Diabetes clinical
- 3. Insulin’s Effects on Glucose
- 4. The Role of Insulin – • Insulin works to maintain blood glucose levels. . . • initiates the process of glucose storage in the liver (glycogenesis) • inhibits the production of glucose from non-CHO sources (gluconeogenesis) • supports the transport of glucose into skeletal muscle and adipose tissue – Increases lipogenesis (storage) • Decreases lipolysis (breakdown) • Increases protein synthesis • Decreases protein degradation
- 5. WHO Definition of Diabetes Mellitus – The term "diabetes mellitus" describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
- 6. Classification of Diabetes Mellitus
- 7. Type 1 Diabetes (Immune- mediated) – 5-10% of all diabetes – Caused by an absolute deficiency of insulin secretion • Autoimmune destruction of pancreatic beta cells – Commonly occurs in childhood and adolescence, but can occur at any age • Rate of beta-cell destruction varies – Risk factors include multiple genetic predispositions and environmental factors
- 8. Type 2 Diabetes 90-95% of all diabetes • Many different causes of this form of diabetes • Specific aetiologies are unknown • Most individuals are obese • ~90% are obese/overweight • Frequently goes undiagnosed • Defective insulin secretion and insufficient to compensate for insulin resistance • Risk increases with age, obesity, and lack of physical activity • Often associated with a strong genetic predisposition
- 9. Gestational Diabetes Mellitus (GDM) – Form of glucose intolerance diagnosed during pregnancy – Common in obese women and women with a family history of diabetes – 15-20 % of all pregnancies are complicated by GDM – Increased risk of developing Type 2 diabetes after pregnancy
- 10. Other forms of diabetes – LADA – Latent autoimmune diabetes in adults, or LADA, is slowly developing autoimmune type 1 diabetes that occurs in adulthood. While type 1 diabetes typically appears in children, has a rapid onset, and requires insulin use immediately, LADA appears in adults, is slow moving, and might not require insulin for months or years. – MODY – Various genes contribute to type 1 and type 2 diabetes, but some forms of diabetes depend on a single gene. There are 12 known types of diabetes caused by the mutation of different single genes. Various genes contribute to type 1 and type 2 diabetes, but some forms of diabetes depend on a single gene. There are 12 known types of diabetes caused by the mutation of different single genes
- 11. Pathophysiology – Type 1 Diabetes is declared after the destruction of 80-85% of Beta-cell mass.
- 12. Pathophysiology of Type 2 Diabetes
- 13. Diabetes Symptoms – The following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they go unnoticed. – Common symptoms of diabetes: – Urinating often – Feeling very thirsty – Feeling very hungry - even though you are eating – Extreme fatigue – Blurry vision – Cuts/bruises that are slow to heal – Weight loss - even though you are eating more – Tingling, pain, or numbness in the hands/feet
- 14. Causes of Diabetes – Type 1 diabetes Viral or bacterial infection Chemical toxins within food Unidentified component causing autoimmune reaction – Type 2 Diabetes Obesity Genetics Living a sedentary lifestyle Increasing age Bad diet
- 15. Diagnosis American Diabetes Association. Standards of Medical Care in Diabetes—2014. Diabetes Care. Volume 37, Supplement 1, January 2014
- 17. Other Complications – Hypoglycemia Severe hypoglycemia (Glucose < 40 mg/dl) Moderate Hypoglycemia (Glucose 40 – 70 mg/dl) Mild Hypoglycemia (Glucose 60 – 70 mg/dl)
- 19. Diabetes treatment – Non Pharmacological treatment Life style Modification – Pharmacological Treatment Obligatory for type 1 diabetes Used when lifestyle intervention alone is inadequate for glycemic control in type 2 diabetes .Treatments administered orally (oral anti diabetic drugs) or by injection. Drugs from different groups can often be used in combination
- 20. Antidiabetic treatment Antihyperglycaemic agents – major sites of action
- 21. Insulin sensitizers – Enhance the effects of insulin
- 22. Insulin secretagogues – Stimulate insulin release from pancreatic β-cells – Different classes act via different receptors – Sulphonylureas are typically longer-acting than meglitinides
- 23. Incretin based therapies There are two types of agent: • GLP-1 (Glucagon like peptide-1) agonists • DPP-4 (Dipeptidyl peptidase-4) inhibitors
- 24. Incretin based therapy – GLP-1 agonists – Mimics native GLP-1
- 25. Incretin based therapy – DPP-4 inhibitors – Dipeptidyl-peptidase 4 inhibitors reduce degradation of GLP 1