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DIABETES MELLITUS LECTURE NOTES, Lecture notes of Medicine

Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin.

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2020/2021

Uploaded on 08/15/2021

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diabetes
Diabetes is a disease that affects your body’s ability to produce or use insulin. Insulin is a hormone.
When your body turns the food you eat into energy (also called sugar or glucose), insulin is released
to help transport this energy to the cells. Insulin acts as a “key.” Its chemical message tells the cell
to open and receive glucose. If you produce little or no insulin, or are insulin resistant, too much
sugar remains in your blood. Blood glucose levels are higher than normal for individuals with
diabetes. There are two main types of diabetes: Type 1 and Type 2.
Type 1 diabetes
When you are affected with Type 1 diabetes, your pancreas does not produce insulin. Type 1
diabetes is also called juvenile diabetes, since it is often diagnosed in children or teens. This type
accounts for 5-10 percent of people with diabetes.
Type 2 diabetes
Type 2 diabetes occurs when the body does not produce enough insulin, or when the cells are
unable to use insulin properly, which is called insulin resistance. Type 2 diabetes is commonly
called “adult-onset diabetes” since it is diagnosed later in life, generally after the age of 45. 90-95
percent of people with diabetes have this type. In recent years Type 2 diabetes has been diagnosed
in younger people, including children, more frequently than in the past.
Other types diabetes
Gestational diabetes occurs during pregnancy and affects about 18 percent of all pregnancies,
according to the American Diabetes Association.
Gestational diabetes usually goes away after pregnancy, but once you've had gestational diabetes,
your chances are higher that it will happen in future pregnancies. In some women pregnancy
uncovers Type 1 or Type 2 diabetes and these women will need to continue diabetes treatment after
pregnancy.
There seems to be a link between the tendency to have gestational diabetes and Type 2 diabetes, and
many women who had gestational diabetes develop Type 2 diabetes later on. Gestational diabetes
and Type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help
prevent diabetes after gestational diabetes.
Pre-diabetes is a condition that causes a person’s blood sugar levels to be higher than normal but not
high enough to be diagnosed with diabetes. The American Diabetes Association estimates that there
are 41 million Americans that have pre-diabetes in addition to the 18.2 million with diabetes.
Pathophysiology of type 1 diabetes
In this condition the immune system attacks and destroys the insulin producing beta cells of the
pancreas. There is beta cell deficiency leading to complete insulin deficiency. Thus is it termed an
autoimmune disease where there are anti insulin or anti-islet cell antibodies present in blood. These
cause lymphocytic infiltration and destruction of the pancreas islets. The destruction may take time
but the onset of the disease is rapid and may occur over a few days to weeks.
There may be other autoimmune conditions associated with type 1 diabetes including vitiligo and
hypothyroidism. Type 1 diabetes always requires insulin therapy, and will not respond to insulin-
stimulating oral drugs.
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diabetes Diabetes is a disease that affects your body’s ability to produce or use insulin. Insulin is a hormone. When your body turns the food you eat into energy (also called sugar or glucose), insulin is released to help transport this energy to the cells. Insulin acts as a “key.” Its chemical message tells the cell to open and receive glucose. If you produce little or no insulin, or are insulin resistant, too much sugar remains in your blood. Blood glucose levels are higher than normal for individuals with diabetes. There are two main types of diabetes: Type 1 and Type 2. Type 1 diabetes When you are affected with Type 1 diabetes, your pancreas does not produce insulin. Type 1 diabetes is also called juvenile diabetes, since it is often diagnosed in children or teens. This type accounts for 5-10 percent of people with diabetes. Type 2 diabetes Type 2 diabetes occurs when the body does not produce enough insulin, or when the cells are unable to use insulin properly, which is called insulin resistance. Type 2 diabetes is commonly called “adult-onset diabetes” since it is diagnosed later in life, generally after the age of 45. 90- percent of people with diabetes have this type. In recent years Type 2 diabetes has been diagnosed in younger people, including children, more frequently than in the past. Other types diabetes Gestational diabetes occurs during pregnancy and affects about 18 percent of all pregnancies, according to the American Diabetes Association. Gestational diabetes usually goes away after pregnancy, but once you've had gestational diabetes, your chances are higher that it will happen in future pregnancies. In some women pregnancy uncovers Type 1 or Type 2 diabetes and these women will need to continue diabetes treatment after pregnancy. There seems to be a link between the tendency to have gestational diabetes and Type 2 diabetes, and many women who had gestational diabetes develop Type 2 diabetes later on. Gestational diabetes and Type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes. Pre-diabetes is a condition that causes a person’s blood sugar levels to be higher than normal but not high enough to be diagnosed with diabetes. The American Diabetes Association estimates that there are 41 million Americans that have pre-diabetes in addition to the 18.2 million with diabetes.

Pathophysiology of type 1 diabetes

In this condition the immune system attacks and destroys the insulin producing beta cells of the pancreas. There is beta cell deficiency leading to complete insulin deficiency. Thus is it termed an autoimmune disease where there are anti insulin or anti-islet cell antibodies present in blood. These cause lymphocytic infiltration and destruction of the pancreas islets. The destruction may take time but the onset of the disease is rapid and may occur over a few days to weeks. There may be other autoimmune conditions associated with type 1 diabetes including vitiligo and hypothyroidism. Type 1 diabetes always requires insulin therapy, and will not respond to insulin- stimulating oral drugs.

Pathophysiology of type 2 diabetes

This condition is caused by a relative deficiency of insulin and not an absolute deficiency. This means that the body is unable to produce adequate insulin to meet the needs. There is Beta cell deficiency coupled with peripheral insulin resistance. Peripheral insulin resistance means that although blood levels of insulin are high there is no hypoglycaemia or low blood sugar. This may be due to changes in the insulin receptors that bring about the actions of the insulin. Obesity is the main cause of insulin resistance. In most cases over time the patients need to take insulin when oral drugs fail to stimulate adequate insulin release. What causes diabetes? The cause of diabetes is unknown. Genetics, diet, obesity and lack of exercise may play a role in developing diabetes, especially Type 2 diabetes. How does diabetes affect my body? Over time, high blood sugar levels (also called hyperglycemia) can lead to kidney disease, heart disease and blindness. The excess sugar in the bloodstream can damage the tiny blood vessels in your eyes and kidneys, and can harden or narrow your arteries. What are the symptoms of diabetes?

  • Extreme thirst
  • Frequent urination
  • Blurry vision
  • Extreme hunger
  • Increased tiredness
  • Unusual weight loss Pathophysiology behind symptoms and complications of diabetes  Polydipsia or increased thirst is due to high blood glucose that raises the osmolarity of blood and makes it more concentrated.  Polyuria or increased frequency of urination is due to excess fluid intake and glucose- induced urination.  Weight loss occurs due to loss of calories in urine.  Polyphagia or increased hunger due to loss or excess glucose in urine that leads the body to crave for more glucose.  Poor wound healing, gum and other infections due to increased blood glucose providing a good source of nutrition to microbes and due to a diminished immunity.  Heart disease – this occurs due to changes in the large blood vessels leading to coronary, cerebral, and peripheral artery diseases, atherosclerosis, dyslipidemia etc.  Eye damage – this is termed diabetic retinopathy and occurs due to damage of the fine blood vessels of the retina in the eye due to long term exposure to high blood sugar.  Kidney damage – similar damage to small and large blood vessels of the kidneys. Initially there is proteinuria or increased outflow of protein and may lead to end stage renal disease (ESRD).  Nerve damage – this can affect the arms and legs and is called stocking-glove numbness/tingling. It can also affect autonomic functions leading to impotence, erectile dysfunction, difficulty in digestion or gastroparesis etc.