E tiopathogenesis of Diabetes Mellitus

1. Etiopathogenesis of Diabetes Mellitus Dr Shahjada SelimAssistant ProfessorDepartment of EndocrinologyBangabandhu Sheikh Mujib Medical University, DhakaEmail: selimshahjada@gmail.com, info@shahjadaselim.com

2. Diabetes mellitus Definition: Diabetes mellitus (DM)is a state of chronic hyperglycemia due to defect in insulin secretion and or its action. Etiopathogenesis of diabetes by Dr Shahjada Selim

3. Diabetes: A global emergency

4. Diabetes around the world

5. Diabetes around the world

6. Diabetes around the world

7. Cell types in pancreatic islets of Langerhans Etiopathogenesis of diabetes by Dr Shahjada Selim

8. Etiopathogenesis of diabetes by Dr Shahjada Selim

9. Insulin • Molecular weight of this peptic substance is 6000. • It consists of 51 aminoacidic parts from 16 differentaminoacids Etiopathogenesis of diabetes by Dr Shahjada Selim

10. Insulin • The most important biologic stimulator of insulin secretion is glucose Etiopathogenesis of diabetes by Dr Shahjada Selim

11. Etiopathogenesis of diabetes by Dr Shahjada Selim

12. Insulin is an anabolic hormone (promotes the synthesis of carbohydrates, proteins, lipids and nucleic acids). The most important target organs for insulin action are: Etiopathogenesis of diabetes by Dr Shahjada Selim

13. Absolute 1. Genetic disorders 2. Autoimmune damaging of β-cells 3. Damaged caused by virusessuch as mumps, or Coxsackie B4 4. Toxic influence on β-cells 5. Diseases of pancreatic gland Relative β-cells Insulin transport Receptors (tissue insensitivity) Insulin insufficiency Etiopathogenesis of diabetes by Dr Shahjada Selim

14. Etiologic classification of DM (1999) I. Type 1 of DM (destruction of β-cells which mostly leads to absolute insulin insufficiency): autoimmune; idiopathic. II. Type 2 of DM (resistance to insulin and relative insulin insufficiency or defect of insulin secretion with or without resistance to insulin). III. Other specific types: • genetic defects of β-cells function; • genetic defects of insulin action; • pancreatic diseases (chronic pancreatitis; trauma, pancreatectomy; tumor of pancreatic gland; fibrocalculosis; hemochromatosis); • endocrine disease (acromegaly, thyrotoxicosis, Cushing’s syndrome); • drug exposures ; • infections and others. IV. Gestation diabetes. Etiopathogenesis of diabetes by Dr Shahjada Selim

15. Type 1 • is characterized by pancreatic islet beta -cell destruction and absolute deficiency. • The onset of the disease is generally in youth, but it can occur at any age. Patients have dependence on daily insulin administration for survival. Etiopathogenesis of diabetes by Dr Shahjada Selim

16. Pathogenesis of type 1 DM Etiopathogenesis of diabetes by Dr Shahjada Selim

17. Etiopathogenesis of diabetes by Dr Shahjada Selim

18. Type 2, or noninsulin-dependent diabetes mellitus (NIDDM) • Type 2 is the most common form of diabetes, accounting for 95 – 90 % of the diabetic population. Most investigators agree that genetic factors underlie Type 2 DM, but it is probably not caused by defects at a single gene locus. Etiopathogenesis of diabetes by Dr Shahjada Selim

19. Pathophysiology of type 2 diabetes GI tract Skeletal Muscle Pancreas Adipocyte Muscle α cells  cells Incretin deficiency Altered fat metabolism Hyperglucagonaemia ↑ hepatic sensitivity to glucagon INSULIN RESISTANCE INADEQUATE INSULIN SECRETION ↑ HEPATIC GLUCOSE PRODUCTION CNS Kidney ↑ BLOOD GLUCOSE Enhanced glucose reabsorption CNS, central nervous system; GI, gastrointestinal; T2DM, type 2 diabetes mellitus Cernea S & Raz I. Diabetes Care 2011;34(suppl 2):S264–S271

20. Etiopathogenesis of diabetes by Dr Shahjada Selim

21. Etiopathogenesis of diabetes by Dr Shahjada Selim

22. Etiopathogenesis of diabetes by Dr Shahjada Selim

23. Pathogenetic and clinical difference oftype I and type II DM Etiopathogenesis of diabetes by Dr Shahjada Selim

24. Pathogenetic and clinical difference oftype I and type II DM Etiopathogenesis of diabetes by Dr Shahjada Selim

25. Pathogenetic and clinical difference oftype I and type II DM Etiopathogenesis of diabetes by Dr Shahjada Selim

26. Pathophysiology of DM Etiopathogenesis of diabetes by Dr Shahjada Selim

27. Stages of DM development I. Prediabetes (risk factors or predispose factors). II. Impaired glucose tolerance (latent DM). III. Clinical manifestation of DM. Etiopathogenesis of diabetes by Dr Shahjada Selim

28. Etiopathogenesis of diabetes by Dr Shahjada Selim

29. Etiopathogenesis of diabetes by Dr Shahjada Selim

30. Insulin Secretion in Non-Diabetics and Type 2 Diabetics 800 Normal 700 Type 2 DM 600 500 400 Insulin Secretion (pmol/min) 300 200 100 06:00 10:00 14:00 18:00 22:00 02:00 06:00 Clock Time (Hours) O'MEARA et al. Am. J. Medicine, 1990;89 Etiopathogenesis of diabetes by Dr Shahjada Selim

31. Prediabetes (risk factors or predispose factors) • obesity • positive family history of DM • persons which were born with weight more than 4,0 kg • women who had-children with weight more than 4kg, abortions and dead child in anamnesis; Etiopathogenesis of diabetes by Dr Shahjada Selim

32. Prediabetes (risk factors or predispose factors) • persons with: atherosclerosis, hypertension • auto-immune diseases • Furunculosis • rubella, mumps, Coxsackie virus, infectious hepatitis, cytomegalovirus, infection mononucleosis; • endocrine disorders Etiopathogenesis of diabetes by Dr Shahjada Selim

33. Etiopathogenesis of diabetes by Dr Shahjada Selim

34. Thank you for attention! Etiopathogenesis of diabetes by Dr Shahjada Selim