L4 Diabetes Mellitus PDF

Diabetes Mellitus Dr. Dalia Ibrahim Wagea Alla B.Sc.. MSc. Ph.D. MLS Assistant Professor of Clinical Chemistry Faculty of Medical Laboratory Science Mashreq University www.mashreq.edu.sd ...

Diabetes Mellitus Dr. Dalia Ibrahim Wagea Alla B.Sc.. MSc. Ph.D. MLS Assistant Professor of Clinical Chemistry Faculty of Medical Laboratory Science Mashreq University www.mashreq.edu.sd  Objectives By the end of this lecture student should be able to:  Define Diabetes Mellitus.  Enumerate symptoms of Diabetes Mellitus  Discuss the bases for classification of Diabetes Mellitus  Describe Pathophysiology of Diabetes Mellitus in each class  Define pre-diabetes  Explain the criteria for testing for pre-diabetes and Diabetes  Mention criteria for the testing and diagnosis of Diabetes Mellitus  State criteria for the testing and diagnosis of Gestational Diabetes Mellitus 2 [email protected]  Definition Of DM Diabetes Mellitus (DM), is Group of metabolic diseases characterized by hyperglycemia resulting from defect in insulin secretion insulin action or both. [email protected] 3 Symptoms of DM Polyuria (Frequent urination) Polydipsia ( Increased thirst). Polyphagia (Increased hunger). Weight loss [email protected] 4 Symptoms of DM In addition they also include: Blurry vision Headache Fatigue Slow healing of cuts Itchy skin. vision changes. [email protected] 5 Symptoms of DM [email protected] 6  Classification of DM National Diabetes Data group (1979) Type I: Insulin dependent diabetes mellitus (IDDM) Type II: Non Insulin dependent diabetes mellitus (NIDDM). [email protected] 7  Classification of DM ADA/WHO Classification (1995) Established in 1995, the International Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, working under the sponsorship of the American Diabetes Association, was given the task of updating the 1979 classification system. The proposed changes included: Eliminating the older terms of IDDM and NIDDM The categories of type 1 and type 2 were retained, with the adoption of Arabic numerals instead of Roman numerals. 8 [email protected]  Classification of DM ADA/WHO Classification (1995) Therefore, the ADA/(WHO) guidelines recommend the following categories of diabetes: Type 1 diabetes mellitus Type 2 diabetes mellitus Other specific types of diabetes Gestational diabetes mellitus. [email protected] 9  Type 1  Characterized by:  Hyper glycaemia primarily result of pancreatic islet β cell destruction, absolute insulin deficiency  Constitutes only 10- 20 % of all diabetes  Commonly occur in child hood and adolescence( juvenile diabetes)  Underweight patient.  Tendency of ketoacidosis.  One or more of the following marker may be found  ( example islet cell antibodies ,insulin antibodies). [email protected] 10  Type 2  Characterized by:  Hyper glycaemia primarily result from insulin resistance with an insulin secretory defect.  Relative insulin deficiency  Constitutes the majority of diabetes cases  Adult onset.  80-90% of patients are overweight [email protected] 11  Type 2 Diabetes [email protected] 12 Comparison of Type1 and Type 2 Feature Type 1 Type2 Onset Sudden Gradual Age of Onset Mostly in children Mostly in adult Body Size Thin or normal Often obese Ketoacidosis Common Rare Autoantibodies Usually present Absent Endogenous insulin Lower or absent Normal ,decreased or increased Prevalence 10% 90% [email protected] 13  Secondary Diabetes Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels. Cushing syndrome (e.g. steroid administration) Hyperthyroidism Parenteral nutrition [email protected] 14 Gestational Diabetes Mellitus Any degree of glucose intolerance occurs in pregnant women without a previous history of diabetes. Causes include metabolic and hormonal changes. Patients with GDM frequently return to normal postpartum [email protected] 15 Gestational Diabetes Mellitus [email protected] 16  Gestational Diabetes Mellitus [email protected] 17 Pathophysiology of DM In both type 1 and type 2 diabetes the individual will be hyperglycemic which can be sever. Glycosuria can also occur this happen when the plasma glucose exceeds (180mg/dl). In type 1 there is higher tendency to produce Ketone. In type 2 seldom generate ketone but in stead have greater tendency to develop hyper osmolar nonketotic states. [email protected] 18  ALTERED CHO METABOLISM ↓ Insulin ↓ ↓ Glucose Utilization + ↑ Glycogenolysis ↓ Hyperglycemia ↓ Glucosuria (osmotic diuresis) ↓ Polyuria* (and electrolyte imbalance) ↓ Polydipsia* * Hallmark symptoms of diabetes [email protected] 19  ALTERED PROTEIN METABOLISM ↓ Insulin ↓ ↑ Protein Catabolism ↓ ↑ Gluconeogenesis (amino acids → glucose) ↓ Hyperglycemia ↓ Weight Loss and Fatigue [email protected] 20  ALTERED FAT METABOLISM ↓ Insulin ↓ ↑ Lipolysis ↓ ↑ Free fatty acids + ketones ↓ Acidosis + Weight Loss [email protected] 21  Criteria for Testing of DM According to ADA recommendation all adult older than 45 year should have measurement of FPG every 3 years unless the individual is diagnosed with diabetes. [email protected] 22  Criteria for Testing of DM Testing should be carried out at an earlier age or more frequency in individuals who display: Obesity Family history High risk population History of GDM or delivery of a large babies Hypertension Low HDL (250 mg/dl. [email protected] 23  Risk Factors Family history. Age (increasing age). Obesity ( BMI ,Adipose tissues in obese people are more resistant to insulin. High fat and cholesterol levels. Smoking. Sedentary lifestyle. [email protected] 24 Criteria for diagnosis of DM Fasting plasma glucose level ≥126 mg/dl (7 mmol/L) Random plasma glucose level ≥ 200 mg/dl (11.1 mmol/L) plus symptoms 2hrs plasma glucose ≥ 200 mg/dl 11.1 mmol/L during O.GTT Hemoglobin A1C test (glycosylated Hb) – Reflects amount of glucose attached to Hb over life of RBC – Indicates overall glucose control over previous 90 – 120 days – > 6% Any of this criteria must be confirmed on subsequent day by any of this methods. [email protected] 25 Categories of Fasting Plasma Glucose Normal Fasting Glucose FPG