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Diabetes mellitus Dr. Essam H. Jiffri.

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1 Diabetes mellitus Dr. Essam H. Jiffri

2 Introduction - Diabetes mellitus is a heterogeneous group of disorders characterized by hyperglycaemia, glycosuria and associated abnormalities of lipid and protein metabolism. -It is common, affecting up to 2% of Westem populations, 17% in Saudi Arabia.

3 Introduction -Insulin metabolism is abnormal in diabetes, either because of: reduced secretion or to insensitivity to its effects. -Two main types of Diabetes: Insulin-dependent (IDDM or type 1 diabetes mellitus, formerly juvenile-onset) Non-insulin-dependent (NIDDM or type 2 diabetes mellitus, formerly maturity onset)

4 Classification of diabetes mellitus
Insulin- Dependent (Type I) Diabetes Non-Insulin- Dependent (Type 2) Diabetes Malnutrition Related Diabetes Mellitus Impaired Glucose Tolerance Secondary Diabetes Gestational Diabetes Mellitus

5 1- Insulin- Dependent (Type I) Diabetes
-Insulin secretion is absent or severely reduced in IDDM as a result of immunological destruction of beta- cells in the islets of Langerhans. -Circulating islet cell antibodies are found in the majority of patients at presentation and infiltration of the islets by T lymphocytes also occurs.

6 1- Insulin- Dependent (Type I) Diabetes
-Genetic factors are important in the development of IDDM-individuals with human leukocyte antigen (HLA) system antigens DR3 and DR4 have increased susceptibility for IDDM. -The environmental event effects, usually a viral infection, particularly with: Coxsackie B4 or mumps.

7 1- Insulin- Dependent (Type I) Diabetes
-Most cases of IDDM present before 30 years of age. -The clinical presentation is often acute, with polyuria, polydipsia, polyphagia, weight loss and tiredness developing over several days and ketosis may be present.

8 2-Non-Insulin-Dependent (Type 2) Diabetes
-Non-insulin-dependent diabetes is a heterogeneous group of disorders in which several features contrast with those found in IDDM. -NIDDM has been divided by the World Health Organization (WHO) into two main groups: Obese Non-obese

9 2-Non-Insulin-Dependent (Type 2) Diabetes
- Insulin secretion is retained, although it is inadequate to control blood glucose levels. - There is resistance to the effects of insulin in due to reduced insulin receptors -Genetic factors are a more important aetiological factor in NIDDM than IDDM. -Identical twins have a near 100% chance and the risk of developing NIDDM is higher than IDDM if a parent has the disease.

10 2-Non-Insulin-Dependent (Type 2) Diabetes
-There are no HLA associations and no islet cell antibodies are found. - Not all patients with NIDDM are over weight, there is a clear association with obesity. - Obese patients develop NIDDM either have: diminished pancreatic reserve or a secretory defect in the pancreatic beta-cells

11 2-Non-Insulin-Dependent (Type 2) Diabetes
-Clinical onset is usually in middle age and the prevalence increases with age. - NIDDM is often detected by urine testing during a routine medical examination. - Patients may complain of polyuria and polydipsia, ketosis is rare.


13 3- Malnutrition-Related Diabetes Mellitus
-Found mainly in developing countries due to protein-deficient diabetes. -The aetiology of these is not clear.

14 4- Diabetes Associated with Other Disorders (Secondary Diabetes)
- Diabetes may occur in association with other conditions, particularly pancreatic disorders such as: chronic pancreatitis haemochromatosis may cause destruction of beta-cells.

15 4- Diabetes Associated with Other Disorders (Secondary Diabetes)
-Endocrinopathies (endocrine disorders) which result in: - increased secretion of counter-regulatory hormones can induce insulin resistance. -Diabetes occurs in association with several genetic disorders, including: Turner's syndrome Down's syndrome

16 5- Gestational Diabetes Mellitus
- Gestational diabetes occurs for the first time in pregnancy. - Glycosuria is common because the renal threshold for glucose is exceeded. - Complications can occur due to blood glucose concentrations in both mother and fetus. - Glucose tolerance reverts to normal after delivery in most cases many later develop frank diabetes.

17 6- Impaired Glucose Tolerance
-Impaired glucose tolerance (IGT) is an asymptomatic condition -Diagnosed on the basis of the response of blood glucose to the ingestion of a standard oral glucose solution (oral glucose tolerance test, OGTT; 75g anhydrous sugar in 300 ml water, blood and urine samples taken at 2h).

18 KEY POINTS Type 1 diabetes mellitus is characterized
by insulin deficiency Type 2 diabetes mellitus is characterized by insulin resistance Diabetes mellitus is diagnosed by clinical features and blood glucose measurements or an oral glucose tolerance test.

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