Dr .

Ola Mohsen Al-Akwa’a

 Definition:

Diabetes is a chronic disease in which the body does

not make or properly use insulin, a hormone that is
needed to convert sugar, starches, and other food into
energy by moving glucose from blood into the cells.
 What is Diabetes?
Body does not make or properly use insulin:
– no insulin production
– insufficient insulin production
– resistance to insulin’s effects

No insulin to move glucose from blood into cells:

– high blood glucose means:
 cells starve
short and long-term complications
5
Symptoms of
Diabetes:
Polydepseia
Polyphagia
Polyurea
 Types of diabetes
• Type I diabetes mellitus (TIDM)
• Type 2 diabetes mellitus (TIIDM)
• Gestational diabetes mellitus (GDM)
• Secondary diabetes mellitus " due to drugs or chemicals“
 Type 1 diabetes
– Also known as juvenile diabetes.
– Usually diagnosed in children and young adults.
– When body’s own immune system destroys the
insulin producing cells of the pancreas – beta cells
– which produce insulin so body does not
produce insulin.

– relatively quick onset .

– Is not preventable
• No primary intervention
– Causes?
• genetics - and something in environment
triggers the disease.
 Type 1 vs. Type 2 Diabetes

No insulin (key) means that sugar Insulin (key) cannot unlock the cell
cannot enter the cell. door. Insulin resistance or inability of
body to use insulin.

KBN 2014
 Type 2 diabetes
– Most common form of diabetes – about 90% of cases
– Used to be called adult onset, non insulin dependent
diabetes
– Body produces insulin, but does not use it properly
• glucose doesn’t move into cells, they pile up in the
bloodstream
– sx’s when they do occur are often ignored because
they may not seem serious
 Type 2 Diabetes
• Insulin resistance .

• Age at onset:
➢ Most common in adults.
➢ Increasingly common in children:
• overweight
• inactivity

13
 Gestational diabetes
 A form of glucose intolerance that is diagnosed in some women
during pregnancy.
 Gestational diabetes occurs more frequently among obese
women and women with a family history of diabetes.
 During pregnancy, gestational diabetes requires treatment to
normalize maternal blood glucose levels to avoid complications in
the infant.
 After pregnancy, 5% to 10% of women with gestational diabetes
are found to have type 2 diabetes.
 Women who have had gestational diabetes have a 20% to 50%
chance of developing diabetes in the next 5-10 years.
 Secondary DM
Secondary causes of Diabetes mellitus include:
 Cushing syndrome( high levels of cortisol)
 Acromegaly
 Thyrotoxicosis
 Pheochromocytoma )tumor of adrenal gland )
 Chronic pancreatitis
 Cancer
 Drug induced hyperglycemia:
➢ Atypical Antipsychotics - Alter receptor binding characteristics, leading to
increased insulin resistance.
➢ Beta-blockers , Calcium Channel Blockers and Thiazide Diuretics - Inhibit
insulin secretion.
➢ Fluoroquinolones Inhibits insulin secretion
➢ Corticosteroids - Cause peripheral insulin resistance and gluconeogenesis.
Pre diabetes: Impaired glucose tolerance and impaired
fasting glucose
 Pre diabetes is a term used to distinguish people who are at
increased risk of developing diabetes. People with pre diabetes
have impaired fasting glucose (IFG) or impaired glucose tolerance
(IGT). Some people may have both IFG and IGT.

 IFG is a condition in which the fasting blood sugar level is elevated

(100 to 125 mg/dL) after an overnight fast but is not high enough
to be classified as diabetes.

 IGT is a condition in which the blood sugar level is elevated (140 to

199 mg/dL after a 2-hour oral glucose tolerance test), but is not
high enough to be classified as diabetes.
 Pre diabetes

• Progression to diabetes among those with pre diabetes

is not unavoidable. Studies suggest that weight loss and
increased physical activity among people with pre
diabetes prevent or delay diabetes and may return
blood glucose levels to normal.

• People with pre diabetes are already at increased risk

for other adverse health outcomes such as heart
disease and stroke.
Metabolic changes in diabetes

Hyperglycemia, is the metabolic abnormality that has been

used to define the presence of diabetes.
 ➢ weight loss
➢ increase in level of
amino acids in blood
increase formation of ➢ more formation of
cholesterol & risk of urea by deamination
atherosclerosis of amino acid.
Diabetic ketoacidosis (DKA) is a serious condition that can lead to
diabetic coma (passing out for a long time) or even death.

When your cells don't get the glucose they need for energy, your body begins to
burn fat for energy, which produces ketones.

Ketones are chemicals that the body creates when it breaks down fat to use for
energy. The body does this when it doesn’t have enough insulin to use glucose.

When ketones build up in the blood, they make it more acidic. They are a
warning sign that your diabetes is out of control or that you are getting sick.

High levels of ketones can poison the body. When levels get too high, you can
develop DKA.

Treatment for DKA usually takes place in the hospital. But you can help prevent it
by
learning the warning signs and checking your urine and blood regularly.
What are the warning signs of DKA?
DKA usually develops slowly. But when vomiting occurs, this life-
threatening condition
can develop in a few hours. Early symptoms include the following:
• Thirst or a very dry mouth
• Frequent urination
• High blood glucose (blood sugar) levels
• High levels of ketones in the urine
Then, other symptoms appear:
• Constantly feeling tired
• Nausea, vomiting, or abdominal pain
• Difficulty breathing
• Fruity odor on breath
• A hard time paying attention, or confusion
Ketoacidosis (DKA) is dangerous and serious. If
your patient have any of the above symptoms,
contact health care provider IMMEDIATELY, or go to
the nearest emergency room in hospital.
 Hypoglycemia
• When blood glucose falls below 60 mg/dl.

• Causes:
1. Most commonly seen in overdose of insulin in treatment of
DM.
2. Hypothroidism.
3. Insulin secreting tumours of pancrease – rare.
4. Hypoadrenalism (Addison's disease)
5. Hypopitruitism.
6. Severe exercise.
7. Starvation.
Oral Complications and Manifestations of Diabetes Mellitus:

Several soft tissue abnormalities have been reported to be associated with

diabetes:
➢ periodontal diseases (periodontitis and gingivitis).
➢ Salivary dysfunction leading to a reduction in salivary flow and changes in
saliva composition, and taste.
➢ Oral fungal and bacterial infections.
➢ There are also reports of oral mucosa lesions in the form of stomatitis,
geographic tongue, benign migratory glossitis, fissured tongue, lichen planus,
lichenoid reaction and angular Chelitis.
➢ Delayed mucosal wound healing.
➢ Mucosal neuro-sensory disorders.
- Is group of tests that are used to diagnose diabetes or its
complications , it includes:
1. C-peptide
2. Blood glucose (4 types: FBS, PPBS, RBS, OGTT)
3. HbA1C
4. Insulin
5. ICA (islet cell antibody) for type I
6. Ketones
7. Microalbuminurea.
 1- C-peptide:
❑ This test is used to differentiate between
type I and II diabetes:
type I DM: low level of insulin and C-peptide
type II DM: normal or high level of C-peptide

❑ Normal value:
Fasting 0.5 - 2.7 ng/ml
❑ Advantages of measuring C-peptide than insulin:
• It is better indicator of B-cell function than peripheral insulin.

• Because C-PEPTIDE has a longer half-life than insulin (2-5 times

longer).

• For these reasons, in plasma C-PEPTIDE concentrations may

reflect pancreatic insulin secretion more reliable than the level
of insulin itself.
 2- Blood glucose:
Types of blood glucose tests:
(4 types: FBS, PPBS, RBS, OGTT)

(1) Fasting blood sugar (FBS):

• measures blood glucose after fasting for at least 8-12 hrs
• It often is the first test done to check for diabetes.
• patient with mild or borderline diabetes may present with
normal FBG values.
• If diabetes is suspected, GTT can confirm the diagnosis.

Normal levels:
60-110mg/dl
(2) Post-Prandial Blood Sugar (2-hour PPBS):
• After the patient fasts for 12 hours, a meal is given which
contains starch and sugar (approx. 100 gm).
• Then after 2 hours blood is collected to measure glucose level.
• Home blood sugar test is the most common way to check 2-hour
postprandial blood sugar levels.
(3) Random blood sugar (RBS)
• measures blood glucose randomly at any time throughout
the day without patient fasting.

• it is useful because glucose levels in healthy people don’t

vary widely throughout the day.

• blood glucose levels that vary widely may indicate a

problem.
(4) Oral glucose tolerance test (OGTT)
• Glucose Tolerance is defined as the capacity of the body
to tolerate an extra load of glucose or it measures the
body's ability to use glucose.

• it is series of blood glucose measurements taken after

drink glucose liquid
• It is considered as definitive diagnostic test for DM.
• It is ordered to:
- confirm the diagnosis, in pre-diabetic
- diagnose gestational diabetes (most commonly)
Procedure:
• Arrive FBS: After an overnight fasting of 12-16 hrs
• Drink: 75-100g dissolved in 250-300ml of water and
given orally.
• After drink: blood samples and urine are collected every
30min for 3hrs (1 hr, 1.5 hr , 2hr, 2.5hr, 3hr )
• A curve between time and blood glucose concentration, is
plotted.
 Interpretation:

• Normal Response :
FBS is normal. After 1 hr it will rise,
returns to normal fasting level within 2
hours.

• Diabetic curve :
FBS: 140mg/dl or 7.8 mmol/L. After
2 hr: 200mg/dl (11 mmol/L) or more.
Glucosuria is usually seen
 3- HbA1c:
• HbA1C: is glucose bound to hemoglobin
• Measures blood glucose conc. over a longer period of time
• it indicates how well diabetes has been controlled in the
2-3 months before the test.

• The A1C level is directly related to complications from

diabetes (lower the A1C level lower risk for
complications)
3- HbA1C
 4. Insulin blood test
What is it used for?
An insulin in blood test is most often used to:
• Find out the cause of hypoglycemia (low blood sugar).
• Diagnose or monitor insulin resistance.
• Monitor the condition of people with type 2 diabetes.
• Find out if there is a type of tumor on the pancreas, known as an
insulinoma. If the tumor has been removed, the test may be used
to see if it has been done
successfully.

Will I need to do anything to prepare for the test?

You will probably need to fast (not eat or drink) for eight hours
before the test.
What do the results mean?
If your insulin levels were too high, it may mean you have:
• Type 2 diabetes
• Insulin resistance
• Hypoglycemia
• An insulinoma (pancreatic tumor).

If insulin levels were too low, it may mean you have:

• Hyperglycemia (high blood sugar)
• Type 1 diabetes
• Pancreatitis, an inflammation of the pancreas.
 5. Islet autoantibodies:
Islet autoantibodies are proteins produced by the immune system that have
been shown to be associated with type 1 diabetes.

Testing can detect the presence of one or more of these autoantibodies in the
blood.

Type 1 diabetes was previously known as juvenile or insulin-dependent

diabetes but has been re-characterized to reflect absolute insulin deficiency.
When autoimmune type 1 diabetes is present, one or more of the islet
autoantibodies will be present in about 95% of those affected at the time of
initial diagnosis.

With type 2 diabetes, the autoantibodies are typically absent.

 6. ketones
How do I check for ketones?
You can detect ketones with a simple urine test using a test strip.

check for ketones when you have any symptoms of DKA.

What if you find higher-than-normal levels of ketones?

Call your health care provider at once if experience the following conditions:
Your urine tests show high levels of ketones.
Your urine tests show high levels of ketones and your blood glucose level is high.
Your urine tests show high levels of ketones and you have vomited more than
twice in four hours.

Do NOT exercise when your urine tests show ketones and your blood glucose is
high.

High levels of ketones and high blood glucose levels can mean your diabetes is
out of control.
 7. Screening for Microalbuminuria in Patients with
Diabetes

Why?
To identify patients with diabetic kidney disease (DKD).
To distinguish DKD patients from diabetic patients with chronic
kidney disease (CKD) from other causes. The latter require further
investigation and possibly different clinical management.

Because markers of kidney damage are required to detect early

stages of CKD. Estimated glomerular filtration rate (GFR) alone can
only detect CKD .
Thank you