Diabetes Mellitus

Types
Type1 -insulin sensitive

Type2 -ins. Resistant
MODY- maturity onset diabetis of young
criteria for diagnosis

@ symptoms plus random alone sugar >200 mg% or fasting >125%
@ after 2hr GTT >200mg %
Pathogenesis
# Type1-
1 autoimmune factor -
insulitis
2 immunological marker- islet cell Ab
3 Enviromental- coxsackie n rubella
# Type 2
1 impaired Secretion, peripheral insulin resistance
excessive hepatic glucose production
# MODY
homozygous mutation of glucokinase
Complication
#acute
diabetic ketoacidosis n hyperglycemic hyperosmol. Coma
# chronic
@ microvascular
retinopathy , macular edema, sensory n motor mono or polyneuropathy, nephropathy
@ macrovascular
coronary art dis. , PVD, cerebral vascular dis,
@ other
GI: diarhea , gastroparesis
genitourinary: uropathy n sexual dysfunctn
dermatological , infection, cataract glaucoma
C/F
Type 1
age < 40, duration- days 2 wks, normal 2 wasted body habitus, polyuria, polydysia,
polyphagia, plasma insulin low
Type 2
age>40, mths 2 yrs duration, obese, diabetic ketoacidosis doesnt develop, norm or
increased pl insulin.
Benedicts test
If reducing sugar in glucose it gives quantitive rslts
light green- 0.1 - 0.5 g%
green - 0.5-1 g%
yellow -1-2g%
red - >2g%
Treatment
Drugs
1 sulphonylurea
@ insulin secretogogues
@ chlorpropamide 100- 500 mg, tolbutamide 500-3000mg, glibenclamide n glipizide
2.5-20mg
@ side eff. Hypoglycemia , wt gain
2 meglitinide
@ repaglinide, nateglinide, meglitinide-o.5-16 mg/day
3 Biguanide
@ metformin - reduce hepatic glucose prod. N improve periphera glu. utilisation.
@ doesnt produce wt gain so useful in obese pts wth type DM
@ started at dose of 500mg twicd day n gradually increased 2 max of 1g tds
@ side eff. acidosis, anorexia, diarhea, metallic taste.
4 alpha glucosidase inhibitors

@ acarbose n miglitol- 25mg
@ inhibits alpha glucosidase enzyme leads to poor absorption of carbohydrates
thereby causing reduced rise in post prandial glucose
5 thiazolidinediones
@ rosiglitazone 2-8 mg OD or pioglitazone 15-25 mg/day
@ the bind 2 peroxisome proliferator activated receptor that regulates
transcription of genes involved in lipid metabolism n insulin action. This promotes
adipocyte diff. N reduce ins resistnce
@ side eff. Wt gain
6. other
@glucagon like peptide 1 analogues
@ dipeptidyl peptidase IV inhibitor - vildagliptin n sitagliptin
#Insulin was discovered in 1921 .

#until 1980 it was obtained by extraction & purification from pancreas of cow &
pig.
#the use of recombinant DNA technology has enabled large scale production of human
insulin.
#it has transformed the management of type 1 DM.
CLASSIFICATION.
It is classified as per duration of action.(all figures in hours)
1. Rapid acting (insulin analogues- lispro, aspart, glulisine)

onset= <0.5
peak= 0.5 to 2.5
duration =3 to 4.5
2. Short acting(soluble regular)

o=0.5 to 1
p=1 to 4
d=4 to 8
3. Intermediate acting (isophane, lente)

o=1 to 3
p=3 to 8
d=7 to 14
4. Long acting(bovine ultralente)

o=2 to 4
p=6 to 12
d=12 to 30
5. Long acting(insulin analogue- glargine, detemir)

o=1 to 2
p=none
d=18 to 24
INSULIN DELIVERY.
1.It is injected s.c. into d anterior abdominal wall, upper arms, outer thigh &
buttocks.
2.The rate of absorption of insulin is influenced by many factors other than the
insulin formulation including the site, depth and volume of injection, skin temp,
local massage & exercise.
3. Absorption is delayed from areas of lipohypertrophy at injection sites, which
results from the local trophic action of insulin. So repeated injections at d same
sites should be avoided.
4. Short acting has to be injected atleast 30min b4 a meal..
5. Fast acting ones can be administered immediately b4 food or even after meals.
6. Once in blood it has a half life of few minutes.
7. It is removed mainly by liver & also the kidneys.
INSULIN REGIMEN.
1. The choice of regimen depends on d desired degree of glycemic control, patient's

lifestyle & ability to adjust the insulin dose.
2. Most ppl require 2 or more injections of insulin daily.
3. Once daily regimen is rarely sufficient.
4. Twice daily administration of a short acting and intermediate acting insulin
given in combination b4 breakfast & evening meal is d simplest regimen & is still
commonly used.
5. Individual requirement vary considerably act usually 2/3rd of total daily dose
is given in morning in ratio of 1:2, short:intermediate acting insulin.
6. The remaining third is given in d evening.
SIDE EFFECTS.
1. Hypoglycemia
2. Weight gain
3. Peripheral edema
4. Insulin antibodies
5. Local allergy
6. Lipodystrophy @ injection site
DAWN PHENOMENON.
It is fasting hypoglycemia caused by release of counter regulatory hormones during
d night as part of d normal circadian rhythm which increase insulin requirement b4
wakening.

Diabetes Mellitus

Uploaded by

Copyright:

Available Formats

Diabetes Mellitus

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Diabetes Mellitus

Uploaded by

Copyright:

Available Formats

Types

Type1 -insulin sensitive

criteria for diagnosis

4 alpha glucosidase inhibitors

#Insulin was discovered in 1921 .

It is classified as per duration of action.(all figures in hours)

1. Rapid acting (insulin analogues- lispro, aspart, glulisine)

2. Short acting(soluble regular)

3. Intermediate acting (isophane, lente)

4. Long acting(bovine ultralente)

5. Long acting(insulin analogue- glargine, detemir)

1. The choice of regimen depends on d desired degree of glycemic control, patient's

You might also like