Presentation on theme: "Diabetes Mellitus Classification & Pathophysiology."— Presentation transcript: 1 Diabetes Mellitus Classification & Pathophysiology Show
2 Definition Diabetes Mellitus is a group of metabolic diseases characterized metabolic diseases characterized by high plasma levels of glucose resulting from defects in insulin
secretion, insulin action, or both. Body is unable to metabolize carbohydrates, fats and proteins The Expert Committee On the Diagnosis and Classification of Diabetes Mellitus (2000 ) 3 An Early definition “ a wonderful but not very frequent
affliction among men, being a meltdown of the flesh and limbs into urine ….. life is short, offensive and distressing, thirst unquenchable, death inevitable” Aretaeus (81- 138A.D) Aretaeus (81- 138A.D) a Roman Physician a Roman Physician 4 Diabetes (siphon) Mellitus (sweet or honey-like )
5 Normal Blood Glucose 3.5 – 8 mmol/L http://healthinmotion.files.wordpress.com/2008/10/1.jpg 6 Classification Type-1 –Autoimmune disease against ß
cells in the pancreas. Possibly viral. Cells destroyed –Genetic predisposition – HLA genes Type-2 –Insulin (high, normal or low) present but cannot be utilized (insulin resistance). Other specific types (secondary ) Gestational LADA (latent autoimmune diabetes in adults) –http://www.mayoclinic.org/diseases-conditions/type-1- diabetes/expert-answers/lada-diabetes/faq-20057880 http://www.mayoclinic.org/diseases-conditions/type-1-
diabetes/expert-answers/lada-diabetes/faq-20057880http://www.mayoclinic.org/diseases-conditions/type-1- diabetes/expert-answers/lada-diabetes/faq-20057880 7
Gestational diabetes Placental hormones affect glucose tolerance Carbohydrate intolerance Insulin resistance 3-8% of pregnancies At risk for eclampsia BG levels normal post natal Precautions to reduce risk 8 History of Insulin
http://www.diabetes.org/research-and-practice/student- resources/history-of-diabetes.html http://www.diabetes.org/research-and-practice/student- resources/history-of-diabetes.html http://www.diabetes.org/research-and-practice/student- resources/history-of-diabetes.html 9 Diabetes (before )
10 Diabetes (after insulin) 11 Pathophysiology of Diabetes Mellitus Lewis : Pg 1183/1359
12 Type I Diabetes Destruction of beta cells. No Insulin is produced produced Often occurs suddenly and most commonly in persons under 30 most before 15 in persons under 30 most before 15 Accounts for up to 10% of persons with diabetes diabetes Increase by 3% - 5% more frequently in children children One of the most common childhood
diseases in developed countries diseases in developed countries
13 Type 1 Pathophysiology Autoimmune destruction of beta cells Total absence of insulin production Glutamic acid decarboxylase (GAD)antibodies islet cell and insulin autoantibodies islet cell and insulin autoantibodies Unchecked glucose production by liver Fasting hyperglycaemia and post - prandial hyperglycaemia post - prandial hyperglycaemia
Increased glycogenolysis, gluconeogenesis gluconeogenesis Fat break-down – ketone bodies (DKA) 14 Type 1 Diabetes http://dev.nsta.org/evwebs/1150/images/type1diabetes.jpg 15 Type
1 diabetes http://www.youtube.com/watch?v=_OOWhuC_9Lw http://www.youtube.com/watch?v=_OOWhuC_9Lw 16 Type 2 Diabetes Most
common type Insulin produced is not effective “sluggish” Insulin resistance Impaired insulin secretion Gradual – most often in people over 40 Controlled by diet, oral meds and in some cases insulin Preventable 17 Type 2 Pathophysiology Insulin resistance - decreased tissue sensitivity to insulin - insulin normally binds to receptors on cell surfaces and receptors on cell surfaces and initiates reactions. initiates reactions. - receptors unresponsive or insufficient or insufficient - decrease in Glut 4 transporters - glucose entry into cell impeded - unable to regulate glucose release by liver Lewis 1185/ 1361
18 Type 2 Pathophysiology Type 2
Pathophysiology Impaired Insulin secretion - beta cells cannot keep up with increased - beta cells cannot keep up with increased demand for insulin to overcome resistance demand for insulin to overcome resistance “fatigued” (compensatory overproduction) “fatigued” (compensatory overproduction) - decrease in production of insulin or insulin - decrease in production of insulin or insulin sluggish. sluggish. Inappropriate glucose production by liver - haphazard not consistent with needs -
haphazard not consistent with needs - leads to high fasting blood glucose - leads to high fasting blood glucose Altered production of hormones and cytokines by adipose tissue (adipokines – adiponectin & leptin adipose tissue (adipokines – adiponectin & leptin - cause insulin resistance - cause insulin resistance 19 Acanthosis nigricans
20 Metabolic syndrome (syndrome X) Increased risk of insulin
resistance Five components - increased glucose levels - increased glucose levels - elevated BP - elevated BP - abdominal obesity - abdominal obesity - high triglycerides - high triglycerides - low HDL’s - low HDL’s Any 3 = Metabolic syndrome 21 Type 2 Diabetes 22 23 Pre-Diabetic Conditions Relates to Type 2 Diabetes pathology Between a normal state and the diabetic state. – IGT & IFG (Impaired) Tests:
- IGT if OGTT = 7.8 to 11.0 mmol/L - IFG if fasting glucose = 5.5 to 6.9 mmol /L usually no symptoms 24 Insulin Dependent Type 2 Pre-diabetics with cellular resistance compensate by pumping out lots of insulin. The hyper insulin state exhausts the beta
cells and create less insulin. Thus, the Type 2 to may also require insulin 25 Diabetes Overview http://www.youtube.com/watch?v=jHRfDTqPzj4&feature=related What is the pathophysiology of type 2 diabetes?The pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining β-cell function, eventually leading toβ -cell failure.
What is the pathophysiology of diabetes mellitus?The pathophysiology of diabetes involves plasm concentrations of glucose signaling the central nervous system to mobilize energy reserves. It is based on cerebral blood flow and tissue integrity, arterial plasma glucose, the speed that plasma glucose concentrations fall, and other available metabolic fuels.
What is the major pathophysiological difference between type1 and type 2 DM?The main difference between the type 1 and type 2 diabetes is that type 1 diabetes is a genetic condition that often shows up early in life, and type 2 is mainly lifestyle-related and develops over time. With type 1 diabetes, your immune system is attacking and destroying the insulin-producing cells in your pancreas.
What is the process of type 2 diabetes?When you have type 2 diabetes, your body still breaks down carbohydrate from your food and drink and turns it into glucose. The pancreas then responds to this by releasing insulin. But because this insulin can't work properly, your blood sugar levels keep rising. This means more insulin is released.
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