DIABETES MELLITUS

Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.

sugar disease. The defect in this condition is that either the pancreas

does not produce enough insulin or it produces sufficient insulin, but the cells of the body are unable to use the insulin properly.

Introduction

Beta Cells: secrete insulin.

The Pancreas

Alpha Cells: secreteglucagon

Autoimmunity occurs in islet of Langerhans against the beta cells...

-Peptide Hormone, regulates blood sugar.

-Causes body cells to take up glucose from the blood.

-Insulin receptors found on: Liver cells Skeletal muscles Adipose tissue

What is Insulin? What does it do?

Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to

serious problems with your heart, eyes, kidneys, nerves, and gums and teeth.

4 major types:1) Type 1 Diabetes2) Type 2 Diabetes3) Gestational Diabetes 4) Pre-diabetes

Types Of Diabetes

Diabetes is becoming a world pandemic. Incidence prevalence are increasing dramatically,

with an estimated 171 million diabetics in 2000 and a projected increase to 366 million by 2030 Type 1 diabetes causes an estimated 5–10% of all

diabetes

Epidemiology

Also called “Insulin dependent diabetes” or “Juvenile diabetes”.

Autoimmune destruction of insulin-producing (beta cells) of the pancreas

Results in total insulin deficiency.

Age of onset: usually childhood, young adulthood

Type 1 Diabetes

Symptoms: Age below 30 years polyuria -Excessive urination Polyphagia-Excessive hunger polydipsia- Excessive thirst sometimes asymptomatic.

Bed wetting in children weight loss Dehydration Coma

EATS A LOT BUT DOES NOT GROW

Triggers: -Poorly understood, plenty of theories. -Molecular mimicry… -Injury to islets… -Random failure of tolerance…

Cell mediated response: -Type 1 diabetes is caused by a T cell–mediated

autoimmune destruction of the pancreatic beta cells.

Pathophysiology

Molecular mimicry: similar epitopes between pathogen and host.

Pathophysiology: Triggers

hGAD65:Autoantigen Coxsackie & hCMV: Viral peptides

Viruses can produce proteins similar to those of the host.Immune cells present viral protein homologous to self protein. Failure of tolerance and autoimmunity

The exact cause of type 1 diabetes is unknown. In most people with type 1 diabetes, the body's own

immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas.

Genetics Environmental Viruses Diet

Causes

Several alleles of HLA-DQB1 are associated with an increased risk of developing type 1 diabetes.

The locus also has the genetic name IDDM1 as it is the highest genetic risk for type 1 diabetes.

The strongest gene, IDDM1, is located in the HLA Class II region on chromosome 6, at staining region 6p21.

Certain variants of this gene increase the risk for decreased histocompatibility characteristic of type 1.

Such variants include DRB1 0401, DRB1 0402 etc.

Genetics:

Race. White people have a greater risk for developing type 1 diabetes than black, Asian, or Hispanic people.

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Inherited (Continuation)

Twin Study: For identical twins, when one twin had type 1 diabetes,

the other twin only had it 30%–50% of the time. Despite having exactly the same genome, one twin had

the disease, where the other did not; this suggests environmental factors, in addition to genetic factors, can influence disease prevalence.

Environmental:

Exposure to:o Epstein-Barr viruso coxsackieviruso mumps virus or cytomegalovirus may trigger the

autoimmune destruction of the islet cells, or the virus may directly infect the islet cells.

Viral exposure:

Research suggests that vitamin D may be protective against type 1 diabetes.

However, early drinking of cow's milk — a common source of vitamin D — may increase infants' risk of the disease

Early vitamin D:

Hypoglycemia

Hyperglycemia

Ketoacidosis

Complications in Type 1 Diabetes

A condition arising due to low blood glucose.

It can be caused by eating less than usual, more exercise than normal or too much insulin administered.

Sometimes referred to as an “insulin reaction”

Must be treated before immediately before symptoms worsen

Hypoglycemia

Shakiness Dizziness Sweating Hunger Headache Pale skin color Sudden moodiness or behavior

changes, such as crying for no apparent reason

Clumsy or jerky movements Seizure Difficulty paying attention or

confusion Tingling sensations around the

mouth

Symptoms

If you pass out from hypoglycemia, people should:

◦ NOT inject insulin◦ Inject glucagon◦ Call for emergency help

Precautions!

A technical term for high blood glucose.

It can be caused by a clog in insulin pump tubing, missing an insulin dose, eating more than usual, stress or less exercise than normal.

Can be a serious problem if you don’t treat it

Hyperglycemia

Hyperglycemia Can Cause Serious Long-Term Problems

Ketones are acids that build up in the blood. They appear in the urine when the body doesn’t have

enough insulin. They can poison the body. They are also an indicator that your diabetes is getting out

of control or that you are getting sick. They are present in high amounts in a condition known as:

Ketoacidosis.

What are Ketones?

Results from a failure to treat hyperglycemia Mostly occur in individuals with type 1

diabetes It is a serious condition that can lead to

diabetic coma or even death. Treatment for this condition usually takes

place in the hospital. You can prevent this by learning the warning

signs and by checking blood and urine regularly.

Ketoacidosis

Increase with duration of diabetes 50% retinopathy in 20 years of Type 1

diabetes Retinal changes related to diabetes

◦ Hemorrhage, swelling, decreased vision Leading cause of blindness

Diabetes & eye disease

Glomerular changes in kidneys of diabetics leading to impaired renal function

First indicator: microalbuminuria

In type 1 diabetics, 10 – 15 years

Diabetic Nephropathy

Increased risk for Type 1 and 2 diabetics

Development of arterial occlusion and thrombosis resulting in gangrene

Peripheral Vascular Disease

Increased susceptibility to infection

Normal inflammatory response is diminished

Slower than normal healing.

Foot ulcers and infections

Other Complications from Diabetes

Latent Autoimmune Diabetes in Adults (LADA)

It is a form of (type 1 diabetes) which is diagnosed in individuals who are older than the usual age of onset of type 1 diabetes.

“ Late-onset Autoimmune Diabetes of Adulthood, "Slow Onset Type 1" diabetes, and sometimes also "Type 1.5

LADA

◦Patient is symptomatic plus Casual plasma glucose (non-fasting) is 200 mg/dl

OR Fasting plasma glucose of 126 mg/dl or higher

OR Two hour plasma glucose level of 200 mg/dl or

greater during an oral glucose tolerance test

Diagnosis

Introduction to self-management

Getting regular exercise

34

Key Pieces Of Diabetes Self-Management

Monitoring blood glucose

Taking medication

Following a meal plan

Eating too much sugar causes diabetes

Diabetes is a nuisance, but not serious

You can catch diabetes from someone else

Herbs and natural supplements can help prevent or treat diabetes

Myths about diabetes

Diabetes can be kept under check by proper care and treatment

Once diabetes is established it cannot be cured, so stop running after magical cures!!.

Can Diabetes be Cured ???

Take insulin through daily shots or an insulin pump.

Eat a healthy diet that spreads carbohydrate throughout the day.

Check blood sugar levels several times a day.

Get regular exercise.

When a small child has diabetes, the parents have the responsibility for blood sugar control.

Treatment may change based on the results of daily home blood sugar tests and other tests or exams.

Treatment

Visual Treatment Recommendations

I-port {$100} 75 injections & 72 hours

Insulin cannot be taken in pill form. If it were to be consumed orally, it would break down during

digestion just like normal proteins in your food. Insulin must be injected into the fat under your skin in order

for it to get into your bloodstream.

Insulin

TreatmentType 1 diabetes is fatal if not treated with external insulin.

Insulin:-fast acting and slow acting

Delivery:-subcutaneous injection-insulin pump

During this procedure, islets (clusters of cells from the pancreas that help make insulin) are taken from the pancreas of a deceased organ donor. Then, the islets are purified, processed, and transferred to someone else. These then begin to make and release insulin individually. This could possibly be the biggest step in helping patients with type 1 diabetes live without insulin injections.

Islet transplantation

Prevention all starts with a better lifestyle eating healthier being active taking medicine as directed taking care of your body check feet to make sure there is no nerve damage or interruption of blood flow take care of teeth control blood pressure and high no smoking! check in with your doctor at least once a month have your blood sugar checked along with weight, blood pressure, and feelings Check blood sugar levels daily by using home monitoring device

How to prevent/control diabetes

ANY QUESTION??????????