The document provides an overview of metabolic disorders with a focus on diabetes mellitus. It defines diabetes as a heterogeneous disorder characterized by abnormal carbohydrate, fat and protein metabolism due to insulin resistance or insufficient insulin production, resulting in hyperglycemia. The document outlines the key types of diabetes, including type 1, type 2, and gestational diabetes. It describes the pathogenesis, clinical features, diagnosis, and management of diabetes. It also briefly mentions disorders of calcium and uric acid metabolism.

1. Unit Eight: Metabolic Disorders
Samara University
Department of Biomedical Sciences
8/17/2022 1
Chapter 8: Metabolic Disorders
DR. MYM
Dr. Mohammed. Y (MD, Lecture)

2. Objectives
 At the end of this session the student will be able to:
 Describe Diabetes Mellitus
 Disorder of calcium and uric acid metabolism
8/17/2022 2
Chapter 8: Metabolic disorder
DR. MYM

3. Definition of Diabetes
A heterogeneous disorder characterized by
abnormal carbohydrate, fat and protein
metabolism, secondary to resistance to the
action of insulin, absolute or relative
insufficient insulin secretion, or both resulting
in hyperglycaemia
Chapter 8: Metabolic disorder
DR. MYM

4. Diabetes = “siphon”or “running
through”
Large urine volume
Mellitus = sweet(Glucose in urine)
Chapter 8: Metabolic disorder
DR. MYM
Definition of Diabetes Cont…

5.  Most important NCD
 382 million people have diabetes
 80% live in LMICs
 Most affected age group – 40 to 59 years
 175 million people are undiagnosed
 5.1 million deaths in 2013 (1 death every 6 seconds)
 Health care expenditure USD 548 billion ( 11% )
 80% spent in rich countries
 79,000 children developed type 1 diabetes in 2013
Chapter 8: Metabolic disorder
DR. MYM
Key Points on Diabetes

6. 2000 2013 2035
177 million 382 million 592 million
World Diabetes prevalence
Chapter 8: Metabolic disorder
DR. MYM

7. 2000 2013 2035
7.1 million 20 million 42 million
Diabetes prevalence in Africa
Chapter 8: Metabolic disorder
DR. MYM

8. 1982 2013 2035
0.34% 1.9 million 2.6 million
Diabetes prevalence in Ethiopia
Chapter 8: Metabolic disorder
DR. MYM

9.  Most Common Metabolic Disease
 Heterogeneous Disorders
 Multiple Etiology
 Disturbance Of Carbohydrate, Protein And Fat Metabolism
 Hyperglycemia - Common Feature
 Defects In Insulin Secretion, Action Or Both
 Symptomatic & Asymptomatic Presentation
 Prone to Acute & Chronic Complications
General Features of Diabetes
Chapter 8: Metabolic disorder
DR. MYM

10.  Symptoms
 Polydypsia
 Polyuria
 Polyphagia
 Nocturia
 Weight loss
 Fatigue
 Pruritus vulvae
Clinical Features
 Amenorrhea
 Slowly Healing Infections
 Visual Problems
 Pain in the Legs
 Erectile Dysfunction
 Signs
 No Characteristic Features
 Wasting & Dehydration
 Evidence Of Complications
Chapter 8: Metabolic disorder
DR. MYM

11. Diagnosis A1C
%
Fasting
Glucose
mg/dL
Random
Glucose*
mg/dL
2-hour
75g OGTT
mg/dL
Normal < 5.7 < 100 - < 140
Prediabetes 5.7–6.4 100–125 - 140–199
Diabetes > 6.5 > 126 > 200 +
symptoms
> 200
* Random glucose cannot be used to diagnose prediabetes
Diagnosis of Diabetes
Chapter 8: Metabolic disorder
DR. MYM

12.  Central obesity (Waist circumference  94 cm for men and  80
cm for women)
Plus
 any two of the following four factors
1. TG 150 mg/dl, or specific treatment for this lipid abnormality
2. HDL <40 mg/l in males and <50 mg/l in females, or specific
treatment for this lipid abnormality
3. Systolic BP 130 or diastolic BP 85 mmHg, or treatment of
previously diagnosed hypertension
4. Fasting plasma glucose 100 mg/dl, or previously diagnosed
type 2 diabetes.
The Metabolic Syndrome Criteria
Chapter 8: Metabolic disorder
DR. MYM

13. Measure midway between lower costal margin & iliac crest
Sex IDF ATP
Males 94 102
Females 80 88
Waist Circumference (cm)
Chapter 8: Metabolic disorder
DR. MYM

14. Risk Factors for Diabetes
 Age > 40 years
 Strong Family History
 Obesity (Diabesity)
 Ethnicity (Blacks/Asians)
 Previous GDM
 Women Who Delivered Babies > 4
Kg
 In Utero Under- & Over Nutrition
 Previous IGT/IFG
 Hypertension
 Dyslipidemia
Chapter 8: Metabolic disorder
DR. MYM

15. Types Of Diabetes Mellitus
 Type 1
 Autoimmune – Type 1A
 Idiopathic – Type 1B
 Type 2
 Predominantly Insulin Resistance
 Predominantly Insulin Secretory Defects
 Gestational Diabetes Mellitus
 Other Specific Types
Chapter 8: Metabolic disorder
DR. MYM

16. Other Specific Types Of Diabetes
1. Genetic Defect Of Beta Cells e.g. MODY
2. Genetic Defects In Insulin Action e.g. Type A Insulin Resistance
3. Diseases Of The Exocrine Pancreas e.g. FCPP, Tumors
4. Endocrinopathies e.g. Acromegaly
5. Drug- Or Chemical Induced e.g. Steroids
6. Infections e.g. Congenital Rubella
7. Rare Immune-mediated Diabetes e.g. "Stiff-man" Syndrome
8. Other Genetic Syndromes e.g. Down's Syndrome
Chapter 8: Metabolic disorder
DR. MYM

17. Type 1A Diabetes Mellitus
 Cellular Mediated Autoimmune Destruction Of Beta Cells
 Markers Of Autoimmunity: ICA, IAA, Anti GAD Antibodies
 Variable Rate Of Beta Cell Destruction
Acute Onset And Profound Symptoms
 Age < 30 Years
 Non-obese (Obesity Not Incompatible)
 Ketonuria &/or Metabolic Acidosis
 Immediate & Permanent Need For Insulin
 No Microvascular Complications at Diagnosis
 Prone to Other Autoimmune Diseases: Graves’, Hashimoto’s,
Addison’s Diseases, etc.
Chapter 8: Metabolic disorder
DR. MYM

18. Pathogenetic Progression of Type 1 Diabetes
B
Cell
Mass
Age yrs
Genetic
Predisposition
N insulin
secretion
Precipitating Event
Antibody +
N FBS
Overt Diabetes
C Peptide
Present C Peptide
Absent
Chapter 8: Metabolic disorder
DR. MYM

19. Chapter 8: Metabolic disorder
DR. MYM

20. Chapter 8: Metabolic disorder
DR. MYM

21. Type 1B Diabetes Mellitus
 Young Patients
 Abrupt Onset (Mean Duration Of Symptoms – 4 Days)
 Prone To DKA Soon After Onset
 No Insulitis on Biopsy/Autopsy
 No Hyper-expression Of MHC Class I Molecules In Islets
 No Diabetes-related Antibodies
 Highly Elevated Serum Pancreatic Enzymes
 Lymphocytic Infiltration Of The Exocrine Pancreas
No Classic Features of Acute/Chronic Pancreatitis
Chapter 8: Metabolic disorder
DR. MYM

22. Type 2 Diabetes Mellitus
 Insulin Resistance
 Relative Insulin Deficiency
 Most are Obese/Abdominal Obesity
 Symptomatic/Asymptomatic
 Age > 40 Years
 Positive Family History
 Hyperosmolar Hyperglycemic State, DKA Very Rarely
 Risk Increases With Age, Obesity, Sedentary Life Style, Prior GDM
 Microvascular Complications May be Present at Diagnosis
 Major Morbidity & Mortality From Macrovascular Disease
 More Frequent in Persons With HPN & Dyslipidemias
Chapter 8: Metabolic disorder
DR. MYM

23. Pathogenesis of Type 2 Diabetes
β-cell Failure
Insulin
Resistance
Environment
Ageing
Pancreas
Muscle &
Adipose Tissue
IGT
Type 2 Diabetes
Genes
NGT or
Metabolic
Syndrome
80%
20%
Impaired
Incretin
Effect

24. Gestational Diabetes
 Glucose intolerance which is first recognized in pregnancy
 Complicates 3-7% of pregnancies
 Onset usually at 24 - 28 weeks
 97% disappears after delivery
 Cause
 Insulin resistance due to increased weight in pregnancy and
hormones
 Complications:
 Fetal death, HTN, UTI, premature birth, macrosomia,
hypoglycemia
 Higher risk of type 2 DM later in life
Chapter 8: Metabolic disorder
DR. MYM

25. Differences B/n Type 1 & Type 2 DM
Type 1 Type 2
Prevalence 1% 5%
Onset Age Yrs. < 40 40
Symptoms Rapid &
Marked
Slow/ No
Genetics: 1st Degree
Monozygotic Concordance
< 10%
50 %
> 20%
90-100%
HLA Yes No
Autoimmunity Yes No
Body Build Lean Obese Or Normal
Metabolism DKA HHS
Treatment Insulin Tablets + Insulin
Chapter 8: Metabolic disorder
DR. MYM

26. Management Components
 Education
 Establish Targets
 Diet
 Exercise
 Reduction of Risk Factors
 Medications
 Oral agents - Type 2
 Insulin – Type 1 & Type 2
Chapter 8: Metabolic disorder
DR. MYM

27. Disorder of calcium and uric acid metabolism
8/17/2022 27
Chapter 8: Metabolic disorder
DR. MYM

28. Quiz2
1. Diabetes is a disturbance of carbohydrate metabolism that does not
affect the metabolism of lipids and proteins(T or F)
2. A family history of diabetes is more common in patients affected by
type 1diabetes than type 2(T or F)
3. One of the following is not a micro vascular complication of DM
A. Stroke C. Nephropathy
B. Retinopathy D. Neuropathy
4. DKA is more common is
A. Type 1 DM C. Gestational DM
B. Type 2 DM D. A&B
5. One of the following is diagnostic for DM
A. A random blood glucose e level 200mg /dl with profound
hyperglycemia(poly symptom)
B. A fasting glucose level of 110 mg /dl
C. A RBS level of 126 mg /dl
D. None
8/17/2022 28
Chapter 8: Metabolic disorder
DR. MYM

29. Reading Assignment
 Disorder of calcium and uric acid metabolism
6. Elaborate Pathogenesis of severe complicated Malaria
8/17/2022 29
Chapter 8: Metabolic disorder
DR. MYM

30. The End
8/17/2022 30
Chapter 8: Metabolic disorder
DR. MYM