Diabetes Preventive Medicine

8/13/2019 Diabetes Preventive Medicine

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What is Diabetes Mellitus?

Simply referred to as Diabetes

A metabolic disease in which a person has highblood sugar that may be due to two main causes:

The body DOES NOT produce insulin (Type 1)

There is INSULIN RESISTANCE wherein the cellsof the body does not respond to the insulin that is

produced (Type 2)

Classical symptoms are polyuria, polydipsia,polyphagia


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Type 1 DM

INSULIN DEPENDENT DIABETES MELLITUS


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Type 1 Diabetes Mellitus

Congenital

Juvenile Diabetes

Bodys failure to produce insulin

Loss of Beta cells in the pancreas due to autoimmune

attack

Requires the person to inject insulin regularly


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In Asia

Cases of babies born in Asia with Type 1 DM has

tripled in the past 20 years (Trade Arabia, 03/08/12)

In 1993, 8 out of 100,000 babies are born with Type 1DM

At present time, 25 out of 100,000 babies are born

with Type 1 DM


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Natural History of the

Disease

STAGE 1 : Healthy level

Risk factors: Genetic predisposition

Autoimmune inflammationdevtof Islet-cell

antibodies

Viral infectionmumps, rubella, CMV may lead to

destruction of Beta cells


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Disease

STAGE 2 : Subclinical Changes

The person may start to exhibit unexplained easyfatigability, lethargy, and loss of weight

Tests may be done to confirm the presence of the

disease, such as the ff:

Fasting blood sugar (126 mg/dl or higher) Random blood sugar (200mg/ml or higher)


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Disease

STAGE 3: Clinical Stage

Polyuria, Polydipsia,

Polyphagia

Lightheadedness,Irritability, Blurred Vision

Recurring Infections

Wounds that dont healnormally


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Disease

STAGE 4: Outcome

If there will be no proper management of thedisease, fatal consequences can develop, such as:

1. KETOACIDOSISaccumulation of ketones in theblood (acetone breath)

2. GANGRENOUS WOUNDSdue to impairedwound healing secondary to poor blood flow

Patients are also at high risk for developingcardiovascular diseases (stroke, hypertension, etc.)


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GANGRENOUS FOOT


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Control and Preventive

Measures for Type 1 DM

Diet and Exercise ALONE cannot fully manage the

disease but is done alongside a drug treatment plan

Pharmacotherapy: INSULIN THERAPY

Pancreatic Transplant


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Diabetes Mellitus Type 2

Also known asNon-Insulin DependentDiabetes Mellitus (NIDDM)orAdult Onset

Diabetes Mellitus (AODM), Obesity-RelatedDiabetes


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History

230 BC- the term diabetes orto pass throughwas

first used by the Greek Appollonius of Memphis

Indian Physician - Sushruta and Charaka in 400-500 AD

with type 1 associated with youth and type 2 with being

overweight

Indian physicians

madhumeha or honey urine


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History

1500BCEEgyptian manuscript mentioning (too great

emptying of the urine)

1921- Insulin became available

The term "mellitus" or "from honey" was added by the

Briton John Rolle in the late 1700s to separate the

condition from diabetes insipidus, which is alsoassociated with frequent urination


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History

early part of the 20th century, when Canadians Frederick

Banting and Charles Herbert Best developed insulin in

1921 and 1922


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DM Type 2

lack of sensitivity to insulin by thecells of the body

increase in insulin resistance

insulin released by the pancreas

may also be defective andsuboptimal


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DM Type 2

Steady decline in beta cell production of insulin

Liver continues to produce glucose despite elevated

glucose level

Early stage, reduced insulin sensitivity

Defects in insulin receptor


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Incidence

occurs mostly in individuals over 30 years old and the

incidence increases with age

Regarding age, data shows that for each decade after 40

years of age regardless of weight there is an increase in

incidence of diabetes


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Prevalence

prevalence of diabetes in persons 65 years of age and

older is around 27%


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Prevalence Rate

Ethnic Group More Common

non-Hispanic

Caucasians

7%

Asian Americans 8%

Hispanics 12%

Blacks 13%Native American 20% to 50%

Women Occurs more frequently

(Gestational Pregnancy)-


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Cause of DM Type 2

direct result of poor eating habits, higher body weight,

and lack of exercise

Obesity (direct relationship)

strong genetic component to developing DM type 2

(children and adult)

The chance of developing DM type 2 doubles for every

20% increase over desirable body weight


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Cause of DM Type 2

Hormonal Disturbance

Acromegalyincrease growth hormoneleading tohyperglycemia

Cushing Syndromeincrease cortisolincrease bloodsugar elevation

Infectious diseases

Immune-mediated disease

Pancreatitis


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4 Classic Signs of DM

Polyuria (frequent urination)

Polydipsia (increased thirst)

Polyphagia (increased hunger)

Weight Loss


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Later Symptoms of DM

Anorexia

Lethargy and depression

Vomiting and/or diarrhoea

Muscle wastage along the back in cats

Oily coat with dandruff in cats


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Sudden onset of cataracts

Blindness secondary to degeneration of the retina in theeye

Coma and death

Unusual hind limb gait


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Type 2 diabetes in Southeastern Asia (Extrapolated Statistics)

East Timor 59,955 1,019,2522

Indonesia 14,026,643 238,452,9522

Laos 356,948 6,068,1172

Malaysia 1,383,675 23,522,4822

Philippine

s5,073,040 86,241,6972

Singapore 256,111 4,353,8932

Thailand 3,815,618 64,865,5232

Vietnam 4,862,517 82,662,8002


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Diagnostic Test

Oral Glucose Tolerance Test


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Gestational Diabetes Mellitus

1. Occurs in about 2%5% of all pregnancies and may

improve or disappear after delivery.

2. Fully treatable, but requires careful medical supervision

throughout the pregnancy.

3. About 20%50% of affected women develop type 2

diabetes later in life.


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be classified into 4 main

areas Intensive Care Treatment

Diet

Activity

Insulin


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Inci and preva (mortali and morbi)

Natural history

4 stages

additional

S C i f t 1 d 2 di b t


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Feature Type 1 diabetes Type 2 diabetes

Onset Sudden Gradual

Age at onset Mostly in children Mostly in adults

Body habitus Thin or normal Often obese

Ketoacidosis Common Rare

Autoantibodies Usually present Absent

Endogenous insulin Low or absentNormal, decreased

or increased

Concordance

in identical twins50% 90%

Prevalence ~10% ~90%

Summary Comparison of type 1 and 2 diabetes

Diabetes Preventive Medicine

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