Clinical Presentation of Diabetes PDF

12.3 clinical presentation of diabetes Definition: Diabetes mellitus Diabetes mellitus = “ Honey urine” Greeks Clinical condition caused by chronic elevated blood sugar level Absolute insulin deficiency Relative insulin deficiency Insulin not produced by pancreases Insulin insu...

12.3 clinical presentation of diabetes Definition: Diabetes mellitus Diabetes mellitus = “ Honey urine” Greeks Clinical condition caused by chronic elevated blood sugar level Absolute insulin deficiency Relative insulin deficiency Insulin not produced by pancreases Insulin insufficient or insulin actions for the body requirements Metabolism affected · Carbohydrates · Protein · Fat INSULIN HORMONE (preproinsulin-proinsulin-insulin) · Synthesized by BETA cells from pancreas in response to elevated blood glucose levels · Pancreas secrete 30u/day, basal and related to meals Proinsulin cleavage Ø Exocytosis of insulin and C fibres equally to be increased in endogenous insulin secretion. Ø Insulin is synthesized in pancreas and cleared by both liver and kidneys Insulin actions Liver Muscle Adipose tissue ANABOLIC EFFECTS Promotes Promotes Ø Glycogen synthesis Ø protein synthesis Ø triglyceride storage Ø Protein synthesis Ø glycogen synthesis Ø Triglyceride synthesis Anti catabolic effect Inhibits Ø Gluconeogenesis Ø Ketogenesis Ø glycogenolysis Diagnostic criteria Symptoms of diabetes Level of glucose Ø Polyuria Ø Fasting plasma glucose > 7.0mmol Ø Polydipsia Ø 2hr plasma glucose >11mmol/l in standard 75g oral glucose tolerance test Ø Weight loss Ø HbA1c >6.5% Impaired fasting glucose Ø Normal= < 5.6 mmol/l Ø Impaired= >5.6 mmol/l/ 7.0mmol/l ORAL GLUCOSE TOLERANCE TEST - Test to diagnose impaired glucose tolerance or diabetes mellitus - Give patient 75g of dextrose and measure after 2 hours Impaired glucose tolerance Diabetes mellitus 2 hrs glucose b/w 7.8-11.1mmol/l 2hrs plasma glucose >11.1mmo/l Classification of diabetes - Type 1 diabetes ( autoimmune and idiopathic) - Type 2 DM - GESTATIONAL DM TYPE 1 dm Type2 DM - Absolute insulin deficiency Ø Insulin resistance= hyperinsulinemia - 2ndary to pancreatic BETA cell destruction Ø Beta cell dysfunction - Dependant on insulin for survival Ø Obese>80% = insulin resistance - Results in Ketone production Ø Non obese 25 Insulin years old Ø GAD anti body positive Maturity onset diabetes of the young ( MODY) Ø 2 yrs Ø Not obese