What is Diabetes Mellitus?

Simply referred to as Diabetes A metabolic disease in which a person has high blood sugar that may be due to two main causes:
The body DOES NOT produce insulin (Type 1) There is INSULIN RESISTANCE wherein the cells of the body does not respond to the insulin that is produced (Type 2)

Classical symptoms are polyuria, polydipsia, polyphagia

Type 1 DM
INSULIN DEPENDENT DIABETES MELLITUS

Type 1 Diabetes Mellitus

Congenital
Juvenile Diabetes

Bodys failure to produce insulin

Loss of Beta cells in the pancreas due to autoimmune attack

Requires the person to inject insulin regularly

In Asia
Cases of babies born in Asia with Type 1 DM has tripled in the past 20 years (Trade Arabia, 03/08/12)
In 1993, 8 out of 100,000 babies are born with Type 1 DM At present time, 25 out of 100,000 babies are born with Type 1 DM

Natural History of the Disease

STAGE 1 : Healthy level Risk factors:
Genetic predisposition Autoimmune inflammation devt of Islet-cell antibodies Viral infection mumps, rubella, CMV may lead to destruction of Beta cells

Natural History of the Disease

STAGE 2 : Subclinical Changes The person may start to exhibit unexplained easy fatigability, lethargy, and loss of weight Tests may be done to confirm the presence of the disease, such as the ff:
Fasting blood sugar (126 mg/dl or higher) Random blood sugar (200mg/ml or higher)

Natural History of the Disease

STAGE 3: Clinical Stage Polyuria, Polydipsia, Polyphagia

Lightheadedness, Irritability, Blurred Vision

Recurring Infections

Wounds that dont heal normally

Natural History of the Disease

STAGE 4: Outcome If there will be no proper management of the disease, fatal consequences can develop, such as:

1. KETOACIDOSIS accumulation of ketones in the blood (acetone breath)

2. GANGRENOUS WOUNDS due to impaired wound healing secondary to poor blood flow Patients are also at high risk for developing cardiovascular diseases (stroke, hypertension, etc.)

GANGRENOUS FOOT

Control and Preventive Measures for Type 1 DM

Diet and Exercise ALONE cannot fully manage the disease but is done alongside a drug treatment plan Pharmacotherapy: INSULIN THERAPY Pancreatic Transplant

Diabetes Mellitus Type 2

Also known as Non-Insulin Dependent Diabetes Mellitus (NIDDM)or Adult Onset Diabetes Mellitus (AODM), Obesity-Related Diabetes

History
230 BC- the term diabetes or to pass through was first used by the Greek Appollonius of Memphis Indian Physician - Sushruta and Charaka in 400-500 AD with type 1 associated with youth and type 2 with being overweight Indian physicians madhumeha or honey urine

History
1500BCE Egyptian manuscript mentioning (too great emptying of the urine) 1921- Insulin became available The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination

History
early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best developed insulin in 1921 and 1922

DM Type 2
lack of sensitivity to insulin by the cells of the body increase in insulin resistance insulin released by the pancreas may also be defective and suboptimal

DM Type 2
Steady decline in beta cell production of insulin Liver continues to produce glucose despite elevated glucose level Early stage, reduced insulin sensitivity Defects in insulin receptor

Incidence
occurs mostly in individuals over 30 years old and the incidence increases with age Regarding age, data shows that for each decade after 40 years of age regardless of weight there is an increase in incidence of diabetes

Prevalence
prevalence of diabetes in persons 65 years of age and older is around 27%

Prevalence Rate
Ethnic Group non-Hispanic Caucasians Asian Americans Hispanics Blacks Native American Women More Common 7% 8% 12% 13% 20% to 50% Occurs more frequently (Gestational Pregnancy)

Cause of DM Type 2
direct result of poor eating habits, higher body weight, and lack of exercise Obesity (direct relationship) strong genetic component to developing DM type 2 (children and adult) The chance of developing DM type 2 doubles for every 20% increase over desirable body weight

Cause of DM Type 2
Hormonal Disturbance
Acromegaly increase growth hormone leading to hyperglycemia Cushing Syndrome increase cortisol increase blood sugar elevation

Infectious diseases Immune-mediated disease Pancreatitis

4 Classic Signs of DM
Polyuria (frequent urination) Polydipsia (increased thirst) Polyphagia (increased hunger) Weight Loss

Later Symptoms of DM
Anorexia Lethargy and depression Vomiting and/or diarrhoea Muscle wastage along the back in cats Oily coat with dandruff in cats

Sudden onset of cataracts

Blindness secondary to degeneration of the retina in the eye

Coma and death

Unusual hind limb gait

Type 2 diabetes in Southeastern Asia (Extrapolated Statistics)

East Timor 59,955 1,019,2522

Indonesia

14,026,643

238,452,9522

Laos

356,948

6,068,1172

Malaysia

1,383,675

23,522,4822

Philippine s
Singapore Thailand

5,073,040

86,241,6972

256,111

4,353,8932

3,815,618

64,865,5232

Vietnam

4,862,517

82,662,8002

Diagnostic Test
Oral Glucose Tolerance Test

Gestational Diabetes Mellitus

1. Occurs in about 2%5% of all pregnancies and may improve or disappear after delivery. 2. Fully treatable, but requires careful medical supervision throughout the pregnancy. 3. About 20%50% of affected women develop type 2 diabetes later in life.

Treating diabetes mellitus can be classified into 4 main areas

Intensive Care Treatment Diet Activity Insulin

 Inci and preva (mortali and morbi) Natural history 4 stages additional

Summary Comparison of type 1 and 2 diabetes

Feature Onset Age at onset Type 1 diabetes Sudden Mostly in children Type 2 diabetes Gradual Mostly in adults

Body habitus
Ketoacidosis Autoantibodies

Thin or normal
Common Usually present

Often obese
Rare Absent Normal, decreased or increased

Endogenous insulin

Low or absent

Concordance in identical twins

50%

90%

Prevalence

~10%

~90%