Diabetes
Mellitus
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Diabetes
Mellitus
Disturbance
of metabolism manifesting as chronic hyperglycaemia, due to absolute
or relative lack of insulin
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Types
Non Insulin
Dependent Diabetes Mellitus (NIDDM)
(previously known as maturity onset type)
- Commoner type (90% approx)
- Occurs in adults (usually > 35 yrs age)
Insulin Dependent Diabetes Mellitus (IDDM)
(previously known as juvenile onset type)
- Less common
- Especially affects children + young adults
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Important
Effects of Insulin
1) blood glucose
levels due to
- Glycolysis
- Neoglucogenesis
- glucose uptake by skeletal / cardiac muscle
2) lipid synthesis
3) protein synthesis, breakdown
4) K+ transport into cells
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WHO
Classification of Diabetes
I. Clinical
A. Diabetes
1. Insulin-dependent diabetes mellitus*
2. Non-insulin-dependent diabetes mellitus*
(a) Non-obese
(b) Obese
3. Malnutrition-related diabetes mellitus*
4. Other types of diabetes associated with certain conditions and
syndromes:
(a) pancreatic disease
(b) disease of hormonal aetiology
(c) drug-induced or chemical-induced conditions
(d) abnormalities of insulin or its receptors
(e) certain genetic syndromes
(f) miscellaneous
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WHO Classification
of Diabetes (Contd…)
B. Impaired
glucose tolerance
(a) Non-obese
(b) Obese
(c) Associated with certain conditions and syndromes
C. Gestational diabetes mellitus
II. Statistical risk classes (subjects with normal glucose tolerance
but substantially increased risk of developing diabetes)
1. Previous abnormality of glucose tolerance
2. Potential abnormality of glucose tolerance
*Major classes as suggested by WHO Study Group on Diabetes Mellitus
(1985)
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Clinical
Features
- Classical
triad :
Polyuria (nocturia), polydipsia, polyphagia
- Others :
fatigue, lassitude, aches, pains, cramps, paraesthesiae, vision disturbances,
delayed healing, pruritus vulvae, balanoposthitis, peripheral vascular
disease
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Blood
Glucose Levels (mg/100 ml)
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Normal
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Impaired
glucose
tolerance
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Diabetes
mellitus
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Fasting |
<
120 |
<
120 |
<
120 |
2
hours afterglucoseload |
<
120 |
120-180 |
>
180 |
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Complications
Of Diabetes
-
Cardiovascular
- Coronary artery disease
- Cerebral thrombosis / stroke
- Peripheral vascular disease
- Eye
- Cataract
- Retinopathy
- Nephropathy
- Neuropathy
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Management
- Diet
- Exercise
- Drugs
1) Sulphonylureas
1st generation : tolbutamide, chlorpropamide,acetahexamide, tolazamide
2nd generation : glibenclamide, glipizide, glicazide, gliquidone
2) Biguanides : phenformin, metformin
3) Alpha - glucosides inibitors : acarbose
4) Insulin Sensitisers : troglitazone
5) Insulin : short acting, intermediate, long-acting,biphasic
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