DIABETES MELLITUS

Dr. Motahar A. Aldarwish

Internist & Endocrinologist
 Diabetes Mellitus
Definition
• Is a group of metabolic diseases characterized by
increased levels of glucose in the blood
(hyperglycemia) resulting from defects in insulin
secretion, insulin action, or both
• related to:
• An endocrine disorder causes Abnormal insulin
production
• Impaired insulin utilization
• Both abnormal production and impaired utilization
 Diabetes Mellitus
Definition

• Leading cause of heart disease, stroke,

adult blindness, and nontraumatic lower
limb amputations
 Diabetes Mellitus
Etiology and Pathophysiology
• Produced by the β cells in the islets of
• Langherans of the pancreas
• Facilitates normal glucose range of 70 to
120 mg/dl
 Diabetes Mellitus
functions of insulin
• Transports and metabolizes glucose for energy
• Stimulates storage of glucose in the liver and muscle
(in the form of glycogen)
• Signals the liver to stop the release of glucose
• Enhances storage of dietary fat in adipose tissue
• Accelerates transport of amino acids (derived from
dietary protein) into cells
• Inhibits breakdown of stored glucose, protein, and
fat.
 Type 1 Diabetes Mellitus

• Formerly known as “juvenile onset” or

“insulin dependent” diabetes
• Most often occurs in people under 30
years of age
• Peak onset between ages 11 and 13
 Type 1 Diabetes Mellitus
Etiology and Pathophysiology

• Progressive destruction of pancreatic β

cells

• Autoantibodies cause a reduction of 80%

to 90% of normal β cell function before
manifestations occur
 Type 1 Diabetes Mellitus
Etiology and Pathophysiology
• Causes:
• Genetic predisposition
• Related to human leukocyte antigens (HLAs)
• Exposure to a virus
 Type 1 Diabetes Mellitus
Onset of Disease

• Manifestations develop when the pancreas

can no longer produce insulin
• Rapid onset of symptoms
• Present at ER with ketoacidosis
Type 1 Diabetes Mellitus
Onset of Disease
• Weight loss
• Polydipsia
• Polyuria
• Polyphagia
 Type 1 Diabetes Mellitus
Onset of Disease

• Diabetic ketoacidosis (DKA)

• Occurs in the absence of exogenous
insulin
• Life-threatening condition
• Results in metabolic acidosis
 Type 2 Diabetes Mellitus

• Accounts for 90% of patients with diabetes

• Usually occurs in people over 40 years of
age
• 80-90% of patients are overweight
 Type 2 Diabetes Mellitus
Etiology and Pathophysiology

• Pancreas continues to produce some

endogenous insulin
• Insulin produced is either insufficient or
poorly utilized by the tissues
 Type 2 Diabetes Mellitus
Etiology and Pathophysiology

• Insulin resistance
• Body tissues do not respond to insulin
• Results in hyperglycemia
 Type 2 Diabetes Mellitus
Etiology and Pathophysiology

• Inappropriate glucose production by the

liver
• Not considered a primary factor in the
development of type 2 diabetes
Type 2 Diabetes Mellitus
 Type 2 Diabetes Mellitus
Onset of Disease

• Gradual onset
• Person may go many years with
undetected hyperglycemia
• 75% of type 2 diabetes is detected
incidentally
 Type 2 Diabetes Mellitus

• Etiology (not well know)

• Genetic factors
• Increased weight.
 Gestational Diabetes

• Develops during pregnancy

• Detected at 24 to 28 weeks of gestation
•  Risk for cesarean delivery, perinatal
death, and neonatal complications
 Secondary Diabetes
• Results from another medical condition or
due to the treatment of a medical condition
that causes abnormal blood glucose levels
• Cushing syndrome
• Hyperthyroidism
• Parenteral nutrition
 Clinical Manifestations
Diabetes Mellitus
• Polyuria
• Polydipsia (excessive thirst)
• Polyphagia
• In Type I
• Weight loss
• Ketoacidosis
 Clinical Manifestations
Non-specific symptoms
• Fatigue and weakness
• Sudden vision changes
• Tingling or numbness in hands or feet
• Skin lesions or recurrent infections
• Prolonged wound healing
• Visual changes
 Diabetes Mellitus
Diagnostic Studies

• Fasting plasma glucose level >126 mg/dl

• Random plasma glucose measurement
>200 mg/dl plus symptoms
• Two-hour OGTT level >200 mg/dl using a
glucose load of 75 g
 Assessing the Patient With
Diabetes

• History :
• Physical Examination
• Laboratory Examination
• Need for Referrals
Complications for uncontrolled diabetes:

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 Prevention:
• Type 1:
• Not preventable, as of right now.
• Studies on ways to possible prevent further
destruction of the beta cells
• Maintain and control sugar levels, insulin
injection
• Healthy life style – exercise and diet
• Islet transplantation?
 Prevention:
• Type 2:
• Primary: maintain a healthy lifestyle
• Secondary: check HgA1c, adjust diet
• HgA1c – blood sugar avg over span of 3 months
• Measures what % of your Hg is coated with sugar
• Nl = 4 % - 5.6%, pre diabetes = 5.7% -6.4% and
diabetes = 6.5% +
• Tertiary: exercise and eat well
• Foot exam?
 Prevention:
• Gestational diabetes:
• Physical activity
• Researchers found being physically active before
and after their pregnancy reduced their risk of GDM
by about 70% or more
• Diet
• A study showed that each 10 gram increase in fiber
a day reduced their risk of GDM by 26%
 Diabetes Mellitus
Drug Therapy: Insulin

• Exogenous insulin:
• Required for type 1 diabetes
• Prescribed for the patient with type 2
diabetes who cannot control blood
glucose by other means
 Diabetes Mellitus
Drug Therapy: Insulin

• Types of insulin
• Human insulin
• Most widely used type of insulin
• Cost-effective
•  Likelihood of allergic reaction
 Diabetes Mellitus
Drug Therapy: Insulin

• Types of insulin
• Insulins differ in regard to onset, peak
action, and duration
• Different types of insulin may be used in
combination therapy
 Diabetes Mellitus
Drug Therapy: Insulin

• Types of insulin
• Rapid-acting: Lispro (onset 15’, peak 60-90’ and
last from 2-4 hours)
• Short-acting: Regular (Onset is 30-60’, peak in
2-3h and last for 4-6 hours, and Regular insulin is only
kind for IV use.
 Diabetes Mellitus
Drug Therapy: Insulin

• Intermediate-acting: NPH or Lente

Onset 3-4h, peak 4-12 hours and lst 16-20 hours. Names
include Humulin N, Novolin N, Humulin L, Novolin L
• Long-acting: Ultralente, Lantus
Onset 6-8h, peak 12-16 h and lasts 20-30h.
Injection Sites
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 Diabetes Mellitus
Drug Therapy: Oral Agents

• Used only in type II DM

• They increases the secretion of insulin by the
pancreatic beta cells, may improve binding
between insulin and insulin receptors or increase
the number of insulin receptors
 Diabetes Mellitus
Drug Therapy: Oral Agents

• Used along with (but not a substitute to) nutrition

and exercise.
• In time, they may no longer be effective in
controlling the patient's diabetes because of
decline of beta cells. In such cases, the patient is
treated with insulin.
 Diabetes Mellitus
Drug Therapy: Oral Agents
• Sulfonylureas: Glipizide, Glyburide and
Glimepiride, Chlorpropamide (Diabinese)
• Meglitinides: Prandin & Starlix
• Biguanides: Metformin
• α-Glucosidase inhibitors: Acarbose. Delay
absorption of CHO
• Thiazolidinediones: Pioglitazone (Actos)
 Diabetes Mellitus
Pancreas Transplantation

• Used for patients with type 1 diabetes who

have end-stage renal disease and who
have had or plan to have a kidney
transplant
 Diabetes Mellitus
New Developments in Diabetic Therapy
• New insulin delivery systems not yet
approved by the FDA:
• Inhaled insulin
• Skin patch
• Oral spray
•
 Diabetes Mellitus
Misconceptions Related to Insulin Treatment

1. Once insulin injections are started (for

treatment of type 2 diabetes), they can never
be discontinued
2. If increasing doses of insulin are needed to
control the blood glucose, the diabetes must be
getting “worse”
3. Insulin causes blindness (or other diabetic
complications)
 Diabetes Mellitus
Misconceptions Related to Insulin Treatment

4. Insulin must be injected directly into the

vein
5. There is extreme danger in injecting
insulin
if there are any air bubbles in the syringe
6. Insulin always causes people to have bad
(hypoglycemic) reactions
Select this paragraph to edit
Email :
[email protected]

Phone No:
777772468

By
Dr. Motahar A. Aldarwish
Internist & Endocrinologist