Diabetes define as a heterogeneous metabolic disorder caused by disturbances of carbohydrates,fat, protein metabolism. Diabetes also called metabolic syndrome ( Also called insulin resistance syndrome)
The hormone insulin moves sugar from the blood into your cells to be stored or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it does make. When raised sugar will be present for prolonged time it Causes blood sugar.
When we eat a carbohydrate,our body change the carbohydrates into glucose. Glucose transported into blood . Your pancreas releases insulin, a hormone that helps move glucose from your blood into your cells, which use it for energy.When our body doesn't use insulin than the amount of glucose increases.
Increased amount of glucose into bloodstream can cause Hyperglycemia ( blood sugar). If we did not get treatment of Diabetes at Right time, it may be life threatens.
Note :-
Diabetes leading cause of morbidity and mortality world over . It becomes major health problem owing to it's seriously complications. China , India and US top countries with highest number of Diabetic population. Mainly it caused by in Changi life style of low activity, and high calories diet.
Classification of Diabetes mallitus :-
On the basis of age, it divided into,
Juvenile- onset ( type 1)
Maturity onset ( type 2)
On the basis of therapy, it divided into
Insulin- Dependent
Non- insulin dependent
Type 1 Diabetes mallitus (DM) :-⤵
Etiology :-
Autoimmune beta cells destruction leading to insulin deficiency
Biochemistry :-
Insulin deficiency due to Destruction of beta cells.
Due to certain genetic variation, the beta cells are recognise no - self and they are destroyed by immune mediated injury.
Due to destruction of beta cells of pancreas, pancreas ultimately fail to Secret insulin in response to Glucose ingestion.
It constitutes about 10% cases of DM Previously called juvenile- onset diabetes (JOD) due to occurrence in Younger age.
This is called insulin- dependent diabetes mallitus (IDDM) because these patients have absolute requirements for insulin replacement as treatment.
Type 1 DM Mainly present in under 30 yr of age .
Plasma insulin -Decreased or absent
Auto antibodies -frequently found
Ketosis -more common
Acute complications -ketoacidosis
Subtype 1A ( immune- mediated) DM :-
Cause by autoimmune destruction of beta cells which usually leads to insulin deficiency.
Subtype 1B ( idiopathic)
Caused by insulin deficiency with tendency to develop ketosis but these patients are for autoimmune markers.
Type 2 diabetes mallitus (DM):-
Etiology:-
progressive loss of beta cell insulin secretion with insulin resistance.
Biochemistry:-
Obesity acts as a diabetogenic factors and leads to a decrease in insulin receptors on the insulin responsive ( target ) cell.
It constitutes about 80% cases of DM.
It was called maturity- onset diabetes (MOD) or non- insulin dependent diabetes mallitus ( NIDDM).
It dominantly Affects the older individuals but now it is present in obese and adolescent children.
More cases of type 2 DM also have requirements of insulin therapy to control Hyperglycemia.
Over eating coupled with underactivity leading to obesity in associated with development of NIDDM.
Mainly caused by the progressive loss of beta cell insulin secretion frequently on the background of insulin resistance.
Recent reached found that NIDDM suggest increased levels of tumor necrosis factor alfa (TNF- ALFA).
Plasma insulin :-normal or increased
Auto antibodies :- rare
Ketosis :- rare
Acute complications :- hypersomolar comma.
Gestational Diabetes mallitus:-
About 4% pregnant women develop DM due to metabolic changes during pregnancy.
It defined as Diabetes diagnosed in the second or third trimester of pregnancy women who din not have overt Diabetes earlier.
Specific types due to other Cause (10%) :-
Genetically defect of beta cell function due to mutation in various enzyme called maturity onset diabetes mallitus of the young ( MODY). Genetically defect in insulin action
Endocrinopathy like Acromegaly, Cushing's syndrome. infection
Pathogenesis of DM :-
Hyperglycemia may result from,
1- Reduced insulin secretion
2- Decreased glucose use by body
3- increase glucose production
General Symptoms of Diabetes mallitus :-
1-Increased thirst and urination
2-Increased hunger
3-Fatigue
4-Blurred vision
5-Numbness or tingling in the feet or hands
6-Sores that do not heal
7-Unexplained weight loss
8-Weakness
9-Poly urea
10-Excessive thrust
11-Slow healing sore
12-Presence of ketones in urine
Risk factors of Diabetes mallitus :-
1-Family history
2-Environmental factor
3-Auto antibodies
4-climates
5-Dyslipidaemia
6-History of cardiovascular disease
7-Women with poly cystic ovary disease
8-Obesity(BMI; 25 kg/meter square)