DIABETES MELLITUS

WHAT IS DIABETES MELLITUS?

Syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin or decreased sensitivity of

tissues to insulin.

WHAT IS INSULIN? A small protein Molecular weight of 5808 Contains 2 amino acid chains linked

by disulfide bonds Helps to store excess energy

TYPES OF DIABETES MELLITUS

TYPE I- IDDM (Insulin dependant Diabetes Mellitus)

Caused by lack of insulin secretion. TYPE II- NIDDM (Non Insulin Dependant

Diabetes Mellitus. Caused by insulin resistance.

TYPE I DIABETES May develop abruptly or over a period of

few days 3 important features of TYPE 1 DM:1. Blood glucose

2. Utilization of fats for energy & formation of cholesterol by liver

3. Depletion of body proteins

CLINICAL MANIFESTATIONSBlood glucose concentration rises to

very high levelsIncreased blood glucose causes loss

of glucose in urineIncreased blood glucose leads to

dehydration Chronic high glucose conc. causes

tissue injuryIncreased utilization of fats and

metabolic acidosis Depletion of body proteins

TYPE II DIABETES More common than TYPE I Often between ages 50-60, thus called

as adult-onset diabetes Most important risk factor: Increasing prevalence of OBESITY

IMPORTANT FEATURES OBESITY INSULIN RESISTANCE METABOLIC SYNDROME which includes:

Accumulation of abdominal fat Fasting hyperglycemia

Lipid abnormalities(eg; blood triglycerides)

OTHER CAUSATIVE FACTORS POLYCYSTIC OVARY SYNDROME- Marked

increase in ovarian androgen production and insulin resistance

CUSHING’S SYNDROME(excess formation of glucocorticoids) OR ACROMEGALY(excess formation of growth hormone)

DIAGNOSIS OF DIABETES MELLITUS URINARY GLUCOSE- glucose gets

excreted in urine unlike in normal conditions where entire glucose is reabsorbed during tubular reabsorption.

FASTING BLOOD GLUCOSE AND INSULIN LEVELS-normal levels:80-90mg/100ml

ACETONE BREATH GLUCOSE TOLERANCE TEST

GLUCOSE TOLERANCE TEST Normal fasting person:

1 gm glucose/kg body wt. ingestedBlood glucose rises from 90mg/100ml-

120mg/100ml-140mg/100mlFalls back to control value in abt 2 hours

Person with diabetes:Since blood glucose is already above

110mg/100mlBlood glucose rises higher on ingestion

Falls back only after 4-6hours but still fails to fall below control value

TREATMENT OF TYPE I DIABETES SINGLE DOSE OF

ONE OF THE LONGER ACTING INSULINS

SOMETIMES ADDITIONAL QUANTITIES ARE ALSO FIVEN IN TIMES WHEN BLOOD GLUCOSE RISES TOO HIGH

TREATMENT OF TYPE II DIABETES Dieting and exercises usually

recommended Drugs may be administered EXOGENOUS INSULIN MUST BE USED TO

REGULATE BLOOD GLUCOSE