DM Flashcards
• Is ametabolic disturbance disease characterized by fasting hyperglycemia…….. due to ………,……..
> 126 mg/di
insufficient insuli release or insulin resistance.
Diabetes Mellitus:
•……… types.
Heterogeneous
Polygenic disease with environmental modifiers (multifactorial).
Insulin-dependent Diabetes Mellitus (IDDM);
Type 1 DM
Cause ?
• Susceptibility alleles are?
• Environmental trigger:
• Auto-immune destruction of islet beta cells leading to decreased
insulin secretion or absolute deficiency.
•Polygenic disease.
• Environmental trigger:
- Viral infections and exposure
to bovine albumin.
• Susceptibility alleles are:
- HLA-DR ,HLA-DR
Protective allele: DR2
Markers for immune destruction of beta cells include
autoantibodies to
glutamic acid decarboxylase (GAD65),
insulin, and tyrosine phosphatase
• There are many
environmental factors that
triggers the initial development of type 1 diabetes.
Viral infection,
Low levels of vitamin D
- Vaccins,
- Cow’s milk feeding in infancy
Vitamin D is believed to help improve
3
Vitamin D is believed to help improve the body’s sensitivity to
insulin. Vitamin D makes B-cells of islets resistant to immune system attacks. Also, it reduces the production of cytokines that kill -cells.
early introduction of cow milk before the age of 1 year increases the risk for Type 1 DM, Many hypotheses explain
• Firstly, Cow milk but not breast milk contain beta lactoglobulin which is similar in structure to human protein glycodelin.
Glycodelin control the activity of T lymphocytes.
-Secondly, a protein called ß casin-1 from cow milk is similar to pancreatic P cells ,this protein confuse the immune system
stimulating it to attack the pancreas.
-Thirdlly, the bovine insulin within the cow milk could be a risk raising
factor.
T
Type 1 DM
• Major phenotypic features:
Age of onset - childhood through adulthood.
-Polyuria, polydipsia, polyphagia.
-Weight loss.
-Hyperglycemia.
Ketosis.
Type 1 DM
Diagnosis
Diagnosis
• Random blood sugar test.
• Fastinge blood sugar test.
• Glycated hemoglobin test
(HbA1C).
Non-Insulin Dependent Diabetes Mellitus type 2
• Results from
imbalance between insulin sensitivity
& insulin secretion,
• Polygenic disease with environmental modifiers.
• Heterogeneous.
Type 2 DM
• Major phenotypic features:
• The greatest risk factors for type 2 DM are…….,……..
-Age of onset: childhood to adulthood,typically occurs in a
dults.
-Hyperglycemia
-Relative insulin deficiency
-Insulin resistance
-Obesity
-Strong family history
- Acanthosis nigricans.
obesity and
family history.
It was demonstrated that Glucokinase mutation
leads to
mild hyperglycemia but not to type 2 DM
development.
Sulfonylurea therapy
In
NIDDM
Acute complication
In IDDM
NIDDM
Acute complication
Ketoacidosis
Hyperosmolar coma
At least eight distinct pathophysiologic abnormalities have been associated with
type 2 diabetes mellitus (T2DM).
1-It is well established that decreased peripheral glucose uptake (mainly muscle)
combined with
2-augmented endogenous glucose production are characteristic features of insulin resistance.
3-Obesity, elevated free fatty acid levels,
4-ß-cell functions is already abnormal at this stage
5-It has been postulated that both impaired insulin and
excessive glucagon secretion in type 2 diabetes
6-the” incretin defect”, defined primarily as inadequate release or response to gastrointestinal incretin hormones upon meal ingestion. (Incretin: GIT hormone which delays gastric emptying,so decrease postprandial hyperglycemia.)
7-hypothalamic insulin resistance(central nervous system) also impairs the ability of circulating insulin to suppress glucose production
8-and renal tubular glucose reabsorption
