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DM I
DM I
Illustration taken from: Lambert C, Bing C. The Way We Eat Now. Harvard Magazine. May-June, 2004;50.
The Problem
20.8 million Americans have diabetes 1.5 million new cases in 2005 more than 3500 each day
Complications of diabetes are a major cause of mortality and morbidity (2002 statistics)
ADA National Diabetes Fact Sheet. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf. Accessed April 11, 2005; ADA Diabetes Statistics. Available at http://www.diabetes.org/utils/printthispage.jsp?PageID=STATISTICS_233181. December 29, 2005.
Countries with the highest numbers of estimated cases of diabetes for 2030
Egypt Philippines Japa n Bangladesh
Brazil
Pakistan Indonesia USA China India 0 20 40 60 80 100
Definition of diabetes
Characterized by hyperglycaemia
Defects in insulin production Autoimmune or other destruction of beta cells Insulin insensitivity
Definition of diabetes
Chronic hyperglycaemia associated with long-term damage to:
Classification
Type 1 diabetes
autoimmune LADA idiopathic Type 2 diabetes
Classification
Other specific types
MODY Defects in insulin action Diseases of the pancreas Endocrine disorders Drug- or chemical-induced Infections
Classification
Uncommon forms of immunemediated diabetes Other genetic syndromes Gestational diabetes
Blood glucose
Glycogen synthesis
Glucose uptake Glycogenolysis Gluconeogenesis (amino acids) Ketone production (fatty acids)
Blood glucose
Glycolysis
Gluconeogenesis (amino acids)
Blood glucose
Blood glucose
Blood glucose
Converted to triglycerides
Clinical diabetes
Pre-diabetes Honeymoon Chronic phase Time (months - years)
No autoimmune markers Permanent insulinopenia Ketoacidosis People of African and Asian origin
Lack of treatment
Autumn/winter peaks
Type 2 diabetes
90%-95% of people with diabetes Insulin insensitivity and relative insulin deficiency Obesity or overweight Complications often present at diagnosis
Insulin resistance and -cell dysfunction are core defects of type 2 diabetes
Genetic susceptibility, obesity, Western lifestyle
Insulin resistance
IR
-cell dysfunction
Type 2 diabetes
Insulin resistance
-cell
Age (years)
Insulin requirements
Insulin insensitivity
Age (years)
Insulin requirements
Insulin insensitivity
Age (years)
Common Symptoms
Classic symptoms increased hunger increased thirst frequent urination weight loss
Others sympmtoms fatigue tingling or numbness in hands and feet recurring infections gums, skin, lung, urinary bladder slow healing blurred vision pruritus vulvae erectile dysfunction
75 g glucose load after 8 hours fasting Readings taken in fasting state and at 1 and 2 hours Possible problems
Urinary ketones
Antibodies
C-peptide
Any degree of glucose intolerance with onset during pregnancy Return to normal glucose regulation after delivery is common Increased perinatal morbidity and mortality if untreated
Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk for GDM (those with marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing as soon as possible
The test should be done in the morning after an overnight fast of 814 h.