Ebpt 1 - Diabetes Part 1 PDF

ESGUERRA, NAVARRO, RAMOS, REYES | EBPT 2 1 DIABETES MELLITUS  According to WHO, the classification of diabetes started in 1965, During...

ESGUERRA, NAVARRO, RAMOS, REYES | EBPT 2 1 DIABETES MELLITUS  According to WHO, the classification of diabetes started in 1965, During this time, we classify diabetes based on the age range of the patient wherein he/she has started to experience the symptoms of diabetes. DEFINITION  In 1985, there has been a change in the classification, this time they based it  A group of metabolic disease characterized by on the patient’s dependency in insulin. inappropriate hyperglycemia resulting from defect in insulin  1999 is the latest classification, the one we use today secretion, insulin action or both. o These GAD antibodies cause an immune response. Glutamic acid is converted into GABA (responsible for insulin secretion) through  Most common endocrine disorder glutamic acid decarboxylase (GAD). With the GAD antibodies, there is o It involves the malfunction of the pancreas which is responsible for inhibition of the conversion of glutamic acid into GABA, thus inhibiting producing insulin (type 2) or the body’s cells do not respond properly insulin secretion. to insulin  Chronic condition - It could develop during the early TYPE 1 DM childhood, particularly if the patient has type 1 diabetes.  Patients with type 1 DM have an absolute insulin For patients with type 2, it starts in patients older than 40 deficiency. years old. o One of the major causes of pancreatic damage or destruction of beta o The two most common classifications of DM are: islet cells.  Type 1 (absolute insulin deficiency)  The result of autoimmune destruction of the β-cells of the  Type 2 (relative insulin deficiency due to β-cell dysfunction pancreas coupled with insulin resistance) o Type 1 is based on the insulin production of our pancreas’ beta islet  DM is a leading cause of eye and kidney disease. Patients cells. Their immune system recognizes the beta islet cells as something foreign; thus it starts to destroy the beta islet cells. with DM are at high risk for CV events, heart failure, and o They need insulin supplementation because their body is no longer able atherosclerotic disease. to produce insulin. o Chronic hyperglycemia can cause vascular and nerve damage, resulting in microvascular, macrovascular, and neuropathic complications  Type 1 DM (5%–10% of cases) usually presents in children and adolescents but can occur at any age. EPIDEMIOLOGY  Associated with a faster onset of symptoms, leading to dependency on extrinsic insulin for survival  Extreme hyperglycemia causes DKA (diabetic ketoacidosis) o DKA is severe condition that occurs when insulin levels are too low, causing the body to break down fat for energy. This leads to the production of ketones, which can result in metabolic acidosis. Symptoms include nausea, vomiting, abdominal pain, rapid breathing, and confusion. DKA can be life-threatening if not treated promptly.  DM is a worldwide problem, significantly impacting people and healthcare systems in low-, middle-, and high-income countries. o Diabetes is one of the largest global health emergencies of the 21st century. Each year, more and more people are living with the condition, which leads to significant morbidity and mortality.  A study in 2017 found out that there are 425 million people worldwide who have diabetes. They expect that in 2045 there would be an increase of 48% of the world’s population to develop diabetes.  Approximately 50–60% of patients with type 1 will present before 20 years of age.  Figures are highest in Caucasians, especially Scandinavians,  In a healthy individual, the pancreas produces insulin, a hormone that helps cells take in glucose from the bloodstream. The insulin binds to insulin whereas the disorder is rare in Japan and the Pacific area receptors on the cell surface, which allows glucose to enter the cell to be used  Type 2 diabetes is more common in people of African, for energy. This process helps keep blood glucose levels stable. African-Caribbean and South Asian family origin.  In Type 1 diabetes, the pancreas fails to produce insulin (shown with a red "X"). Without insulin, glucose cannot enter the cells. As a result, glucose builds CLASSIFICATION OF DIABETES up in the bloodstream, leading to high blood sugar (hyperglycemia).  In type 2 diabetes, the pancreas is able to produce insulin but the cells fail to AGE RANGE DEPENDENCY ON LATEST CLASSIFICATION respond to insulin properly. (1965) INSULIN (1985) (1999-)  Infantile or  Insulin-dependent  Type 1 LATENT AUTOIMMUNE DIABETES OF ADULTS (LADA) Childhood diabetes mellitus  Type 2  Young  Non-insulin-  A variant of type 1 DM is called latent autoimmune dependent Other Classifications  Adult diabetes of adults (LADA). diabetes mellitus  Gestational  Elderly Diabetes  Latent autoimmune diabetes in adults (LADA) is a type of  Monogenic defects diabetes that starts in adulthood and slowly gets worse over (MODY, Neonatal time. Diabetes  These patients often have a poor response to oral agents  Antiglutamic acid decarboxylase and require insulin therapy much sooner than most patients (GAD) antibodies with type 2 DM.  ESGUERRA, NAVARRO, RAMOS, REYES | EBPT 2 2 o Although some sources list LADA under Type 1, it is still a subject for CLASSIFICATIONS DISORDER an ongoing debate because of its autoimmune nature similar to Type 1 Monogenic  Maturity-onset diabetes of the young (MODY) and LADA tends to be less acute and may not require insulin at the time defects caused by a mutation in GCK, HNF1A, HNF1B, of diagnosis. This eventual need for insulin therapy links it to T1D rather or HNF4A gene than type 2 where insulin resistance is the primary cause.  Neonatal diabetes caused by a mutation in o It is a subject for debate because it has characteristics associated with KCNJ11, ABCC8, INS, GATA6, EIF2AK3, or Type 2 (adult onset, slower progression) FOXP3 gene Genetic  Down syndrome IDIOPATHIC TYPE 1 DM syndromes  Hemochromatosis  Idiopathic type 1 DM is a non-autoimmune form of diabetes associated with  Klinefelter syndrome diabetes frequently seen in patients of African and Asian descent.  Turner syndrome  These patients have periods of profound hyperglycemia but Diseases  Cystic fibrosis Impacting the  Pancreatitis only intermittently require insulin therapy. Pancreas Leading  Pancreatic cancer to Diabetes TYPE 2 DM  Pancreatectomy  Patients with type 2 have relative insulin deficiency and  Post-transplantation diabetes mellitus Endocrine  Acromegaly the body’s inability to effectively use insulin diseases o Some people who have type 2 diabetes would still require insulin  Aldosteronoma supplementation, meaning there is still a deficiency of insulin, but type frequently  Cushing syndrome 2 diabetes is mainly because of the body’s ineffective insulin receptors. associated with diabetes  Glucagonoma Insulin receptors no longer recognize insulin, thus do not produce the  Hyperthyroidism effect that it has  Pheochromocytoma  They have varying degrees of β- cell dysfunction often  Somatostatinoma coupled with insulin resistance. Medication -  Atypical antipsychotics (eg, risperidone, induced diabetes olanzapine)  Type 2 DM accounts for 90% to 95% of all cases of DM.  β-blockers (e, propranolol, atenolol)  When compared to people of European ancestry, Native  β-adrenergic agonists (eg, albuterol) Americans, Latino/Hispanic Americans, African Americans,  Calcineurin inhibitors (eg, cyclosporine, Asian Americans, and Pacific Islanders are more likely to tacrolimus) develop type 2 DM.  Diazoxide  Symptoms are slower in onset and less marked than those  Gatifloxacin of type 1  Glucocorticoids (eg, dexamethasone, prednisone)  Extreme hyperglycemia causes HHS (Hyperglycemic  Growth hormone (rhGH) Hyperosmolar State)  HMG-CoA reductase inhibitors (eg, o HHS is a condition is characterized by extremely high blood glucose atorvastatin, simvastatin) levels without significant ketone production. It often occurs in older  Niacin/nicotinic acid Pentamidine adults with type 2 diabetes and can be precipitated by infection, dehydration, or illness. Symptoms include severe dehydration,  Protease inhibitors (eg, ritonavir, saquinavir) confusion, and potentially coma. HHS can also be life-threatening and  Thiazide diuretics (eg, chlorthalidone, requires urgent medical treatment. hydrochlorothiazide)  Maturity onset diabetes of the young (MODY) - It’s more of a type 2 diabetes GESTATIONAL DIABETES but is usually associated with genetics, i.e., if a family member has diabetes type 2 diabetes and there is a change in the genes. At a very young age,  Women who develop diabetes during pregnancy are usually during adolescence, patients already start to develop and have classified as having gestational diabetes (GDM). symptoms of diabetes. o Excess weight before pregnancy often plays a role. Usually, various hormones work to keep blood sugar levels in check. But during PATHOPHYSIOLOGY pregnancy, hormone levels change, making it harder for the body to process blood sugar efficiently. This makes blood sugar rise  Not classified as GDM if patient have diabetes prior to being pregnant. o If DM is diagnosed prior to pregnancy, this is not GDM, but rather pregnancy with pre-existing DM. Hormone changes during pregnancy result in increased insulin resistance, and GDM may ensue if the mother cannot increase insulin secretion to adequately compensate to maintain normoglycemia. The pancreas is divided into an exocrine portion and an endocrine portion (islets of  Hyperglycemia in pregnancy is associated with adverse Langerhans). The exocrine portion, comprising 85% of the mass of the pancreas, outcomes including hypertension and fetal macrosomia secretes digestive enzymes while the endocrine gland (1-2% of mass) is made of o Fetal macrosomia is when a newborn who's much larger than average. different cell types that secrete a specific hormone. This could be because of high blood sugar in pregnant women which to increased insulin production promoting excess fat storage and growth CELL TYPE RELATIVE HORMONE for the baby ABUNDANCE PRODUCED Alpha 25% Glucagon OTHER TYPES OF DIABETES Beta 70% Insulin  Less common types of diabetes are caused by genetic Delta