The document discusses diabetes mellitus, describing it as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. It outlines the key roles of insulin and glucagon in regulating carbohydrate metabolism and maintaining glucose homeostasis. The document also examines the different types of diabetes, their symptoms and management through lifestyle modifications, medications, and monitoring for complications.
The document discusses diabetes mellitus, describing it as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. It outlines the key roles of insulin and glucagon in regulating carbohydrate metabolism and maintaining glucose homeostasis. The document also examines the different types of diabetes, their symptoms and management through lifestyle modifications, medications, and monitoring for complications.
The document discusses diabetes mellitus, describing it as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. It outlines the key roles of insulin and glucagon in regulating carbohydrate metabolism and maintaining glucose homeostasis. The document also examines the different types of diabetes, their symptoms and management through lifestyle modifications, medications, and monitoring for complications.
The document discusses diabetes mellitus, describing it as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. It outlines the key roles of insulin and glucagon in regulating carbohydrate metabolism and maintaining glucose homeostasis. The document also examines the different types of diabetes, their symptoms and management through lifestyle modifications, medications, and monitoring for complications.
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Diabetes Mellitus
Jokotade O. Adeleye Endocrine Unit Dept of Medicine UCH Insulin and glucagon-most important endocrine secretions of the pancreas. They have major actions on carbohydrate metabolism and are important in the regulation of carbohydrate metabolism. Demonstrate a coordinated function in keeping blood glucose concentration constant within fairly normal limits in spite of considerable variation in glucose uptake and utilisation. Maintain glucose homeostasis by actions on liver, muscle and adipose tissue leading to a balance of glucose production and utilisation Gluconeogenesis- Involves all mechanisms and pathways responsible for converting non carbohydrates to glucose
Glycogen-major storage form of CHO. Also a ready
availailble source of hexose units for maintainance of blood glucose
Glycolysis: Pathway by which glucose is
metabolised to pyruvate and lactate in all mammalian cells. Insulin Promotes glucose uptake in peripheral tissues Promotes glycogenesis Inhibits glycogenolysis and gluconeogenesis Promotes glycolysis Actions of Insulin 1)Insulin increases/facilitates the transport of glucose, amino acids, free fatty acids into cells, mainly liver, muscle, and adipose tissue. 2)Anabolic: Insulin acts as an anabolic hormone activating transport systems and enzymes involved in intracellular utilization and storage of glucose, amino acids and fatty acids. It promotes protein synthesis, and prevents protein degradation. also lipogenic and promotes glycogenesis by the stimulation of the enzyme system for conversion of glucose to glycogen. 3) Inhibits catabolism- it is a potent inhibitor of catabolic processes catabolic such as glycogenolysis, lipolysis and gluconeogenesis. Diabetes mellitus is the most common endocrine metabolic disease encountered in Nigeria and has a worldwide distribution. Characterized by acute and long term complications and these result in increased morbidity and mortality, especially in developing countries due to inadequate facilities for treatment and inability of patients to afford the cost of care. The vascular, renal, neuropathic and retinal long term complications lead to premature disability and death. A group of metabolic diseases characterized by hyperglycemia and disturbances of carbohydrate, fat and protein metabolism due to defects in insulin secretion, insulin action or both. Characteristic symptoms polyuria (a consequence of osmotic diuresis secondary to sustained hyperglycemia leading to a loss of glucose, free water and electrolytes in the urine) polydypsia
weight loss. Type 1 DM In most patients with type 1 DM, there is an autoimmune destruction of the B islet cells of the pancreas resulting in absolute insulin deficiency. Genetic and environmental factors are believed to contribute to the development of this disease Peak incidence is in childhood and adolescence. Usually occurs before 30 years of age, but it may be seen later in life. Plasma insulin low or immeasurable The onset of symptoms is usually abrupt, Abrupt onset of symptoms over days to 2-3 weeks. ketoacidosis may be a presenting feature. Most of these patients are characteristically lean. Type 2 DM This form of diabetes is a term used for individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency. The vast majority of the cases of diabetes are type 2, which accounts for up to 90% of persons with diabetes. Believed to develop as a consequence of interaction between genetic and environmental factors. Usually seen in middle age or beyond (after the age of 40 years) but may be seen in younger persons Symptoms are often insidious in onset, They may however be asymptomatic Type 2 DM may also manifest for the first time as a result of its long term complications. Many patients with this form of diabetes are overweight or obese. It has a strong genetic basis the presence of type 2 DM in a first degree relative is an established risk factor for the disease. Environmental factors are also very important determinants of the development of type 2 DM The environmental factors include-a high fat diet and excessive caloric consumption, obesity, physical inactivity, alcohol, smoking and stress. Age Family history of DM Obesity (generalized and central) Physical inactivity Race/Ethnicity Previous gestational diabetes mellitus Impaired glucose tolerance Acute metabolic complications Diabetic ketoacidosis & Hyperosmolar non ketotic State
D.K.A. May be the first manifestation of type 1 DM Also precipitated by cessation of insulin, infection, surgery, emotional stress Symptoms include: anorexia, nausea, vomiting, abdominal pain, Kussmauls respiration (deep rapid breathing) Dehydration due to increased urinary loss Hyperglycemia, ketonuria, ketonaemia, acidosis Hyperosmolar non ketotic state Precipitating factors - infection, C.V.D., M.I.
Features: - Profound dehydration due to sustained hyperglycaemia, hyperosmolality, C.N.S signs, high risk of thrombotic complications. Chronic / Long-term complications I) Macrovascular disease: There is narrowing/occlusion of large blood vessels. This is responsible for ischaemic heart disease and cerebrovascular disease It is also responsible for peripheral vascular disease.
II) Microvascular disease—Narrowing of the lumen of
small blood vessels at the capillary and arteriolar level are responsible for diabetic retinopathy, neuropathy, nephropathy and diabetic cardiomyopathy
III) Others 1)Symptoms of diabetes plus casual plasma glucose concentration > 200mg/dl (11.1mmol/L). The classic symptoms of diabetes include polyuria, polydypsia and unexplained weight loss Or 2) Fasting plasma glucose >126mg/dl (7.0mmol/L). Fasting is defined as no caloric intake for at least 8hrs or 3) 2 hours plasma glucose >200mg /dl during an OGTT. Test should be performed as described by WHO using a glucose load containing the equivalent of 75mg anhydrous glucose dissolved in water. FPG ≥ 110mg/dl (6.0mmol/l) but < 126 mg/dl (7.0mmol/l) is known as impaired fasting glucose. - 2 hours post glucose load or 2 hours post prandial ≥ 140 (7.8mmol/l) but < 200 mg/dl (11.1mmol/l) is known as impaired glucose tolerance. -Urinalysis as a diagnostic tool for diabetes is cheap and easy to perform, but has a number of limitations, which do not make it ideal. Physical Examination should include weight, height, BMI, Blood Pressure. Investigations: - - F.B.S; 2HR PP - Urinalysis for protein, glucose and ketones - Urine for microalbuminuria (If there is no overt proteinuria) - Electrolytes and Urea & plasma creatinine - Lipid profile - E.C. G - Chest X-ray - Others as indicated. What are the aims of management? Alleviate symptoms
Blood sugar as close as possible to
normal Prevent or minimize complications
Reduce morbidity and mortality
Management Lifestyle modification Dietary/nutritional therapy Exercise:Daily regular exercise appropriate for patient’s age, level of fitness. Drugs: Patients with Type 1 DM must also have insulin to survive Many patients with Type 2 DM will require the oral hypoglycemic agents and a number may eventually require insulin Weight loss, especially in the overweight/obese patient with Type 2 DM OTHERS Health education Monitor weight Self monitoring of blood sugar with glucose monitors advocated. Monitor for evidence of complications
