1 / 108

Diabetes Mellitus an overview

Diabetes Mellitus an overview. Aly A. Abdel-Rahim, MD.

oshin
Download Presentation

Diabetes Mellitus an overview

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Diabetes Mellitusan overview Aly A. Abdel-Rahim, MD

  2. Diabetes is a disorder caused by the presence of too much glucose in the blood. A first depiction of this “sugar disease” was described in the “Ebers Papyrus”, a papyrus sold to the German Egyptologist Georg Moritz Ebers in 1872. It was said to have been found close to a mummy in the tomb of Thebes and appears to have been written between 3000 and 1500 BC.

  3. History • Reference to diabetes was made 1550 BC. • In the 2nd Century AD, Aretaeus gave an excellent description of diabetes. • Thomas Willis in the 17th Century detected the sweet test of urine. • Mathew in the 18th Century showed that the sugar in urine comes from the blood.

  4. History • Minkowski and Von Mering discovered that disease of the pancreas is responsible for diabetes to develop in the 19th century. • In the 19th century treatment of diabetes was confined to food regulation which reduced urination but did not prevent wasting and complications.

  5. History • In the second half of the 19th Century, Paul Langerhans, a German student, identified clusters of cells within the pancreas responsible for the production on glucose lowering substance. “islets of Langerhans”. • Insulin: in Latin insula= island. So the name was coined before the hormone was discovered.

  6. History • Banting and Best “a student” worked in McLeod's labs in Toronto. • In 1921they made the exocrine cells atrophy by ligation of the pancreatic duct. • They made aqueous extracts of the remaining tissue keeping it cold and filtered it. • The extract was injected into a diabetic dog on 30 July 1921.

  7. History • They convinced themselves that they had discovered the active pancreatic hormone which normalizes the blood sugar.

  8. History • The first person to be treated with insulin was Leonard Thompson (1908-1935). The first injection was in 11 January 1922

  9. History: Noble Prize 1923 Banting McLeod Best Collip

  10. Definition of diabetes • A syndrome of chronic hyperglycaemia with other metabolic abnormalities together with micro and macro-vascular complications.

  11. What is wrong with diabetes • Insulin deficiency • Insulin resistance Hyperglycaemia

  12. Classification of diabetes • Type 1DM • Type 2DM • IFG: impaired fasting glycaemia • IGT: impaired glucose tolerance • GDM: Gestational diabetes mellitus • Secondary DM.

  13. Criteria of diagnosis • FBS > 125. • PP > 200 • OGTT. normal: • FBS <100 • PP <140

  14. T1DM • Usually in young age • Characterized by absolute insulin deficiency. • Increased catabolism and liability to ketosis. • Stormy presentation. • must be treated with insulin.

  15. T2DM • Usually in older age. • Relative insulin deficiency. • Increased insulin resistance. • Can be treated with OHA or insulin. • Slow onset, less likely to develop ketosis. • May present with complications.

  16. MODY Maturity onset diabetes of the youth • A special type of diabetes similar to type 2 diabetes but develop in young age groups. • Increased prevalence worldwide. • Associated with increased childhood obesity.

  17. Diabetes related to drugs • Glucocorticoids • Diazoxide. • Thiazides. • Phyention • Pentamidine

  18. GDM Gestational diabetes mellitus • Diabetes discovered for the first time during pregnancy. • Every pregnant lady should be screened. • Usually disappears after labor. • Increased risk to develop T2DM later in life.

  19. Diabetes is a pandemic

  20. Prevalence of diabetes in the EMME region

  21. Prevalence of IGT in the EMME region

  22. Prevalence of DM & IGT by region

  23. Estimated 10 prevalence of diabetes

  24. Estimated 10 top number of diabetes patients

  25. Social profile related to diabetes in Egypt • with an average income per person of $1,490 in 2001, fighting poverty remains a substantial challenge. • In it dropped to $1.390 in 2003 and then $1.310 in 2004. * • People living under poverty line (<1 $/day) 3.7% *WHO statistics 2005

  26. Social profile related to diabetes in Egypt • Life expectancy is 69.1 years. • National poverty rate (% of population) 16.7 . • Child malnutrition, weight for age (% of under 5) 4.0 in 2003 increased to 8.6 2004. Source: World Development Indicators database, August 2005

  27. Prevalence of diabetes in Egypt • Herman : 9.3% above 20y of age. • Arab 4.3% above 20y of age. • Why the difference ??? region e.g.: desert and Nubians.

  28. Prevalence of diabetes in Egypt • Herman : 9.3% above 20y of age. • Arab 4.3% above 20y of age. • Why the difference ??? region e.g.: desert and Nubians.

  29. Diagnosis • How to diagnose diabetes: • Signs and symptoms • Blood glucose test • OGTT • HbA1c

  30. Diagnosis • Most people are diagnosed with diabetes when they are suspected to have symptoms of polyurea, polydepsia, fatigue, loss of weight. • This is confirmed by fasting or PP blood glucose. • In case of doubt OGTT may be done. • Urine testing should not be used in diagnosis.

  31. Diagnosis • Peers and medical ‘advisors’ should be aware of the following: • T1DM & T2DM are two distinct diseases. • T1DM is stormy at presentation, delay in diagnosis can be disastrous. • Among the presentations of T1DM could be some non-specific symptoms like vomiting, abdominal pain….

  32. Diagnosis • T2DM may present with late symptoms, like numpness, disturbed vision, generalized oedema. • Patients with hypertension, dyslipidaemia, MI and family history of diabetes are very likely to develop T2DM.

  33. Pathophysiology of T1DM Absence of insulin secretion Failure to use glucose as a fuel Hyperglycaemia & using fat Ketosis

  34. Pathophysiology of T1DM • Possible contributing factors: • Autoimmune disease. • HLA typing • Viruses • chemicals

  35. Pathophysiology of T1DM • Remission. • The honeymoon period

  36. Pathophysiology of T2DM Insulin resistance hyperinsulinaemia Relative hypoinsulinaemia Hyperglycaemia, dyslipidaemia, atherosclerosis, HTN

  37. Pathophysiology of T2DM • Causes of insulin resistance: • Hereditary. • Decreased glucose transporters. • Decreased insulin receptors • Post receptor mechanisms • Chemical mediators e.g. TNFα

  38. Pathophysiology of T2DM • Loss of first phase of insulin secretion. • Delayed insulin release.

  39. Insulin

  40. Insulin

  41. Insulin

  42. Insulin

  43. Insulin • Action of insulin: • On glucose metabolism • On amino acid metabolism • On lipid metabolism

  44. Insulin • Short acting

  45. Insulin • Intermediate acting

  46. Insulin • Peak less insulin • Act for 24 hours no peak

  47. Insulin • Premixed insulin

  48. Insulin • Preparation of human insulin:

More Related