Type 2 diabetes - A 2016 update by Zeena NackerdienZeena Nackerdien
The International Diabetes Federation maintains that one in two adults are undiagnosed for diabetes and that estimates that one in eleven people had diabetes in 2015. If one takes into account that most of the cases involves the preventable condition of Type 2 diabetes, it comes as no surprise that many countries are being hit by staggering socioeconomic costs. Diabetes sites, chat rooms, aps, and ads for ever-evolving and increasingly complex disease management schemes are commonplace on Google. But what does all the information mean? The American Diabetes Association, American Association of Clinical Endocrinologists, The Canadian Diabetes Association, WebMD, and the International Diabetes Federation resources served as the major resources for this accompanying slide deck that tries to unpack some of the major subtopics related to prediabetes and Type 2 diabetes. The slide deck is organized according to disease definition, epidemiology, etiology/pathophysiology, diagnosis, treatment, and prevention. Particular topics such as the early use of insulin could be expanded into several separate slide decks narrating benefits and risks with supporting evidence. However, this deck is meant to provide interested readers with an overview of the Type 2 diabetes literature landscape, with the caveat that specific cases and Type 2 diabetes-related complications should always be discussed with a healthcare provider.
Image credits: slideteam.net; Wikimedia
What is diabetes mellitus, Epidemiology of diabetes, Diabetes diagnosis, Features of diabetes, WHO classification of Diabetes Mellitus, Complications of diabetes, Metabolic alterations of diabetes, Oral glucose tolerance test, WHO criteria of OGTT interpretation, Classification of diabetes mellitus, Gestational diabetes, Pre-diabetes, Insulin, Biosynthesis of insulin, Insulin actions, Hypoglycemia, Impaired fasting glucose, Insulin structure
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
Type 2 diabetes - A 2016 update by Zeena NackerdienZeena Nackerdien
The International Diabetes Federation maintains that one in two adults are undiagnosed for diabetes and that estimates that one in eleven people had diabetes in 2015. If one takes into account that most of the cases involves the preventable condition of Type 2 diabetes, it comes as no surprise that many countries are being hit by staggering socioeconomic costs. Diabetes sites, chat rooms, aps, and ads for ever-evolving and increasingly complex disease management schemes are commonplace on Google. But what does all the information mean? The American Diabetes Association, American Association of Clinical Endocrinologists, The Canadian Diabetes Association, WebMD, and the International Diabetes Federation resources served as the major resources for this accompanying slide deck that tries to unpack some of the major subtopics related to prediabetes and Type 2 diabetes. The slide deck is organized according to disease definition, epidemiology, etiology/pathophysiology, diagnosis, treatment, and prevention. Particular topics such as the early use of insulin could be expanded into several separate slide decks narrating benefits and risks with supporting evidence. However, this deck is meant to provide interested readers with an overview of the Type 2 diabetes literature landscape, with the caveat that specific cases and Type 2 diabetes-related complications should always be discussed with a healthcare provider.
Image credits: slideteam.net; Wikimedia
What is diabetes mellitus, Epidemiology of diabetes, Diabetes diagnosis, Features of diabetes, WHO classification of Diabetes Mellitus, Complications of diabetes, Metabolic alterations of diabetes, Oral glucose tolerance test, WHO criteria of OGTT interpretation, Classification of diabetes mellitus, Gestational diabetes, Pre-diabetes, Insulin, Biosynthesis of insulin, Insulin actions, Hypoglycemia, Impaired fasting glucose, Insulin structure
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
this is a brief study on prediabetes , in present scenario many of them are prediabetic ......
please comment
thank you
Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
this is a brief study on prediabetes , in present scenario many of them are prediabetic ......
please comment
thank you
DIABETES MELLITUS Definition : It is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin.
Type 1 Diabetes :
Charactarized by an absolute deficiency of insulin secretion caused by pancreatic beta cell destruction usually resulting from auto immune attack
Type 2 Diabetes :
Caused by relative insulin deficiency due to combination of peripheral resistance to insulin action and an inadequate compensatory response to insulin secretion by pancreatic beta cells.
Introduction
pancreas
Pathology of insulin
Pathogenesis of DM
What is diabetes mellitus
Types of diabetes mellitus
Evaluation of plasma glucose levels
Clinical features of DM
Complications of DM
Treatment
Non-pharmacological Management of Diabetes Mellitus.pptxSamson Ojedokun
Diabetes mellitus DM, is a metabolic disorder of biomolecules characterized by chronic hyperglycemia due to defects in insulin synthesis or utilization or both
DM requires lifelong therapy. A multidisciplinary approach is needed to control glycemia, as well as to limit the development of its devastating complications and manage such complications when they do occur.
Increases cost of living and reduces life expectancy
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Mellitus is Latin for “sweet as honey”.
Pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.
The Pancreas secretes insulin and Glucagon directly into the blood stream.
It also secretes digestive enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.
Insulin and Glucagon have opposite effects on liver and other tissues for controlling blood-glucose levels.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. Biosynthesis
• produced in the beta cells of the pancreatic islets
• initially synthesized as a single-chain 86-amino-acid precursor
polypeptide, preproinsulin
• Subsequent proteolytic processing removes the aminoterminal
> proinsulin
• Cleavage of an internal 31-residue fragment from proinsulin,
generates
• C peptide and the A (21 amino acids) and B (30 amino
acids) chains of insulin
• The mature insulin molecule and C peptide
• stored and secreted from secretory granules in the beta cells
4. Secretion
Mechanisms of glucose-stimulated insulin secretion and abnormalities in diabetes
• Glucose regulate insulin secretion by the
pancreatic beta cell
• Glucose is transported by a glucose
transporter (GLUT1 in humans, GLUT2 in
rodents
• glucose metabolism by the beta cell
alters ion channel activity
• leading to insulin secretion
7. DEFENITION
• Diabetes mellitus (DM) refers to a group
of common metabolic disorders that
share the phenotype of hyperglycemia
• Distinct types of DM are caused by
genetics and environmental factors
• factors contributing to hyperglycemia
include :
• reduced insulin secretion
• decreased glucose utilization
• increased glucose production
• leading cause of end-stage renal
disease (ESRD), non- traumatic lower
extremity amputations, and adult
blindness
8. CLASSIFICATION
• DM is classified on the basis of the pathogenic process that leads to
hyperglycemia, as opposed to earlier criteria such as age of onset or type of
therapy
• The two broad categories of DM are designated type 1 and type 2
• Both preceded by a phase of abnormal glucose homeostasis
• Type 1 DM is the result of complete or near-total insulin defi
ciency
• Type 2 DM heterogeneous group characterized by variable degrees
• insulin resistance
• impaired insulin secretion
• increased glucose production
9. CLASSIFICATION
• Two features of the current
classification of DM diverge
• insulin-dependent
diabetes mellitus (IDDM)
• non-insulin-dependent
diabetes mellitus
(NIDDM)
• Type 2 DM eventually require
insulin treatmeant for control of
glycemia
• type 1 DM most commonly
develops before the age of 30,
an autoimmune beta cell
destruction
11. RISK FACTOR
• The overweight group (BMI > 23
kg/m2)
• Less physical activity
• Families with a history of
DM
• Newborn's weight > 4k
• Hypertension (>140/90)
• HDL <35mg/dl atau
trigliserida >250 mg/dl
• Usia > 45 tahun
• Polycystic ovary syndrome or
acanthosis nigricans
• History of cardiovascular disease
12. Etiologic Classification of Diabetes Mellitus
• Type 1 diabetes (beta cell destruction, usually leading to absolute insulin deficiency)
• Immune mediated
• Idiopathic
• Type 2 diabetes (insulin resistance with relative insulin deficiency to insulin secretory
defect)
• Other specific types of diabetes
• Genetic defects of beta cell function characterized by mutations in
• Hepatocyte nuclear transcription factor (HNF) 4α (MODY 1)
• Glucokinase (MODY 2)
• HNF-1α (MODY 3)
• Insulin promoter factor-1 (IPF-1; MODY 4)
• Genetic defects in insulin action
• Type A insulin resistance
13. Etiologic Classification of Diabetes Mellitus
• Diseases of the exocrine pancreas
• (pancreatitis, pancreatectomy,
neoplasia, cystic fibrosis,
hemochromatosis)
• Endocrinopathies
• (acromegaly, Cushing’s
syndrome, glucagonoma,
pheochromocytoma)
• Drug or chemical induced
• (glucocorticoids, vacor (a
rodenticide), pentamidine,
nicotinic acid)
• Gestational diabetes mellitus
(GDM)
15. Clinical Manifestation
Patients with diabetes mellitus most
commonly present with :
• increased thirst
• increased urination
• lack of energy and fatigue
• bacterial and fungal infections
• delayed wound healing
Some patients can also complain of
numbness or tingling in their hands or
feet or with blurred vision.
• can have modest hyperglycemia >
proceed to severe hyperglycemia or
ketoacidosis due to infection or stress
17. Pathophysiology
In T1DM
• cellular-mediated, autoimmune destruction of pancreatic beta cells
• Has a strong genetic predisposition
• The major histocompatibility complex (MHC) > reported for approximately 40
to 50% of the familial aggregation of T1DM
• The significant determinants > polymorphisms of class II MHC genes
encoding DQ and DR4-DQ8, with DR3-DQ2 > found in 90% of T1DM
patients
• destruction is generally rapid in children and faster in adults
• Autoantibodies against islet cells, insulin, glutamic acid decarboxylase-65
(GAD-65), and zinc transporter 8 (Zn T8) may be detected in the serum of
such patients
• These patients are generally not obese
18. Pathophysiology
In T1DM
• more prone to develop other autoimmune disorders such as Addison disease,
Graves disease, Hashimoto thyroiditis, and celiac disease
20. Diagnosis
Diabetes can be diagnosed either by the hemoglobin A1C criteria or plasma glucose
concentration (fasting or 2-hour plasma glucose)
• Fasting Plasma Glucose (FPG)
• A blood sample is taken after an 8 hour overnight fast
• fasting plasma glucose (FPG) level of more than 126 mg/dL (7.0 mm/L) >
consistent with the diagnosis
• Two-Hour Oral Glucose Tolerance Test (OGTT)
• measured before and 2 hours after the ingestion of 75 gm of glucose
• DM is diagnosed if the plasma glucose (PG) level in the 2-hour sample is
more than 200 mg/dL (11.1 mmol/L)
• atients need to consume a diet with at least 150 g per day of
carbohydrates for 3 to 5 days and not take any medications
21. Diagnosis
• Glycated Hemoglobin (Hb) A1C
• This test gives an average of
blood glucose over the last 2 to 3
months
• Hb A1C greater than 6.5% (48
mmol/mol) are diagnosed as
having DM
• Hb A1C is a convenient, rapid,
standardized test
• Hb A1C is costly and lower
sensitivity
• Anemia due to deficiency of
iron or vitamin B12 leads to
spurious elevation of Hb A1C
23. Differential Diagnosis
The list of differential diagnosis of diabetes mellitus consists of various conditions
that would exhibit similar signs and symptoms :
• Drug-induced signs and symptoms due to corticosteroids, neuroleptics,
pentamidine, etc.
• Genetic aberrations in beta-cell function and insulin action
• Metabolic syndrome (syndrome X)
• Infection
• Endocrinopathies such as acromegaly, Cushing disease, pheochromocytoma,
hypothyroidism, etc
• Complications of iron overload (hemochromatosis)
• Conditions affecting the exocrine part of the pancreas such as pancreatitis, cystic
fibrosis, etc.
25. Interaksi obat – tubuh
• Farmakokinetika (nasib obat dalam tubuh)
• Obat diberikan denga rute berbeda-beda
• Tempat kerja obat (target kerja obat)
• Absorbsi
• Distribusi
• Eleminasi
• Me
• Farmakodinamika (efek obat terhadap tubuh)
• obat harus berikatan dengan reseptor untuk menimbulkan efek
• Interaksi obat-reseptor
• Obat agonis/antagonis
• Lama kerja obat
27. Treatment / Management
• Principles of Management of type 2 DM
• Algorithm for Management of Type 2 DM Without Metabolic
Decompensation
• patient centered approach
• These considerations include the drug's effect on
cardiovascular and renal comorbidities, the effectiveness of
reducing blood glucose, the risk of hypoglycemia, the effect
on weight gain, the cost
31. Deterrence and Patient Education
• Patients must be educated about the importance of blood glucose
management to avoid complications associated with DM
• Stress must be given on lifestyle management, including diet control and
physical exercise
• Self-monitoring of blood glucose is an important means for their diabetes
management
• Healthcare professionals should educate patients about the symptoms of
hypoglycemia (such as tachycardia, sweating, confusion)
• Patients should be motivated to stop smoking
33. Complications
• uncontrolled diabetes mellitus can cause several complications, both acute
and chronic
• Diabetes mellitus is one of the leading causes of cardiovascular disease
(CVD), blindness, kidney failure, and amputation of lower limbs
• Acute complications include
• Hypoglycemia
• diabetic ketoacidosis
• hyperglycemic hyperosmolar state
• hyperglycaemic diabetic coma
• Chronic microvascular complications include
• nephropathy, neuropathy, and retinopathy
• Chronic macrovascular complications include :
• coronary artery disease (CAD), peripheral artery disease (PAD), and
cerebrovascular disease
36. Introduction
• Diabe(c Ketoacidosis is a medical emergency with a significant
morbidity and mortality
• It should be diagnosed promptly and managed intensively
• DKA is characterized by the triad of hyperglycemia, ketosis, and
acidosis
• DKA complicates mainly Type 1 diabetes
48. Prognosis
• DM is associated with increased atherosclerotic cardiovascular disease
(ASCVD)
• treating blood pressure, statin use, regular exercise, and smoking cessation
are of great importance in ameliorating risk
• The overall excess mortality in those with T2DM is around 15% higher
• The prevalence of vision-threatening diabetic retinopathy in the United
States is about 4.4% among adults with diabetes,
• hile it is 1% for end-stage renal disease
50. REFERENCES
1. Harrison's principles of internal medicine. (1998). New York
:McGraw-Hill, Health Professions Division,
2. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2
diabetes mellitus and its complications. Nat Rev Endocrinol. 2018
Feb;14(2):88-98.
3. Malek R, Hannat S, Nechadi A, Mekideche FZ, Kaabeche M. Diabetes and
Ramadan: A multicenter study in Algerian population. Diabetes Res Clin
Pract. 2019 Apr;150:322-330.
4. Hussain S, Chowdhury TA. The Impact of Comorbidities on the
Pharmacological Management of Type 2 Diabetes Mellitus. Drugs. 2019
Feb;79(3):231-242.
5. Martinez LC, Sherling D, Holley A. The Screening and Prevention of
Diabetes Mellitus. Prim Care. 2019 Mar;46(1):41-52.
