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LAY OUT Definition
Types
Etiology
Sign/symptoms
Complications
Ketoacidosis
Diagnosis
Treatment
References
Acknowledgements
DEFINITION “It is a metabolic syndrome of impaired Carbohydrate,Lipid & protein metabolism characterized by “Hyperglycemia” either due to insufficient insulin or defective insulin receptors leading to Polyuria, Polydipsia & Polyphagia.”
TYPES OF DM1) Type 1 DM
2) Type 2 DM
Type 2 is further classified as:
• Non-Obese Type 2 DM
• Obese Type 2 DM
TYPE 2 DM
Due to combined insulin resistance & decrease insulin secretions also known as :
Noninsulin Dependent DM (NIDDM)
Adult onset DM
SUB TYPES OF NIDDMNON-OBESE TYPE
2 DM
Do not show the early phase of insulin release in response to raised Plasma glucose but B cells do respond to other Insulinogenicstimuli.
OBESE TYPE 2 DM
Insulin Resistance cause Hyperplasia of B cells .Hyperinsulinemiacause Down Regulation of insulin receptors. Obesity is of Abdominal type (Apple Like ).
TYPE 1DM TYPE2 DM
• Autoimmune Diseases
• Idiopathic
• Environmental Factors
Mumps
Rubella
Viruses
• Nutrients
Cow milk
• Mutation of insulin receptor Gene (19)
• Auto antibodies to insulin receptor
• Obesity
• Hemo-chromatosis
FACTORS CAUSING INSULIN RESISTANCE
Obesity
Excess Glucocorticoids
Excess Growth Hormone
Lipodystrophy
Ploycystic Ovary Disease
Mutation in Insulin Receptor
Contraceptive agents
B cell Adenoma
Other causes
EARLY Complications
• Diabetic Ketoacidosis
DKA
• Common
in Type 1
• Hyperosmolar
Hyperglycemic
Nonketotic
syndrome
HHNS
• Common
in Type 2
DKAInsulin + Glucagon
Hormone Sensitive Lipase
Lipolysis + Fatty acid oxidation
KETONE BODIES
(8-15mmol/l)
Ketonemia
Ketonuria
Ketoacdisis
Coma
HHNSBlood
glucose+Cellular
dehydration
Hyperosmolarity
(340mOsm/l)
Brain cells shrinkage
Coma
SIGN/SYMPTOMSDKA
1. Hyperglycemia
2. Nausea
3. Air Hunger
4. Fruity Breath Odor
5. Hypotension
6. Tachycardia
7. Abdominal Pain
8. Fatigue
HHNS
1. Altered Consciousness
2. Hyperthermia
3. Motor & sensory impairment
4. Seizures
5. Dry skin & Mucous Mem.
6. Hypotension
7. Extreme thirst
8. Hperglycemia
DIAGNOSISDKA
• Metabolic Acidosis
• Blood Glucose is relatively low 350mg/dl
• Ketone bodies in Urine
• Low Bicarbonate & Blood ph
HHNS• No acidosis
• Blood glucose level is up to 800-1000 mg/dl
• Altered Level of Consciousness
• No fruity smell of Breath
MANAGEMENTDKA
Intravenous Fluids
Administration of Potassium
Administration of Sodium Bicarbonate
Insulin
Mannitol /Hypertonic saline 3% to treat Cerebral Edema
HHNS
Intravenous Fluids to treat Dehydration
Electrolyte Replacementspecially K+
Insulin to lower blood Glucose level
INSULIN SHOCK & HYPOGLYCEMIA
Type 1 DM
Insulin therapy/Missing meals/ Excersise
Sign/symptoms
• Blood Glu (50-70mg/100ml) CNS excites
• Hallucinations
• Trembling/sweating
• Blood Glu (20-50mg/100ml)
• Clonic Seizures/Unconsciousnes
• Coma
DIAGNOSIS
• low blood Glucose level
• No rapid deep breathing
TREATMENT
• Iv Glucose
• Glucagon
• Epinephrine
DIAGNOSTIC TEST FOR DMo GLUCOSURIA
To detect Glucose in Urine
by a Paper Strip Method
o FASTING BLOOD GLUCOSE LEVEL
Normal : 60-110 mg/dl
Impaired: 110-126 mg/dl
Abnormal: >126 mg/dl
o GLUCOSE TOLERANCE TEST (GTT)
• Indicate Milder or Early DM
Standard Oral GTT
Intravenous GTT
FASTING
2Hrs
Normalmg/dl
100
<140
Impairedmg/dl
100-125
140-199
Diabetesmg/dl
>126
>200
NON PHRAMACOLOGICAL THERAPY
DIET1. TYPE 1 DM :
Fat + Cholesterol+ Carbohydrate
2. TYPE 2 DM : (Cont’d)
“Caloric” Restriction
( Cont’d)
• ARTIFICIAL
SWEETNERS
Aspartate
Saccharin
Acesulfame
• NUTRITIVE SWEETNERS
Fructose
Sorbitol
PHARMACOLOGICAL THERAPY
o INSULIN both for DM Type 1 & 2
o Drugs Inc. Insulin sensitivity :
Thiazolidinedione
Metformin
Troglitazone
o Drugs Inc. Insulin Release :
Sulfonylureas
(Glyburide & Tolbutamide)
o α- Glucosidase Inhibitors
REFERENCESo Harrison’s Principles Of Internal
Medicine (17th Edition)
o William’s Book Of Endocrinology
(11th Edition)
o Guyton & Hall Physiology
(12th Edition)
o Medical Biochemistry By Mushtaq
Ahmad (7th Edition)
o Textbook Of Medical Biochemistry By MN.Chatterjea (8th Edition)
o Wikipedia
ACKNOWLEDGEMENTS• ALLAH ALMIGHTY
• Prophet (SAW)
• My Parents
• HOD of Biochemistry
“Dr. Khawaja Muhammad Fayyaz”
• My Sister
Dr. Sidra Zafar
• My Friends