Ms.

Maria Aslam
Assistant Professor
UIDNS
 DIABETES MELLITUS
0 Diabetes mellitus: More commonly referred to as
"diabetes" -- a chronic disease associated with
abnormally high levels of the sugar glucose in the
blood. Diabetes is due to one of two mechanisms:
0 Inadequate production of insulin (which is made
by the pancreas and lowers blood glucose), or
0 Inadequate sensitivity of cells to the action of
insulin.
3
 DEFINITION

0 “Diabetes mellitus is a group of metabolic

diseases characterized by:
0 hyperglycemia resulting from
0 defects in insulin secretion,
0 insulin action,
0 or both”.
Understanding Diabetes
0 Complex disease
0 Digestion breaks
down carbohydrates
 sugar (glucose)
0 Sugar bloodstream
0 Insulin moves sugar
into cells for energy
Body Function Without Diabetes
 TYPES OF DIABETES
MELLITUS

0 Type 1 diabetes
0 Type 2 diabetes
0 Diabetes secondary to
other conditions
0 Impaired glucose
tolerance
0 Gestational
diabetes
 Type 1 Diabetes
0 Insulin-producing cells are destroyed
0 Daily insulin replacement necessary
0 Age at onset: usually childhood, young
adulthood
0 Juvenile Onset Diabetes Mellitus
0 Insulin Dependent Diabetes Mellitus
 Type 2 Diabetes
0 Type 2 diabetes, the pancreas doesn’t make
enough insulin or the body’s cells can’t use
insulin properly (called insulin resistance).
0 This causes glucose to build up in your
blood instead of moving into the cells.
0 Adult Onset Diabetes Mellitus
0 Non Insulin Dependent Diabetes Mellitus
 Type 2 diabetes is associated with older age,
obesity, family history of diabetes, history of
gestational diabetes, impaired glucose
metabolism, physical inactivity, and
race/ethnicity.
 Type 2 diabetes is increasingly being diagnosed
in children and adolescents
 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.
0 Type 1 Diabetes 0 Type 2 Diabetes
0 Type 1 is much rarer than 0 Type 2 diabetes mellitus
type 2 diabetes. affects around 85% of
0 Approximately 15% of people with diabetes.
people with diabetes mellitus 0 Affects people of different
have type 1 diabetes. ethnicities
0 It usually develops at an 0
It is usually diagnosed at a
early age, but can occur at later age than type 1
any time.
diabetes mellitus.
0 People with type 1 diabetes
0 Type 2 diabetes is often,
mellitus have to use daily
but not always, associated
insulin injections to manage
their condition. with excess body weight
and lack of exercise.
 Secondary Diabetes
Secondary diabetes is diabetes that results as a
consequence of another medication, endocrine disease
or hereditary disease.

0 Pancreatic diseases, 0 Drug Therapy

0 Pancreatitis 0 Diuretics
0 Pancreatic cancer 0 Oral contraceptives
0 Thyroid hormones
0 Endocrine diseases as
0 Antidepressants
0 Cushing's syndrome
0 Catecholamines
0 Acromegaly 0 Abnormalities in insulin
0 Primary Aldosteronism receptors
0 Genetic syndromes
 Insulin Resistance
0 Insulin resistance is when cells in your muscles,
body fat and liver start resisting or ignoring the
signal that the hormone insulin is trying to send
out
0 which is to grab glucose out of the bloodstream
and put it into our cells.
0 Glucose, also known as blood sugar, is the
body’s main source of fuel. 
 Honey Moon Phase
0 The honeymoon period (i.e., partial remission) of
type 1 diabetes mellitus is characterized by
reduced insulin requirements while good
glycemic control is maintained.
0 The clinical significance is the potential
possibility for pharmacological intervention
during this period to either slow down or arrest
the ongoing destruction of the remaining beta-
cells.
0 Type 1 diabetes mellitus (T1DM) is an
autoimmune condition that results in low plasma
insulin levels by destruction of beta cells of the
pancreas. As part of the natural progression of
this disease, some patients regain beta cell
activity transiently. This period is often referred
to as the ‘honeymoon period’ or remission of
T1DM. During this period, patients manifest
improved glycemic control with reduced or no
use of insulin or anti-diabetic medications. The
incidence rates of remission and duration of
remission is extremely variable.
 Brittle Diabetes
0 Brittle diabetes also called labile diabetes, is a term
used to describe hard-to-control type 1 diabetes.
People with brittle diabetes frequently experience
large swings in blood sugar (glucose) levels which can
quickly move from too high (hyperglycemia) to too
low (hypoglycemia) or vice versa. This type of
diabetes is very rare, but serious, and may require
hospitalization.
Impaired Fasting Glucose (IFG)

0 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.
 Impaired Glucose Tolerance
IGT

0 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.
 Impaired Glucose Tolerance

0 Impaired glucose tolerance means that blood

glucose is raised beyond normal levels, but not
high enough to warrant a diabetes diagnosis
0 Fasting plasma glucose is less than 140mg per dl
0 Plasma glucose level during oral glucose
tolerance test is intermediate between normal and
diabetic
0 Impaired glucose tolerance (IGT) is a pre-
diabetic state of dysglycemia, that is associated
with
0  insulin resistance and
0 increased risk of cardiovascular pathology.
0 IGT may precede type 2 diabetes mellitus by
many years.
0 IGT is also a risk factor for mortality.
 Prediabetes

 Prediabetes is a term used to distinguish people

who are at increased risk of developing diabetes.
 People with prediabetes have impaired fasting
glucose (IFG) or impaired glucose tolerance
(IGT). Some people may have both IFG and IGT.
 Gestational diabetes
 A form of glucose intolerance that is diagnosed in
some women during pregnancy.
 Gestational diabetes occurs more common 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, 5-10% of women with gestational
diabetes are found to have type 2 diabetes.
0 Women who have had gestational diabetes
have a 20% to 50% chance of developing
diabetes in the next 5-10 years.
0 Gestational diabetes mellitus occurs when
pregnant women have high blood glucose
levels due to hormones produced in
pregnancy.
 LADA
 Latent Autoimmune Diabetes in Adults (LADA) is a
form of autoimmune (Type 1 Diabetes) which is
diagnosed in individuals who are older than the usual
age of onset of type 1 diabetes.
 Alternate terms that have been used for "LADA"
include Late-onset Autoimmune Diabetes of
Adulthood, "Slow Onset Type 1" diabetes, and
sometimes also “Type 1.5”
 Often, patients with LADA are mistakenly thought to
have Type 2 Diabetes, based on their age at the time of
diagnosis.
 MODY
MODY – Maturity Onset Diabetes of the
Young
MODY is a monogenic form of diabetes with
an autosomal dominant mode of inheritance:
◦ Mutations in any one of several transcription factors
or in the enzyme glucokinase lead to insufficient
insulin release from pancreatic ß-cells, causing
MODY.
◦ Different subtypes of MODY are identified based on
the mutated gene.
 Originally, diagnosis of MODY was based on presence
of non-ketotic hyperglycemia in adolescents or
young adults in conjunction with a family history of
diabetes.

 However, genetic testing has shown that MODY can

occur at any age and that a family history of diabetes
is not always obvious.
 CAUSES
0 Type 1 Diabetes:
0 Type 1 diabetes occurs when your immune system, the
body’s system for fighting infection, attacks and destroys the
insulin-producing beta cells of the pancreas. Scientists think
type 1 diabetes is caused by genes and environmental factors,
such as viruses, that might trigger the disease.

0 Type 2 Diabetes
0 Overweight, obesity, and physical inactivity
0 Insulin resistance
0 Genes and family history

0 Gestational Diabetes:
0 Insulin resistance
0 Family history
 SYMPTOMS
Symptoms of diabetes
includes:
0 increased thirst and urination
0 increased hunger
0 fatigue
0 blurred vision
0 numbness or tingling
in the feet or hands
0 sores that do not heal
0 unexplained weight loss
 Classic symptoms of Diabetes

0 Diabetes mellitus may present with

characteristic symptoms such as
0 Polyuria, or excessive urination
0 Polydipsia , or excessive thirst
0 Polyphagia, or increased appetite
0 blurring of vision
0 weight loss
0 In its most severe forms, ketoacidosis or
a non–ketotic hyperosmolar state may
develop and lead to stupor, coma and, in
absence of effective treatment, death.
0 Ketonuria
0 ketonemia
0 Often symptoms are not severe, or may
be absent, and consequently
hyperglycaemia sufficient to cause
pathological and functional changes may
be present for a long time before the
diagnosis is made.