Diabetes Mellitus

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Diabetes Mellitus

• Type I

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Insulin-dependent / Type I DM

• require insulin
• autoimmune attack on ß-cells
• symptoms when 80 to 90 of ß-cells are
  destroyed

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Glucose tolerance test

• 75 g of glucose after overnight fast
• blood glucose every 30 minutes
• Diabetics
• 140 mg/dL (initial)
• gt 200 mg/dL (follow up)
• Normal
• 70 to 90 mg/dL (initial)
• 140 mg/dL (follow up)
• False-positives may result

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Signs / Symptoms

• 3 Ps
• polyuria
• polydipsia
• Polyphagia
• FBS 140 mg/dL (7.8 mmol/L)
• ketoacidosis

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Metabolic changes in Type I

• Hyperglycemia
• Ketoacidosis
• Hypertriglyceridemia

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Major metabolic events in DM
Decrease
Increase
Insulin
Glucagon
Breakdown of tissue proteins
Lipolysis
Free fatty acids in plasma
Gluconeogenesis
Glycogenolysis
Glucose uptake by tissues
Hepatic output of ketone bodies
Hepatic output of glucose
Ketoacidosis
Hyperglycemia
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Insulin secretory capacity
Acute stress
Honeymoon period
Clinical threshold
Ketoacidosis
12 13 14
Years of autoimmune destruction of ß-cells
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IDDM NIDDM
Age of onset usually young 35
Nutrit. status at onset freq. undernourished commonly obese
Prevalence 10 20 of diagnosed DM 80 - 90 of diagnosed DM
Genetic influence moderate very strong
Defect / deficiency ß-cells eliminated / no insulin prod. ß-cells are insufficient / or receptors lack
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IDDM NIDDM
Ketosis common rare
Plasma insulin low to absent normal to high
Acute complications ketoacidosis hyperosmolar coma
OHA unresponsive Responsive
Insulin treatment always necessary usually not required
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Treatment of Type I

• Insulin treatment
• standard treatment
• intensive treatment