DIABETES MELLITUS
WHAT IS DIABETES MELLITUS?
Syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin or decreased sensitivity of
tissues to insulin.
WHAT IS INSULIN? A small protein Molecular weight of 5808 Contains 2 amino acid chains linked
by disulfide bonds Helps to store excess energy
TYPES OF DIABETES MELLITUS
TYPE I- IDDM (Insulin dependant Diabetes Mellitus)
Caused by lack of insulin secretion. TYPE II- NIDDM (Non Insulin Dependant
Diabetes Mellitus. Caused by insulin resistance.
TYPE I DIABETES May develop abruptly or over a period of
few days 3 important features of TYPE 1 DM:1. Blood glucose
2. Utilization of fats for energy & formation of cholesterol by liver
3. Depletion of body proteins
CLINICAL MANIFESTATIONSBlood glucose concentration rises to
very high levelsIncreased blood glucose causes loss
of glucose in urineIncreased blood glucose leads to
dehydration Chronic high glucose conc. causes
tissue injuryIncreased utilization of fats and
metabolic acidosis Depletion of body proteins
TYPE II DIABETES More common than TYPE I Often between ages 50-60, thus called
as adult-onset diabetes Most important risk factor: Increasing prevalence of OBESITY
IMPORTANT FEATURES OBESITY INSULIN RESISTANCE METABOLIC SYNDROME which includes:
Accumulation of abdominal fat Fasting hyperglycemia
Lipid abnormalities(eg; blood triglycerides)
OTHER CAUSATIVE FACTORS POLYCYSTIC OVARY SYNDROME- Marked
increase in ovarian androgen production and insulin resistance
CUSHING’S SYNDROME(excess formation of glucocorticoids) OR ACROMEGALY(excess formation of growth hormone)
DIAGNOSIS OF DIABETES MELLITUS URINARY GLUCOSE- glucose gets
excreted in urine unlike in normal conditions where entire glucose is reabsorbed during tubular reabsorption.
FASTING BLOOD GLUCOSE AND INSULIN LEVELS-normal levels:80-90mg/100ml
ACETONE BREATH GLUCOSE TOLERANCE TEST
GLUCOSE TOLERANCE TEST Normal fasting person:
1 gm glucose/kg body wt. ingestedBlood glucose rises from 90mg/100ml-
120mg/100ml-140mg/100mlFalls back to control value in abt 2 hours
Person with diabetes:Since blood glucose is already above
110mg/100mlBlood glucose rises higher on ingestion
Falls back only after 4-6hours but still fails to fall below control value
TREATMENT OF TYPE I DIABETES SINGLE DOSE OF
ONE OF THE LONGER ACTING INSULINS
SOMETIMES ADDITIONAL QUANTITIES ARE ALSO FIVEN IN TIMES WHEN BLOOD GLUCOSE RISES TOO HIGH
TREATMENT OF TYPE II DIABETES Dieting and exercises usually
recommended Drugs may be administered EXOGENOUS INSULIN MUST BE USED TO
REGULATE BLOOD GLUCOSE
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