Diabetes mellitus yashwant kumar

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  • 1. Diabetes Mellitus TYPE 1 BY YASHWANT KUMAR GROUP -8.

2. Diabetes MellitusThe disease is characterized by an absolutedeficiency of insulin caused by anautoimmune attack on the cells of thepancreas.About 10% of the ten million diabetics inUSA has type 1 diabetes, only (2/3)isdiagnosed.Complication: stroke, heart attack, kidneydisease, eye disease and nerve damage. 3. Diabetes Insulin(synthesis, storage, secretion)insulin mRNA is translated asa single chain precursor calledpreproinsulinremoval of signal peptideduring insertion into theendoplasmic reticulumgenerates proinsulinZnProduced within the pancreasby cells islets ofLangerhansWithin the endoplasmicreticulum, proinsulin isexposed to several specificendopeptidases which excisethe C peptide, therebygenerating the mature form ofinsulinStored as granules 4. Diabetes Insulin(Biochemical Role)-Tyrosine Kinasereceptors are thelocksin which the insulinkey fits- Involved in signaltransduction(insulin hormonebeing 1st messenger) 5. ALTERED CHO METABOLISM Insulin Glucose Utilization+GlycogenolysisHyperglycemiaGlucosuria(osmotic diuresis) Polyuria*(and electrolyte imbalance)Polydipsia** Hallmark symptoms of diabetes 6. ALTERED PROTEIN METABOLISMInsulinProtein Catabolism Gluconeogenesis (amino acids glucose) Hyperglycemia Weight Loss and Fatigue 7. ALTERED FAT METABOLISMInsulin Lipolysis Free fatty acids + ketones Acidosis + Weight Loss 8. Type 1 Diabetes MellitusFormerly known as juvenile onset orinsulin dependent diabetesMost often occurs in people under 30years of agePeak onset between ages 11 and 13 9. Type 1 Diabetes MellitusEtiology and PathophysiologyProgressive destruction of pancreaticcellsAuto antibodies cause a reduction of80% to 90% of normal cell functionbefore manifestations occur 10. Type 1 Diabetes MellitusEtiology and Pathophysiology Causes: Genetic predisposition Exposure to a virus 11. Type 1 Diabetes MellitusOnset of DiseaseManifestations develop when thepancreas can no longer produce insulin Rapid onset of symptoms Present at ER with impending or actual ketoacidosis 12. Type 1 Diabetes Mellitus Onset of DiseaseWeight lossPolydipsia (excessive thirst)Polyuria (frequent urination)Polyphagia (excessive hunger)Weakness and fatigueKetoacidosis 13. Type 1 Diabetes MellitusOnset of DiseaseDiabetic ketoacidosis (DKA) Life-threatening complication ofType 1 DM Occurs in the absence of insulin Results in metabolic acidosis 14. Clinical ManifestationsType 1 Diabetes MellitusPolyuriaPolydipsiaPolyphagiaWeight loss 15. DIFFERENCE 16. Type 1 Diabetes MellitusDiagnostic Studies Fasting plasma glucose level 7 mmol/L Random plasma glucose level11.1 mmol/L plus symptoms mmol/L 2 hr post challenge Hemoglobin A1C test (glycosylated Hgb) Reflects amount of glucose attached to Hgb over life of RBC Indicates overall glucose control over previous 90 120 days Impaired Glucose Tolerance Test patient is challenged with glucose load. Patient should be able to maintain normal BG. Diabetes if BG > 11.1 17. Diabetes MellitusDrug Therapy: Insulin Exogenous insulin: Required for all patient with type 1 DM. Types of insulin Human insulin Most widely used type of insulin Cost-effective Likelihood of allergic reaction 18. Diabetes MellitusDrug Therapy: Insulin Insulins differ in regard to onset, peak action, and duration Different types of insulin may be used for combination therapy Rapid-acting: Lispro *Short-acting: Regular *Intermediate-acting: NPH or Lente Long-acting: Ultralente, Lantus 19. Injection SitesFig. 47-5 20. Diabetes MellitusDrug Therapy: Insulin Insulin delivery methods Ordinary SQ injection Insulin pen preloaded with insulin; dial the dose Insulin pump Continuous basal infusion. At mealtime, userprograms to deliver bolus infusion thatcorrelates with amount of CHOs ingested. Allowstight control and greater flexibility with mealsand activity 21. Diabetes MellitusDrug Therapy: Insulin Insulin delivery methods Intensive insulin therapy Multiple daily injects and frequent SMBG Problems with insulin therapy Hypoglycemia (BS < 3.9 mmol/L) Due to too much insulin in relation to glucoseavailability Allergic reactions Local inflammatory reaction Lipodystrophy 22. Diabetes MellitusNutritional Therapy Exercise Essential part of diabetes management Increases insulin sensitivity Lowers blood glucose levels Decreases insulin resistance 23. Diabetes MellitusPancreas Transplantation Used for patients with type 1 DM who have end-stage renal disease and who have had or plan to have a kidney transplant Eliminates the need for exogenous insulin Can also eliminate hypoglycemia and hyperglycemia 24. Diabetes Oral Medications 6 Classes : Sulfonylureas Biguanides Sulfonylureas and biguanide combination drugs Thiazolidinediones Alpha-glycosidase inhibitors Meglitinides 25. Thank You