IM Lec#6 By Abdallah Al-oweidi

by **Sura** 3/11/2011, 12:04 am

http://www.mediafire.com/?53s5evbe9hgfv77

by **Shadi Jarrar** 4/11/2011, 7:45 pm

Diabetes mellitus

Physiology:

- Sugar regulating hormone is Insulin

- Insulin is produced in B-cells of the pancreas

- Insulin allow entrance of sugar into the Cells

- Lack/Deficiency of Insulin Induce hyperglycemia

- Insulin resistance induce Hyperglycemia, even when the Insulin is present in normal levels in the blood

- Absolute Deficiency in Insulin causes Diabetes Type 1.

Type 1 Diabetes characterized by: 1- Absolute Deficiency in Insulin

2- Usually in young age patients (early age onset)

3- Treatment by Insulin Injection

Q- What cause B-Cells Deficiency? Answer: Unknown, possibly Autoimmune disease, due to destruction of B-cells.

Note:

- NOT every patient / person that have Insulin Resistance Have Diabetes ( when the B-cells are effective, they can substitute for the increase in demand )

- In case of insulin resistance the pancreas increase the level of insulin release to meet the demands of the body to avoid hyperglycemia, but this doesn’t indicate diabetes mellitus!

2- Diabetes type 2: Insulin Resistance plus Relative B-cells Dysfunction, usually occurs in old age patients, Not insulin dependent But the patient may use Insulin in treatment regimens along with oral hypoglycemic agents.

- Hypoglycemic agents stimulate the B-cells of the pancreas to release more insulin.

3- Gestational Diabetes (discovered during pregnancy): Due to Hormonal changes during pregnancy that induce hyperglycemia and diabetes and ends with labor (Usually).

4- Secondary diabetes: occurs due to a Known cause as a secondary cause to a primary disease or drugs such as Steroids (cortisone, …) or Cushing syndrome (increased endogenous cortisol levels)

Glucose blood levels:-

- Not every increase in blood glucose level is considered as diabetes.

- Fasting blood sugar – FBS - ( 8 hours of fasting before the test )

- Postprandial ( 2 hours after meal )

- Random blood sugar ( anytime during the day independent on meal ingestion )

- Refer to the following table to classify the patient as diabetic or normal.

	Normal	Impaired fasting /Glucose tolerance	Diabetic
FBS	<100 mg/dl	100< X <126 mg/dl	>126mg/dl
Postprandial	<140 mg/dl	140 < X < 200 mg/dl	≥ 200 mg/dl

· Impaired fasting tolerance is considered as the gray zone in between Normal and diabetic and is highly susceptible to become a diabetic.

- Two positive tests not necessarily from the same type can indicate that the patient is diabetic.

- In case of Random blood sugar, if the patient Glucose level was higher than 200 mg/dl can be considered as diabetic only if he has symptoms suggestive of hyperglycemia like ( polyuria , polydipsia )

Q: Do we have to treat Diabetes, why? Yes, Because of the complications of diabetes.

Complications of Diabetes: A- Acute: for type 1 patient: Diabetic acidosis (can be fatal if not treated)

For type 2 patients: Hyperosmolar Non-ketotic state

B- Chronic:

1- Macro :

- Coronary artery disease (CAD ) -ex. Myocardial infarction ,…-----à Most common cause of death in diabetes type 2 patients is CAD particularly atherosclerosis in the heart .

- Cerebral -vascular Disease ( CVD )

- Peripheral-vascular Disease ( PVD )

2- Micro :

- Retinopathy

- Neuropathy

- Nephropathy ( protenuria )

Treatment:

- Type 1 : should be treated by insulin Injection

- - Type 2 : May not be treated by Insulin & may use oral hypoglycemic agents ,

Ex.: 1- sulfonylurea’s (decrease release of glucose by the liver), 2- Metmorfin- known as glucophage - (decrease the resistance to insulin by the cells)

- Type 3 (Gestational type): should be given insulin injection and not oral hypoglycemic agents, because the oral hypoglycemic agents can affect the fetus.

Notes: 1 - 50 % of pregnant women with gestational type diabetes suffer from hypoglycemia after delivery

2 - As long as the glucose blood level is controlled extraction is indicated, but in uncontrolled diabetes we should postpone the extraction procedure unless extremely necessary, because the immune system is impaired and there is high risk of infection.

IM Lec#6 By Abdallah Al-oweidi

IM Lec#6 By Abdallah Al-oweidi

Re: IM Lec#6 By Abdallah Al-oweidi