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(Past,Present and Future)Vikas Reddy
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):- 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
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.
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.
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.
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.
Diabetes Mellitus(Past,Present and Future)Vikas Reddy
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):- 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
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.
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.
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.
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 provides an overview of diabetes mellitus (DM) presented by Dr. Mukesh Kumar Samota. It begins with definitions and classifications of DM, then discusses epidemiology, genetics, pathophysiology, risk factors, approaches to patients, management, and complications. Type 2 DM is the main focus. It is characterized by insulin resistance and impaired insulin secretion. Worldwide prevalence is rising due to obesity, sedentary lifestyles, and aging populations. Management involves lifestyle changes, medications, monitoring, and preventing complications through screening and treatment.
This document outlines an ECE module on blood glucose regulation and diabetes mellitus. The goal is for students to understand blood glucose regulation, metabolic derangements in diabetes, and biochemical tests used to diagnose diabetes. The module will discuss glucose regulation and pathophysiology of diabetes, clinical manifestations, diagnostic criteria and tests, and guidelines for blood glucose monitoring. It will involve lectures, case discussions, and skills like using a glucometer. Key topics include insulin/glucagon function, types of diabetes, glucose tolerance tests, HbA1c, ketone bodies, microalbuminuria, and self-monitoring of blood glucose.
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
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.
Type 1 and type 2 diabetes can be diagnosed based on blood sugar testing, urine testing, or glycated hemoglobin (HbA1c) levels. A random plasma glucose of ≥200 mg/dL, fasting plasma glucose of ≥126 mg/dL, or 2-hour postprandial glucose of ≥200 mg/dL during an oral glucose tolerance test confirms a diagnosis of diabetes. Urine testing detects glucose and ketone bodies. An HbA1c level of ≥6.5% indicates diabetes. Gestational diabetes develops during pregnancy and increases perinatal risks.
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
3.a)diabetes mellitus and periodontal disease i punitnaidu07
This document provides an overview of diabetes mellitus and periodontal diseases. It begins with classifications of diabetes, including type 1 caused by autoimmune destruction of insulin-producing cells, and type 2 related to insulin resistance and impaired insulin secretion. Complications of diabetes are discussed, involving pathways like advanced glycation end products, protein kinase C activation, and the polyol pathway. Oral manifestations of diabetes include increased periodontal disease risk. Proper dental management can help diabetic patients reduce risks.
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.
Type 2 diabetes is a chronic metabolic disease characterized by high blood glucose levels resulting from defects in insulin secretion and insulin action. The document provides an overview of type 2 diabetes, including its causes, risk factors, pathophysiology, clinical presentation, diagnosis, management through diet, exercise and oral hypoglycemic agents. It also discusses the classification, epidemiology and complications of diabetes as well as the role of insulin and pancreatic function in glucose homeostasis.
This document discusses childhood diabetes mellitus. It defines diabetes as a metabolic disorder characterized by chronic hyperglycemia. Type 1 diabetes accounts for over 90% of childhood cases and is an autoimmune disease triggered by environmental factors in genetically susceptible individuals. Proper treatment involves education, insulin therapy tailored to the individual, diet and exercise, and regular monitoring to prevent complications and achieve metabolic control goals. Advances allow more precise glucose monitoring and individualized insulin regimens.
DIABETES MELLITUS TYPE 1 & MANAGEMENT OF DIABETIC KETOACIDOSIS Rakesh Verma
1) Type 1 diabetes is characterized by low or absent insulin production and is caused by autoimmune destruction of pancreatic beta cells.
2) It requires lifelong insulin replacement therapy via injections or pumps to control blood glucose levels and prevent complications.
3) Intensive insulin regimens aim to mimic normal physiology using rapid, short, intermediate and long-acting insulin preparations in combination with diet, exercise and glucose monitoring.
The document discusses types and treatments of diabetes mellitus. It describes the two main types as type 1, characterized by a lack of insulin production, and type 2, related to insulin resistance and deficiency. Symptoms include frequent urination, increased thirst and hunger. Type 1 is an autoimmune disease treated with insulin injections while type 2 can be managed through lifestyle changes and medications. Complications of diabetes include damage to blood vessels and organs. The number of people with diabetes is growing worldwide.
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.
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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
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia, due to defect in insulin secretion, insulin action or both .
This document summarizes benign prostatic hyperplasia (BPH). It discusses the pathology and pathogenesis of BPH, including that it affects glandular epithelium, stromal cells, and causes increased growth. It also covers the symptomatology, evaluation, and various treatment options for BPH including watchful waiting, medical therapy, and prostatectomies. Surgical treatments discussed are transurethral resection of the prostate (TURP), retropubic prostatectomy (RPP), and transvesical prostatectomy (TVP).
This document provides an introduction to pathology. It defines pathology as the study of disease through scientific methods and examines the mechanisms of disease from etiology to clinical manifestation. The key points are:
1. Pathology studies the etiology, pathogenesis, morphologic changes, and functional derangements that result from disease processes.
2. Diseases are examined through diagnostic techniques including histopathology, cytopathology, and biochemical/immunological testing to identify structural and molecular alterations.
3. The natural course of a disease involves stages from initial exposure through biological onset, clinical onset, potential resolution or death.
This document provides an overview of diabetes mellitus (DM) presented by Dr. Mukesh Kumar Samota. It begins with definitions and classifications of DM, then discusses epidemiology, genetics, pathophysiology, risk factors, approaches to patients, management, and complications. Type 2 DM is the main focus. It is characterized by insulin resistance and impaired insulin secretion. Worldwide prevalence is rising due to obesity, sedentary lifestyles, and aging populations. Management involves lifestyle changes, medications, monitoring, and preventing complications through screening and treatment.
This document outlines an ECE module on blood glucose regulation and diabetes mellitus. The goal is for students to understand blood glucose regulation, metabolic derangements in diabetes, and biochemical tests used to diagnose diabetes. The module will discuss glucose regulation and pathophysiology of diabetes, clinical manifestations, diagnostic criteria and tests, and guidelines for blood glucose monitoring. It will involve lectures, case discussions, and skills like using a glucometer. Key topics include insulin/glucagon function, types of diabetes, glucose tolerance tests, HbA1c, ketone bodies, microalbuminuria, and self-monitoring of blood glucose.
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
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.
Type 1 and type 2 diabetes can be diagnosed based on blood sugar testing, urine testing, or glycated hemoglobin (HbA1c) levels. A random plasma glucose of ≥200 mg/dL, fasting plasma glucose of ≥126 mg/dL, or 2-hour postprandial glucose of ≥200 mg/dL during an oral glucose tolerance test confirms a diagnosis of diabetes. Urine testing detects glucose and ketone bodies. An HbA1c level of ≥6.5% indicates diabetes. Gestational diabetes develops during pregnancy and increases perinatal risks.
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
3.a)diabetes mellitus and periodontal disease i punitnaidu07
This document provides an overview of diabetes mellitus and periodontal diseases. It begins with classifications of diabetes, including type 1 caused by autoimmune destruction of insulin-producing cells, and type 2 related to insulin resistance and impaired insulin secretion. Complications of diabetes are discussed, involving pathways like advanced glycation end products, protein kinase C activation, and the polyol pathway. Oral manifestations of diabetes include increased periodontal disease risk. Proper dental management can help diabetic patients reduce risks.
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.
Type 2 diabetes is a chronic metabolic disease characterized by high blood glucose levels resulting from defects in insulin secretion and insulin action. The document provides an overview of type 2 diabetes, including its causes, risk factors, pathophysiology, clinical presentation, diagnosis, management through diet, exercise and oral hypoglycemic agents. It also discusses the classification, epidemiology and complications of diabetes as well as the role of insulin and pancreatic function in glucose homeostasis.
This document discusses childhood diabetes mellitus. It defines diabetes as a metabolic disorder characterized by chronic hyperglycemia. Type 1 diabetes accounts for over 90% of childhood cases and is an autoimmune disease triggered by environmental factors in genetically susceptible individuals. Proper treatment involves education, insulin therapy tailored to the individual, diet and exercise, and regular monitoring to prevent complications and achieve metabolic control goals. Advances allow more precise glucose monitoring and individualized insulin regimens.
DIABETES MELLITUS TYPE 1 & MANAGEMENT OF DIABETIC KETOACIDOSIS Rakesh Verma
1) Type 1 diabetes is characterized by low or absent insulin production and is caused by autoimmune destruction of pancreatic beta cells.
2) It requires lifelong insulin replacement therapy via injections or pumps to control blood glucose levels and prevent complications.
3) Intensive insulin regimens aim to mimic normal physiology using rapid, short, intermediate and long-acting insulin preparations in combination with diet, exercise and glucose monitoring.
The document discusses types and treatments of diabetes mellitus. It describes the two main types as type 1, characterized by a lack of insulin production, and type 2, related to insulin resistance and deficiency. Symptoms include frequent urination, increased thirst and hunger. Type 1 is an autoimmune disease treated with insulin injections while type 2 can be managed through lifestyle changes and medications. Complications of diabetes include damage to blood vessels and organs. The number of people with diabetes is growing worldwide.
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.
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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
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia, due to defect in insulin secretion, insulin action or both .
This document summarizes benign prostatic hyperplasia (BPH). It discusses the pathology and pathogenesis of BPH, including that it affects glandular epithelium, stromal cells, and causes increased growth. It also covers the symptomatology, evaluation, and various treatment options for BPH including watchful waiting, medical therapy, and prostatectomies. Surgical treatments discussed are transurethral resection of the prostate (TURP), retropubic prostatectomy (RPP), and transvesical prostatectomy (TVP).
This document provides an introduction to pathology. It defines pathology as the study of disease through scientific methods and examines the mechanisms of disease from etiology to clinical manifestation. The key points are:
1. Pathology studies the etiology, pathogenesis, morphologic changes, and functional derangements that result from disease processes.
2. Diseases are examined through diagnostic techniques including histopathology, cytopathology, and biochemical/immunological testing to identify structural and molecular alterations.
3. The natural course of a disease involves stages from initial exposure through biological onset, clinical onset, potential resolution or death.
This document provides an overview of preeclampsia and eclampsia. It begins with an introduction and outlines risk factors and classifications. It then describes clinical features such as hypertension and proteinuria. The pathophysiology section explains how abnormal placentation leads to reduced blood flow and imbalance of prostaglandins. Complications are also discussed, including renal failure, pulmonary edema, and intrauterine growth restriction. The document provides information on diagnosis and management of preeclampsia and eclampsia.
This seminar presentation discusses hypersensitivity reactions, which are exaggerated or inappropriate immune responses to benign antigens. It covers the objectives, mechanisms, classification, complications, and references related to hypersensitivity reactions. There are four main types of hypersensitivity reactions: Type I involves IgE antibodies and mast cell degranulation, Type II involves antibody-mediated cell cytotoxicity, Type III involves immune complex formation and deposition, and Type IV involves T-cell mediated reactions. The presentation provides examples and details of each type of hypersensitivity reaction and their clinical implications.
This document discusses inflammation. It defines inflammation as the body's local response to injury or infection aimed at eliminating the cause of injury and initiating repair. The cardinal signs of inflammation are redness, swelling, heat, pain, and loss of function. The early response involves vasodilation and increased permeability, causing swelling. The late response involves neutrophils in acute inflammation and macrophages in chronic cases, which work to destroy pathogens and initiate healing. Understanding inflammation is important for diagnosing conditions like appendicitis and treating diseases.
This document provides an overview of hyaline membrane disease (HMD), also known as respiratory distress syndrome (RDS), for nursing students. It defines RDS as a lack of pulmonary surfactant, outlines its pathophysiology and risk factors. The document discusses the clinical presentation of RDS, including respiratory distress, radiographic findings and laboratory abnormalities. It also covers diagnosis, differential diagnoses, treatment including surfactant replacement and supportive care, complications and prevention of RDS through antenatal corticosteroids.
1. Acute inflammation is rapid in onset and short in duration, characterized by fluid and protein exudation and neutrophil accumulation. Chronic inflammation is slower in onset and longer lasting, characterized by mononuclear cell infiltration, ongoing tissue destruction, and attempts at repair through fibrosis.
2. The key features of acute inflammation are vasodilation, increased vascular permeability, and recruitment of leukocytes from the blood vessels to the site of injury. Chronic inflammation features mononuclear cell infiltration, persistent tissue damage, and attempts to repair through fibrosis and angiogenesis.
3. Granulomatous inflammation is a pattern of chronic inflammation seen with certain infections, featuring focal collections of activated macrophages that develop an epithelial-like appearance known
Cellular injury can result in adaptation, reversible injury, irreversible injury leading to necrosis or apoptosis, or intracellular accumulation. The outcome depends on the injurious agent and cell type. Adaptations include hypertrophy, hyperplasia, atrophy, and metaplasia. Reversible injury includes fatty changes and pigment accumulation. Necrosis is cell death resulting from hypoxia, free radicals, membrane damage, or calcium influx. There are several types of necrosis including coagulative, liquefactive, fat, caseous, and gangrenous. Apoptosis is programmed cell death that does not cause inflammation.
This document discusses pelvic inflammatory disease (PID) and ectopic pregnancy. It defines PID as an infection of the upper female genital tract that spreads to involve the uterus, fallopian tubes, and ovaries. Common causes are Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis. Risk factors include multiple sexual partners and past gynecological procedures. Symptoms can range from mild to severe abdominal pain. Diagnosis involves clinical exams and tests. Complications include infertility and ectopic pregnancy. Ectopic pregnancy is defined as implantation outside the uterus, most commonly in the fallopian tube. Causes may include anatomical obstructions or abnormalities in the fallop
The document discusses acid-base balance and disturbances. It defines the two main buffer systems - metabolic (kidneys) and respiratory (lungs) - that work to maintain blood pH between 7.35-7.45. Five primary acid-base imbalances are described: metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis, and mixed disturbances. Diagnosis involves blood tests including arterial blood gases and electrolytes to classify the disturbance based on pH, PCO2, and bicarbonate levels. Treatment focuses on addressing the underlying cause rather than just the pH effect.
This document provides an overview of autoimmune diseases. It defines autoimmune diseases as conditions where the immune system mistakenly attacks and destroys healthy body tissue. The causes include genetic factors, environmental triggers like infections, and defects in immunologic tolerance. Some specific autoimmune diseases discussed are rheumatoid arthritis, type 1 diabetes, Hashimoto's thyroiditis, Graves' disease, myasthenia gravis, and systemic sclerosis. The mechanisms, clinical features, pathology, and treatment options are described for each condition.
Patient safety is a fundamental principle of healthcare. Adverse events may result from problems in practice, products, procedures or systems. Improving patient safety demands a complex, system-wide effort involving performance improvement, risk management, infection control, safe clinical practices, and a safe environment of care. Unsafe injections expose millions of people to infections worldwide each year. Ensuring single-use injection devices and safety boxes are available in every healthcare facility can prevent reuse and unsafe waste disposal.
The document discusses integumentary disorders and provides information on the anatomy and functions of the skin. It describes common skin conditions like eczema, acne, and psoriasis. Eczema is characterized by redness, dryness, and itching. Acne presents as inflamed papules and pustules on the face and back. Psoriasis causes thickened red patches covered with silvery scales. The document outlines signs, causes, and management approaches for various dermatological disorders and skin lesions.
A nebulizer converts liquid medication into a mist that can be inhaled directly into the lungs, allowing for rapid onset of medication effects. There are different types of nebulizers that administer medication via mouthpiece or mask. Nebulizers are commonly used to treat conditions involving airflow obstruction like asthma. Proper use involves preparing equipment and medication, positioning the patient, administering the treatment, and monitoring for side effects.
This document provides an overview of the endocrine system, including the major glands and hormones. It describes the hypothalamus and pituitary glands which regulate many other endocrine glands. Other glands covered include the thyroid, parathyroid, adrenal, pancreas, ovaries, testes, thymus, and pineal. The document outlines how to assess endocrine disorders and lists some common laboratory studies. It also provides details on diabetes mellitus, describing the main types of diabetes including type 1, type 2, and gestational diabetes.
This document provides guidance on performing a cardiac and abdominal examination. It outlines the objectives, symptoms, and physical examination techniques for assessing the cardiovascular and abdominal systems. The cardiovascular section covers inspection of the jugular veins, palpation of pulses, auscultation of heart sounds, and measurement of blood pressure. The abdominal section reviews inspection, auscultation, percussion and palpation techniques. Proper examination order and identification of normal versus abnormal findings are emphasized.
This document summarizes several endocrine system disorders including hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism, Cushing's syndrome, Conn's syndrome, Addison's disease, and pituitary adenomas. It provides epidemiological data on certain disorders and describes associated symptoms, diagnostic evaluations, and medical management approaches. Multiple endocrine neoplasia syndromes are also briefly discussed.
This document provides guidance on effectively breaking bad news to patients. It discusses the importance of this communication skill for healthcare professionals. The document outlines best practices for setting, perception checking, invitation, knowledge sharing, exploring the patient's response, and summarizing. Key aspects include ensuring privacy, empathy, clarity, and allowing time for the patient's questions and reactions. The SPIKES protocol is presented as a framework for structuring the discussion. Examples of both best practices and things to avoid are also highlighted.
2 Assessment of patient with respiratory disorder.pptxMohammedAbdela7
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This document provides an overview of critical thinking, evidence-based medicine, and how to practice evidence-based medicine. It defines critical thinking as the process of conceptualizing and evaluating information to guide beliefs and actions. Evidence-based medicine is defined as integrating the best research evidence with clinical expertise and patient values/circumstances. The history of evidence-based medicine is discussed, from Cochrane's work in the 1970s highlighting gaps between research and practice, to Guyatt coining the term "evidence-based medicine" in 1991 and Sackett explaining the combination of research, expertise, and patient factors in 1996. The five steps to practice evidence-based medicine are described as developing questions, finding evidence, appraising evidence, integrating
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
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Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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 Diabetes
3
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 INSULIN
8
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
(Achain-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.
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.Aform 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→HLADR-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)Avariant 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
21
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”
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.
FFAimpair glucose utilization &
β-cell function, promote glucose
production by liver.
Causes fasting & post prandial
hyperglycemia.
Insulin resistance
↓
Adipocyte : lipolysis ,FFAflux
↓
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 DM
24
27. Diagnosis of Diabetes Mellitus
ARPG concentration :
≥200mg/dLaccompanied 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
34. 🠶SECONDARY PREVENTION :- The aims include-
a. T
o maintain normal blood glucose levels close within normal limits
b. T
o maintain ideal body weight.
1. 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. T
o 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
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.
🠶 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.
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.
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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.
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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 Preparations
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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 SYRINGE
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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 administration
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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
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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
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59. 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.
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
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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
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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- DKA
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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 HNS
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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
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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
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68. The IDF & the WHO created the International Diabets
Day in response to diabetic epidemic
68
69. THE THEME!
2006 : Diab
2005 : Diabetes and foot care.
2007-
etes in the disadvantaged and the vulnerable.
2009
2008 : Diabetes in children and adolescents.
-2013 : Diabetes education and prevention.
2014-2015 : Healthy living and diabetes.
“2016 : EYESON DIABETES”
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70. References
M. Gillespie
🠶 Harrison’s textbook of internal medicine.
🠶 PSM-PARK
🠶 Journal : Type 1diabetes: Pathogenesis & prevention-Kathleen
🠶 Textbook of Pathology : Harshmohan
🠶 Internet source
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