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Healthcare Communications

Diabetes Mellitus

 

Diabetes Mellitus

Disturbance of metabolism manifesting as chronic hyperglycaemia, due to absolute or relative lack of insulin

 

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

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

 

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

 

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)

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

 

Blood Glucose Levels (mg/100 ml)


 
Normal

Impaired
glucose
tolerance

Diabetes
mellitus
Fasting < 120 < 120 < 120
2 hours after glucose load < 120 120-180 > 180

 

 

Complications Of Diabetes

- Cardiovascular
- Coronary artery disease
- Cerebral thrombosis / stroke
- Peripheral vascular disease
- Eye
- Cataract
- Retinopathy
- Nephropathy
- Neuropathy

 

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