1. Diabetes Mellitus Type 2

2. Diabetes Mellitus
Diabetes mellitus is “a group of common metabolic disorders that share the phenotype of hyperglycemia.” (HPIM 17th ed.)
“Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.” (WHO, 2011)

3. Diabetes Mellitus
Type 2 DM is characterized by insulin resistance and abnormal insulin secretion
According to the WHO, there were 2,770,000 Filipinos with Type 2 DM in 2000 and projects that by 2030, this number will rise to 7,798,000 and the Philippines is going to be in the Top 10 countries with the highest number of people with diabetes.

4. DM Type 2 Pathophysiology
Early stages: near normal glucose tolerance despite insulin resistance
Pancreatic β-cells compromise and ↑ insulin output
↑ insulin resistance
↑ compensatory hyperinsulinemia
Pancreatic β-cells unable to sustain hyperinsulinemic state
Impaired glucose tolerance

5. DM Type 2 Pathophysiology
Impaired glucose tolerance
↓ insulin production
↑ hepatic gluconeogenesis
Overt diabetes with fasting hyperglycemia
Pancreatic β-cell failure
↑ postprandial glucose

6. DM Type 2 Pathophysiology
Metabolic Abnormalities
Abnormal muscle & fat metabolism
Impaired insulin secretion
Increased hepatic glucose and lipid production

7. DM Type 2 Pathophysiology
Abnormal muscle and fat metabolism
Obesity
Genetic susceptibility
Insulin resistance
Impaired glucose utilization
hyperglycemia
↑ hepatic gluconeogenesis
↑ FPG
↓ peripheral glucose usage
Postprandial hyperglycemia
↑ impairement in glycogen formation of skeletal muscles

8. DM Type 2 Pathophysiology
Impaired insulin secretion
2nd genetic defect
Insulin resistance
↑ insulin secretion
Mild insulin secretory defect
Grossly inadequate insulin secretion
Pancreatic β-cell failure

9. DM Type 2 Pathophysiology
Increased hepatic glucose and lipid production
Liver insulin resistance
Unsuppressed liver gluconeogenesis
Fasting hyperglycemia
↓ glycogen storage

10. DM Type 2 Pathophysiology
Increased hepatic glucose and lipid production
Adipose tissue insulin resistance + obesity
↑ FFA acid flux from adipocytes
↑ hepatic lipid (VLDL, Triglyceride) synteheis
Steatosis in liver
Non-alcoholic fatty liver disease
Abnormal liver Fxn Tests

11. DM Type 2 Pathophysiology
Increased hepatic glucose and lipid production
Adipose tissue insulin resistance
↑ FFA flux from adipoctyes
↑ lipid synthesis (VLDL, triglyceride) in hepatocytes
Steatosis in liver
Nonalcoholic fatty liver diseae
Abnormal liver function tests
Dyslipidemia (↑ trig, ↓ HDL, ↑ LDL)

12. DM and Psoriasis IL-23 Stimulate Th 17 cells Release IL-17
Induce psoriatic cytokines TNF-α, IL-1, IL-6, IL-8
Insulin resistance
Dyslipidemia
Endothelial production

13. DM and Cancer Hyperinsulinemia ↓ IGFBP I, II, III ↓ IGF action
↑ free/bioactive IGF-I levels
↓ cellular apoptosis
↑ tumor growth
↑ survival and progression of early malignant cells