody is demonstrable: has a high degree of genetic predisposition: generally has a late onset (past middle age). Over 90% cases of diabetes are type 2 DM
Abnormality in gluco-receptor of β cells so that they respond at higher glucose concentration or relative β cell deficiency. In either way. insulin secretion is impaired: may progress to β cells failure.
Reduced sensitivity of peripheral tissues to insulin: reduction in number of insulin receptors, “down regulation” of insulin receptors.
Insulin history:
Insulin was discovered in 1921 by Banting and Best who demonstrated the hypoglycaemic action of an extract of pancreas prepared after degeneration of the exocrine part due to ligation of pancreatic duct.
It was first obtained in pure crystalline form in 1926 and the chemical structure was fully worked out in 1956 by Sanger.
Insulin is a two chain polypeptide having 51 amino acids and MW about 6000.
The A-chain has 21 while B-chain has 30 amino acids.
Insulin is synthesized in the β cells of pancreatic islets as a single chain peptide Preproinsulin (110 AA) from whic
Diabetes mellitus (DM):- It is a metabolicdisorder characterized by hyperglycaemia, (fasting plasma glucose ≥ 126 mg/dl and/or ≥ 200 mg/dl 2 hours after 75 g oral glucose),glycosuria, hyperlipidaemia, negative nitrogen balance and sometimes ketonaemia.
Diabetes mellitus, one of the major public health problems worldwide, is a metabolic disorder of multiple etiologies distinguished by a failure of glucose homeostasis with disturbances of carbohydrate, fat and protein metabolism as a result of defects in insulin secretion and/or insulin action.
According to International Diabetes Federation (IDF) report, elevated blood glucose is the third uppermost risk factor for premature mortality, following high blood pressure and tobacco use globally
Cardiovascular diseases, neuropathy, nephropathy, and retinopathy are among the major risks that are associated with diabetes.These chronic complications may lead to hardening and narrowing of arteries (atherosclerosis) that could advance to stroke, coronary heart disease, and other blood vessel diseases, nerve damage, kidney failure, and blindness with time
Two major types of diabetes mellitus are
1. Insulin-dependent diabetes mellitus (IDDM) / juvenile onset diabetes mellitus
2. Noninsulin-dependent diabetes mellitus (NIDDM) / maturity onset diabetes mellitus
Insulin-dependent diabetes mellitus (IDDM) / juvenile onset diabetes mellitus
There is β cell destruction in pancreatic islets; majority of cases are autoimmune (type 1A) antibodies that destroy β cells are detectable in blood, but some are idiopathic (type 1B)-no βcell antibody is found.
2.Noninsulin-dependent diabetes mellitus (NIDDM) / maturity onset diabetes mellitus
Type 2 diabetes mellitus (T2DM) is the most prevalent metabolic disease worldwide.
There is no loss or moderate reduction in β cell mass: insulin in circulation is low. normal or even high. no anti-β -cell antibody is demonstrable: has a high degree of genetic predisposition: generally has a late onset (past middle age). Over 90% cases of diabetes are type 2 DM
Abnormality in gluco-receptor of β cells so that they respond at higher glucose concentration or relative β cell deficiency. In either way. insulin secretion is impaired: may progress to β cells failure.
Reduced sensitivity of peripheral tissues to insulin: reduction in number of insulin receptors, “down regulation” of insulin receptors.
Insulin history:
Insulin was discovered in 1921 by Banting and Best who demonstrated the hypoglycaemic action of an extract of pancreas prepared after degeneration of the exocrine part due to ligation of pancreatic duct.
It was first obtained in pure crystalline form in 1926 and the chemical structure was fully worked out in 1956 by Sanger.
Insulin is a two chain polypeptide having 51 amino acids and MW about 6000.
The A-chain has 21 while B-chain has 30 amino acids.
Insulin is synthesized in the β cells of pancreatic islets as a single chain peptide Preproinsulin (110 AA) from which
The document provides an overview of diabetes mellitus including:
- Types of diabetes such as type 1, type 2, and gestational diabetes.
- Pathophysiology involving insulin resistance and insulin deficiency.
- Clinical manifestations like polyuria, polydipsia, and blurred vision.
- Diagnosis using blood glucose levels and HbA1c testing.
- Management through diet, exercise, oral medications, and insulin therapy.
- Complications affecting the eyes, kidneys, nerves, and cardiovascular system.
This document summarizes information about diabetes, including its definition, classification, effects of insulin, and treatments. It begins with an overview of diabetes, defining it as a group of metabolic disorders involving hyperglycemia. It then discusses the two main types of diabetes - type 1 characterized by insulin deficiency and type 2 characterized by insulin resistance - and their causes. Subsequent sections provide details on insulin biosynthesis and secretion, its counter-regulation, effects in different tissues, and role in glucose homeostasis. The document concludes by outlining several classes of medications used to treat diabetes, including sulfonylureas, thiazolidinediones, and newer drugs that target incretin hormones.
Type 2 diabetes is a major health problem in Pakistan, affecting 33 million adults. It occurs when the body does not produce enough insulin or cannot effectively use the insulin it produces, resulting in elevated blood sugar levels. Treatment involves lifestyle modifications like diet and exercise as well as medications to lower blood sugar. These include insulin, oral medications that stimulate insulin release, increase insulin sensitivity, or slow carbohydrate absorption. The goals of treatment are to reduce symptoms and prevent complications affecting the heart, blood vessels, eyes, kidneys and nerves.
This document summarizes diabetes mellitus and its management. It defines diabetes as a clinical syndrome characterized by hyperglycemia. The two most common types are type 1, caused by autoimmune destruction of insulin-producing cells, and type 2, characterized by insulin resistance and inability to produce sufficient insulin. Environmental and genetic factors contribute to both types. Symptoms, diagnosis, and treatment options like diet, medications, and insulin are discussed in detail. The goals of management are to improve hyperglycemia symptoms and minimize long-term complications through glycemic control.
The endocrine pancreas
Islets of Langerhans (endocrine pancreas) contain 4 major
and 2 minor cell types.
●Major cell types:
1.β cell produces insulin.
2.α cell secretes glucagon.
3.δ cells contain somatostatin, which suppresses
both insulin and glucagon release.
• DM is a heterogeneous group of syndromes characterized by
an elevation of fasting blood glucose caused by absolute or
relative deficiency of insulin
• Hyperglycemia in diabetes results from defects in insulin
secretion ( destruction of β cells of the pancreas ), insulin
action, or most commonly both.
• Diabetes is the leading cause of adult blindness and
amputation and a major cause of renal failure, nerve damage,
heart attacks, and strokes.
• Most cases of diabetes mellitus can be separated into two
groups
- Type 1 (insulin-dependent DM)
- Type 2 (noninsulin dependent DM)
Type 1 Diabetes Mellitus
• Onset: usually during childhood
• Caused by absolute (complete) deficiency of insulin:
- Maybe caused by both:
1. autoimmune attack of b-cells of the pancreas, i.e. a
genetic determinant that allows the β cells to be
recognized as “nonself”
2. environmental factors as viral infection or toxins
• Rapid symptoms appear when 80-90% of the b-cells
have been destroyed
• Commonly complicated by diabetic ketoacidosis (DKA)
• Treated only by insulin
• the islets of Langerhans become
infiltrated with activated T
lymphocytes, leading to a
condition called insulitis .
• Over a period of years, this
autoimmune attack on the β cells
leads to gradual depletion of the
β-cell population. However,
symptoms appear abruptly when
80%–90% of the β cells have been
destroyed.
• At this point, the pancreas fails to
respond adequately to ingestion
of glucose, and insulin therapy is
required to restore metabolic
control and prevent lifethreatening ketoacidosis.
Metabolic changes of type 1 DM
1-Hyperglycemia: increased glucose in blood, Due to:
Decreased glucose uptake by muscles & adipose tissues &/or
Increased hepatic gluconeogenesis
2-Ketoacidosis:
• increased ketone bodies in blood (in untreated or
uncontrolled cases) results from increased mobilization of
fatty acids (FAs ) from adipose tissue, combined with
accelerated hepatic FA β-oxidation and synthesis of 3-
hydroxybutyrate and acetoacetate.
• in 25 – 40% of newly diagnosed type 1 DM
• in stress states demanding more insulin (as during
infection, illness or during surgery)
• In patients who have no compliance with therapy
3- Hypertriglyceridemia: increased TAG in blood
• Released fatty acids from adipose tissues are
converted to triacylglycerol. Triacylglycerol is
secreted from the liver in VLDL to blood.
• Chylomicrons (from diet fat) accumulates (low
lipoprotein lipase in DM due to decreased
insulin)
• Increased VLDL & chylomicrons results in
hypertriacylglyceridemia
INTERTISSUE RELATIONSHIP IN T1DM
Diagnosis of type 1 DM
• Clinically:
Age: during childhood or puberty (< 20 years of age)
- Polyuria (frequent urina
This document provides an overview of diabetes mellitus (DM), including its anatomy, physiology, epidemiology, classification, diagnosis, complications, and treatment. It discusses the two main types of DM - type 1 caused by beta cell destruction leading to insulin deficiency, and type 2 caused by insulin resistance and impaired insulin secretion. Key facts include that DM affects over 382 million people worldwide, is classified based on etiology, and can be diagnosed through blood glucose and A1C levels. Treatment involves lifestyle changes, glucose-lowering medications like insulin and sulfonylureas, and managing complications to control blood sugar levels.
This document discusses diabetes mellitus (DM), including:
- DM is characterized by high blood glucose levels and can lead to damage of organs over time. There are different types of DM.
- Over 400 million people worldwide have DM, with the highest prevalence in Pakistan.
- Risk factors for type 1 DM include genetics, while risks for type 2 DM include family history, obesity, and inactivity.
- Treatment involves lifestyle changes like nutrition and exercise as well as medications like insulin, oral drugs, and managing complications.
This document summarizes Type 1 diabetes mellitus. It begins by stating that Type 1 diabetes is characterized by an absolute deficiency of insulin caused by an autoimmune attack on the beta cells of the pancreas. About 10% of diabetics in the USA have Type 1 diabetes, and only two-thirds are diagnosed. Complications of Type 1 diabetes include stroke, heart attack, kidney disease, eye disease, and nerve damage. The document then discusses insulin synthesis, storage, and secretion by the pancreas, as well as insulin's biochemical role in signal transduction and glucose utilization. It provides details on the onset, etiology, pathophysiology, clinical manifestations, diagnostic studies, drug and insulin therapy, nutritional therapy, and pancre
This document discusses diabetes mellitus (DM), including its symptoms, complications if left untreated, and types. It focuses on Type 1 and Type 2 DM. Type 1 is an autoimmune disorder where antibodies destroy insulin-producing beta cells. Type 2 is caused by insulin resistance or insufficient insulin production. The document also covers insulin, its structure and production, mechanism of action, types used to treat DM, and oral hypoglycemic agents including sulfonylureas like tolbutamide.
Includes Information about Pharmacotherapeutic of Diabetes Mellitus, all details about etiology, Pathophysiology, pharmacology, treatment, current clinical trials on DM etc.
Introduction to Diabetes & anti diabetic drug screening methodsAnurag Raghuvanshi
This document provides an introduction to diabetes and anti-diabetic drug screening methods. It begins by classifying diabetes and defining the main types - type 1, type 2, gestational, and secondary. It then describes the pancreas and its beta cells that produce insulin. Various models for inducing diabetes in animals are discussed for screening anti-diabetic drugs, including chemical agents like alloxan and streptozotocin, viral induction, immune-mediated induction using anti-insulin serum, genetic alteration in mice/rats, pancreatectomy, and hormone-induced using dexamethasone. Common screening methods and their principles, procedures, advantages, and limitations are summarized.
1. Diabetes mellitus results from inadequate insulin supply or inadequate tissue response to insulin, leading to hyperglycemia. There are three main types: type 1 is autoimmune and causes complete insulin deficiency; type 2 is more common and involves relative insulin deficiency and insulin resistance; type 1b is a rare form not caused by autoimmunity.
2. Symptoms of diabetes include fatigue, weight loss, polyuria, polydipsia, and blurry vision. Diagnosis involves blood glucose criteria and HbA1c levels. Treatment involves lifestyle changes, oral medications like metformin and sulfonylureas, and insulin for more severe cases.
3. Complications include diabetic ketoacidosis, characterized by
The document discusses diabetes mellitus (DM), including its classification into types 1 and 2, gestational diabetes, and other types. It covers the anatomy and functions of the pancreas, which produces insulin and digestive enzymes. Diagnostic criteria for DM include hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests. Complications of uncontrolled DM are also mentioned. Treatment involves lifestyle changes, insulin therapy, and managing comorbidities.
This document summarizes recent advances in the treatment of diabetes mellitus. It discusses improved methods for monitoring blood glucose levels and diagnosing diabetes. New therapies described include insulin sensitizers, inhibitors of intestinal carbohydrate absorption, various methods of insulin administration including pumps, and immunotherapy approaches. The document concludes that future treatment will depend on ongoing clinical trials of immunomodulation and immunosuppressive therapies to help preserve pancreatic beta cell function and reduce insulin requirements.
Similar to Diabetes Mellitus(Past,Present and Future) (20)
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
2. DEFINITION
“Diabetes is not a single disease rather it is a heterogeneous group of
Syndromes characterized by elevation of blood glucose caused by a
relative or absolute deficiency of Insulin.”(Lippincott’s )
2
3. 1.Diabetes is one of the first diseases described with an Egyptian manuscript
from 1500 BCE mentioning “too great emptying of the urine.” The first described cases are
believed to be of type 1 diabetes.
2.Indian physicians around the same time identified the disease and classified it
as madhumeha or honey urine noting that the urine would attract ants.
3.The term "diabetes" or "to pass through" was first used in 250 BCE by the
Greek Apollonius of Memphis.
4.Type 1 and type 2 diabetes were identified as separate conditions for the first time by the
Indian physicians Sushruta and Charaka with type 1 associated with youth and type 2 with
obesity.
History of Diabetes3
4. SEVERITY OF THE PROBLEM
The worldwide prevalence of DM has risen dramatically over the
past 2 decades, from an estimated 30 million cases in 1985 to 388
million cases in 2015.
4
8. Frederick Banting, MD, and his then student assistant,
Charles Best, MD, extracted insulin from dog pancreas
in laboratory space provided by Professor J.J.R.
Macleod. They inject the insulin into dogs whose
pancreases have been removed, and the animals’
blood sugar levels go down. James Collip purifies the
extract so that it can be used in humans. Banting and
Macleod were awarded the 1923 Nobel Prize in
Physiology.
DISCOVERY OF INSULIN8
9. 9
PHYSIOLOGY OF INSULIN SYNTHESIS, SECRETION AND ITS
ACTION
SYNTHESIS OF INSULIN :-
1.GLUCOSE LEVELS >70mg/dl stimulate insulin synthesis primarily by
enhancing protein translation and processing(HNF 4-α,HNF 1-β,NeuroD1).
2.PRE PROINSULIN(86 A.A)→PROINSULIN(84 A.A)→INSULIN
(A chain-21 A.A,B chain-30 A.A)+C PEPTIDE(31 A.A).
3.Clinical implication:-
As C-peptide is cleared more slowly than insulin:-
a)it acts as a useful marker for insulin secretion.
b)allows discrimination of endogenous and exogenous sources of insulin in
evaluation of hypoglycaemia.
15. 1.Since chronic DM 2 eventually require insulin treatment for
control of hypoglycemia,the use of the term NIDDM created
considerable confusion. Thus the terms IDDM & NIDDM are
obsolete.
2.A second difference is that age or treatment modality is not a
criterion:
1.DM 1 common in <30 yrs of age but in 5-10% of individuals
who develop DM after 30 yrs have DM1.
2.DM2 children & young adults, particularly obese adolescents
15
16. 16
ADA(2014)ETIOLOGICAL CLASSIFICATION OF DM
1.DM1 & DM2- Polygenic DM.
2.MODY and monogenic diabetes are subtypes
of DM characterized by AD inheritance, early
onset of hyperglycemia & impaired insulin
secretion.
3.A form of acute onset of DM1 related to
viral infection of islets has been noted in
japan-Fulminant Diabetes.
4.Overt Diabetes
17. 17 Pathogenesis of
polygenic DM-1A
1.Defect in the insulin gene located on Chr.2-
short forms of variable tandem repeats in the promoter region→disease susceptibility
Whereas long forms→protection
2.Defect during induction of central tolerance
In individuals with long/protective repeats→demonstration of increased expression of insulin(m-RNA) in
thymus→more efficient deletion of insulin specific T cells.
3.Polymorphisms in HLA complex on Chr.6→HLA DR-3 &/ HLA DR4 haplotypes
Due to this polymorphism the APC recognize insulin,GAD,ICA-512/IA-2,β-cell specific zinc
transporter(ZnT-8) as foreign antigens and present them to autoreactive T cells.
4.Other susceptibility factors include- suppressors of T cell activation
a)CTLA-4(cytotoxic T lymphocyte antigen 4) gene
b)A variant of PTNP22-gene encoding for LYP(lymphoid tyrosine phosphate)
18. Historical Model of Type 1 Diabetes Pathogenesis
Proposed by late Dr.George Eisenbarth in 1986
1.In a child born with defect in the insulin gene
↓
2.Shorter forms of variable tandem repeats in the promoter region
↓
3.Decreased expression of insulin(m RNA) & inefficient deletion of insulin specific T cells
↓← “triggering” insult, likely environmental
4.Injured β-cells release self antigens
↓
5.These self antigens are sequestered by the APC & presented to autoreactive T cells
↓
6.Migration of T cells to Islets & destruction of β-cells
↓
7.When 85-90% of β-cells are destroyed,symptoms of the disease occur.
18
20. 20 Temporal model for development of DM-1A
After initial
clinical
presentation of
DM-1A
a“honeymoon”
phase may ensue
during which
glycemic control
is achieved by
modest dose of
insulin or rarely
insulin is not
required
21. Pathogenesis of DM2
INSULIN RESISTANCE IMPAIRED INSULIN SECRETION
1.The disease is polygenic and multifactorial(genetic susceptibility + envi. factors such as obesity,
nutrition & physical activity modulate the phenotype)
2.The genes that predispose to DM2 are incompletely identified but the most prominent is a variant of
the transcription factor 7-like 2 gene has been associated with DM2 in several populations
3.The concordance of DM2 in identical twins is between 70 and 90%,if both the parents have DM2
the risk approaches 40%
4..“Post receptor” defects in insulin regulated phosphorylation & dephosphorylation(signal
transduction) appear to play a imp role in insulin resistance.
5.Not all insulin signal transduction pathways are resistant to effects of insulin(eg: cell growth &
differentiation using mitogenic activated protein kinase pathways)→thereby potentially accelerating
the risk of developing “atherosclerosis”
21
22. Pathophysiology
INSULIN RESISTANCE
IMPAIRED INSULIN SECRETION
EXCESSIVE HEPATIC
GLUCOSE PRODUCTION
ABNORMAL FAT METABOLISM
In early stages of insulin resistance→ Compensatory hyperinsulinemia→ Maintenance of NGT
↓
As disease progresses islets fail to sustain hyperinsulinemic state
↓
IGT characterized by elevation of post prandial glucose
↓
Insulin secretion + hepatic glucose production = Overt Diabetes with fasting hyperglycemia
a)Increased hepatic glucose output results in increased FPG levels.
b)Decreased peripheral glucose usage results in postprandial hyperglycemia.
22
23. Metabolic abnormalities in DM2
IMPAIRED INSULIN SECRETION IS
BECAUSE
ABNORMAL FAT
METABOLISM
INCREASED HEPATIC
GLUCOSE AND LIPID
PRODUCTION
Chronic hyperglycemia paradoxically
impairs islet cell function - “glucose
toxicity”
Improvement in glycemic control is often
associated with improved islet cell
function
Elevated fatty acid & dietary
fat(“lipotoxicity”)worsen islet function &
reduced GLP1 contributes to reduced
insulin secretion.
Increased adipocyte mass in
obese(predisposing) individuals
↓
FFA & adipokines ,an adipokine
adiponectin(insulin sensitizer)
is decreased in obesity causing
hepatic insulin resistance.
FFA impair glucose utilization &
β-cell function, promote glucose
production by liver.
Causes fasting & post prandial
hyperglycemia.
Insulin resistance
↓
Adipocyte : lipolysis ,FFA flux
↓
Lipid syn. in liver causing
NAFLD + abnormal LFT &
also responsible for
dyslipidemia.
23
24. Some individuals with phenotypic DM2 present
with diabetic ketoacidosis but lack autoimmune
markers-Ketosis prone DM2.
On other hand,some individuals with
phenotypic DM2do not have absolute insulin
deficiency but have autoimmune markers(GAD
& ICA autoantibodies) suggestive of DM1-
Latent Autoimmune Diabetes of the
Adult(LADA)
VARIANTS OF DM24
27. Diagnosis of Diabetes Mellitus
A RPG concentration :
≥200mg/dL accompanied by
classical symptoms of DM is
also sufficient for the
diagnosis of DM.
The current criteria for
diagnosis of DM emphasize
the HbA1C or the FPG as
the most reliable and
convenient tests for
identifying DM in
asymptomatic individuals.
27
29. Screening for Diabetes in high risk group
HIGH RISK GROUP :- 1.Those in the age group of 40 &above
2.Those with a family history of diabetes
3.The obese
4.Women who have had a baby weighing more than 4.5 kg
5.Women who show excessive weight gain during pregnancy.
6.P’s with premature atherosclerosis.
Urine examination :-
1.Urine test for glucose,2 hours after a meal (sensitivity:10-50%,specificity:90%)
2.Blood sugar testing
29
31. DIABETES-PREVENTION AND CARE
PRIMARY PREVENTION :- 2 strategies have been suggested
1.Population strategy :-Pressing need for PRIMORDIAL PREVENTION,that is
prevention of emergence of risk factors.
Preventive measures comprise of :- a.adoption of healthy nutritional habits which
includes an adequate protein intake,high intake of dietary fibre and avoidance of
sweet foods.
2.High risk strategy :-Obese individuals with sedentary life style.
Therefore correction of these factors may reduce the risk of DM & its
complications.
Other measures include avoid consumption of alcohol,intake of diabetogenic
drugs like OCP.
31
32. EXERCISE
Encourage increased duration and frequency of physical activity (where
needed), up to 30-45 minutes on 3-5 days per week, or an accumulation of 150
minutes per week of moderate intensity aerobic activity.
Adults with diabetes should be advised to perform at least 150min/ week of
moderate-intensity aerobic physical activity (50– 70% of maximum heart rate),
spread over at least 3 days/week with no more than 2 consecutive days without
exercise.
32
33. SMOKING CESSATION
Smoking cessation is one of
the few interventions that
can safely and cost-effectively
be recommended for all
patients.
33
34. SECONDARY PREVENTION :- The aims include-
a. To maintain normal blood glucose levels close within normal limits
b. To maintain ideal body weight.
2.The treatment is based on :- a. Diet alone-small balanced meals more frequently.
b. Diet & OAD
c. Diet & Insulin
3.SELF CARE :- It is a crucial element of secondary prevention-
The diabetic should take a major responsibility for his own care with medical guidance which
includes-
a. To strictly follow diet & drug regimens
b. Exm. Of his own urine & blood glucose monitoring
c. Abstinence from alcohol
d. Maintenance of optimum weight
e. Attending periodic check-ups
f. Recognition of symptoms associated with glycosuria and hyperglycemia
34
36. FOOT CARE
The key educational elements for diabetes patients at low risk of complications
are captured with the mnemonic CARE:
Control: control blood glucose levels (in accordance with recommendations from
your healthcare professional).
Annual: attend your annual foot screening examination with your healthcare
professional.
Report: report any changes in your feet immediately to your healthcare
professional.
Engage: engage in a simple daily foot care routine by washing and drying
between your toes, moisturizing and checking for abnormalities.
In a study conducted by Suman Saurabh et al, they found that even 5-6 min of time
devoted to individual patient education improved their foot care practice. When
consistently reinforced, this education is likely to result in healthy habit formation,
which may prevent disability and reduce medical expenditure in the long run.
36
37. Nutritional recommendation in adults with
diabetes :
Hypocaloric diet low in
carbohydrate(foods with high
glycemic index must be avoided)
Minimal trans fat consumption
Fructose preferred over sucrose
and starch
Protein in diet
Other components : Dietary
fibers,vegetables,whole
grains,non nutrient sweetners.
37
41. TERITIARY PREVENTION
Diabetes is a major cause of disabitlity through its
complications(blindness, kidney failure,coronary
thrombosis,gangrene of lower extremities)
Main AIM of Teritiary prevention :- Organize diabetic clinics and units
capable of providing diagnostic and management skills of a high
order.
It should also be involved in basic, clinical & epidemiological research.
It has also been recommended that local & national registers for
diabetes should be established.
41
49. Bovine (beef) Insulin- differs from human insulin by three amino
acid residues & is antigenic to man.
Porcine (pig) Insulin- differs from human insulin by only one
amino acid residue & is less immunogenic.
Conventional Insulin Preparations49
51. Syringes for insulin users are
designed for standard U-100
insulin. The dilution of insulin is
such that 1 mL of insulin fluid
has 100 standard "units" of
insulin. Since insulin vials are
typically 10 mL, each vial has
1000 units.
STANDARD U-100 INSULIN SYRINGE51
52. •The abdomen, but at least 2 in. (5.1 cm) inches from the belly button.
•The top outer area of the thighs. Insulin usually is absorbed more slowly from this site, unless you
exercise soon after injecting insulin into your legs.
•The upper outer area of the arms.
•The buttocks.
Sites for injection of insulin
52
54. 1.Pinch the skin and put the needle in at a 45º angle.
2.If your tissues are thick enough, you may be able to inject straight
up and down (90º angle).
3.Push the needle all the way into the skin.
4.Leave the syringe in place for 5 seconds after injecting.
5. Rotation of the injection site is important to prevent
lipohypertrophy or lipoatrophy.
Method for insulin administration54
57. SURGERY
Insulin resistance by itself does not require surgical treatment;
however, patients who have already developed heartdisease may
require coronary artery bypass surgery.
In addition, very obese patients
those with a BMI of 40 or higher—may benefit from bariatric
surgery.
The ADA(American Diabetic Association) clinical guidelines state
that bariatric surgery should be considered in individuals with DM
& a BMI > 35kg/sq.meter
57
58. EMERGING THERAPIES
1.Whole pancreas transplantation may normalize glucose tolerance & is an
imp. therapeutic option in DM1 with end stage renal disease.
2.Closed loop pumps that infuse appropriate amount of insulin in response
to changing glucose levels are potentially feasible now that continuous
glucose monitoring(CGM) technology has been developed.
3.Newer therapies under development for DM2:-
a.Activators of glucokinase
b.Inhibitors of 11 β hydroxysteroid dehydrogenase-1
c.GRP40 agonists
d.Monoclonal Ab to reduce inflammation
e.salsalate
58
59. Some alternative treatments for insulin resistance and type 2 diabetes have been studied by
the Agency for HealthcareResearch and Quality (AHRQ).
1.An earlier study of Ayurvedicmedicine reported certain
herbs such as fenugreek, holy basil, Coccinia indica, and Gymnema sylvestre appear to be
effective in loweringblood sugar levels and merit further study.
3. The AHRQ report also noted that the Ayurvedic practice of combining herbalmedicines with
yoga and other forms of physical activity should be investigated further.
4.Other alternative treatments for insulin resistance and type 2 diabetes include chromium
supplements, ginseng,biofeedback, and acupuncture.
5.Thebody needs chromium to produce a substance called glucose tolerance factor, which incr
eases the effectiveness ofinsulin.
59
60. ACUTE -
a. Diabetic ketoacidosis
b. Hyperglycemia hyperosmolar state
c. Hypoglycemia
d. Diabetic coma
e. Respiratory infections
f. Periodontal disease
Complications of Diabetes
CHRONIC-
a. Diabetic Cardiomyopathy
b. Diabetic Nephropathy
c. Diabetic Neuropathy
d. Diabetic amyotrophy
e. Diabetic Retinopathy
f. Diabetic Myonecrosis
g. Diabetic Foot
60
61. Medical emergency
Mechanism:
Fatty acid ketone bodies (normal if periodic,
serious problem if sustained)
Diabetic Ketoacidosis (DKA)
Low insulin levels
Decrease in the pH of the blood DKA
Dehydration, rapid & deep breathing, loss of
consciousness,hypotension, shock DEATH
61
62. Insulin Replacement- administered as IV bolus-dose of 0.2-0.3
U/kg followed by 0.1 U/kg/hour i.v infusion.
First 4 hrs.-blood glucose levels must decrease by 10%
Once patient is conscious give insulin Subcutaneously
Fluid replacement- NS at a rate of 1L/hr. initially, later depending
upon the fluid requirement of the patient
Potassium-to combat hypokalemia. KCL – 10-20mEq/hr.- after 4
hrs. of insulin administration
Antibiotics to treat associated infection (if any)
Treatment- DKA62
63. As a result of decreased blood glucose levels water drawn
osmotically out of the cells into the blood kidneys force glucose
into the urine increase blood osmolarity & loss of water
dehydration & electrolyte imbalance
Lethargy progresses to coma
More common in type 2 DM
Hyperosmolar nonketotic state (HNS)63
64. Correct dehydration- by giving IV Fluids
Reduction of blood sugar levels with insulin
Manage the underlying cause ex. An acute infection which may
have precipitated the illness.
Treatment of HNS64
65. Cardiovascular diseases- CAD, Angina, MI etc.
Peripheral Vascular disease- causes intermittent claudication
Stroke- (ischemic type)
Carotid artery stenosis
Abdominal aortic aneurysm
Type 1 DM- often associated with female infertility due to PCOS,
delayed puberty, Late menarche, Hyperandrogenism.
Macrovascular complications
Higher morbidity &
mortality
65
66. High blood sugar- dangerous to mother + fetus
Risk of miscarriage, stillbirth, birth defects
In the mother risk of DKA, Eye problems
(retinopathy), Pregnancy induced high BP,
Preeclampsia.
Pregnancy related complications
66
68. The IDF & the WHO created the International Diabets
Day in response to diabetic epidemic
68
69. THE THEME!
2005 : Diabetes and foot care.
2006 : Diabetes in the disadvantaged and the vulnerable.
2007-2008 : Diabetes in children and adolescents.
2009-2013 : Diabetes education and prevention.
2014-2015 : Healthy living and diabetes.
“2016 : EYES ON DIABETES”
69
70. References
Harrison’s textbook of internal medicine.
PSM-PARK
Journal : Type 1diabetes: Pathogenesis & prevention-Kathleen M. Gillespie
Textbook of Pathology : Harshmohan
Internet source
70