Disturbances of carbohydrate

metabolism. Diabetes mellitus.

The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University

under Ministry of Health of the Russian Federation

Lecture presentation

Professor Pirozhkov S.V.

 Department of Pathophysiology

2014-2015 education year

TYPICAL FORMS OF DISORDER OF TYPICAL FORMS OF DISORDER OF CARBOHYDRATE NETABOLISMCARBOHYDRATE NETABOLISM

●● Hypoglycemia (< 3.3 mmol/L of blood)

●● Hyperglycemia (> 5.6 mmol/L of blood)

●● Glycogenoses

●● Aglycogenoses

●● Pentosemia, hexosemia

CAUSES OF HYPOGLYCEMIACAUSES OF HYPOGLYCEMIA

● Neurogenic

● Endocrinogenic

● Hepatic

● Renal

● Inadequate substrate supply

● Use of drugs

SYMPTOMS OF HYPOGLYCEMIA

I. Associated with activation II. Associated with glucose

of the sympathetic system deprivation of the brain

(autonomic response) (neuroglycopenia)

● sweating ● dizziness

● tremor ● headache

● tachycardia ● blurred vision

● anxiety ● poor reasoning

● sharp sensation of hunger ● ataxia

● confusion

● seizures ● loss of consciousness

CAUSES OF HYPERGLYCEMIACAUSES OF HYPERGLYCEMIA

● Neurogenic

● Endocrinogenic

● Alimentary

● Hepatogenic

Diabetes mellitus is a disease or syndrome characterized by systemic derangements of carbohydrate, lipid and protein metabolism, acid-base and water-mineral balance, resulting from absolute or relative deficiency of pancreatic insulin

Epidemiology of diabetes mellitus Epidemiology of diabetes mellitus (DM):(DM):

► Worldwide, more than 140 million people suffer from DM.

► Approximately 80% to 90% of patients have type 2 DM.

► DM increases with ageing. In 2000 the prevalence of DM was:

0.19% in people < 20 years old;

8.6% in people > 20 years old;

20.1% in individuals > 65 years old

Insulin deficiency

KETOACIDOSISPOLYPHAGIA HYPERGLYCEMIA

GLUCAGON EXCESS

Muscle

Kidney

Adipose tissue

Increased lipolysis (free fatty acids)

Increased protein catabolism (amino

acids)

Liver

Gluconeogenesis

Ketogenesis

Metabolic derangements typical for diabetes mellitus type I

POLYURIA

MAIN MANIFESTATIONS OF METABOLIC DISORDERS IN DIABETES MELLITUS

MAIN MANIFESTATIONS OF METABOLIC DISORDERS IN DIABETES MELLITUS

CARBOHYDRATES PROTEINS LIPIDS WATER

Hyperazot-emia, increased blood urea nitrogen

Hyper-glycemia

Glucose-uria

Hyperlactacidemia

Azoturia

ACIDOSIS

Hyper-lipidemia

Ketonemia

Ketoneuria

Polyuria

Poly-dypsia

Genetic aspects of diabetes mellitus type 2:Genetic aspects of diabetes mellitus type 2:

► ► Among identical twins, the concordance Among identical twins, the concordance rate is 70% to 90%rate is 70% to 90%

►► In first-degree relatives with type 2 In first-degree relatives with type 2 diabetes (diabetes (and in non-identical twinsand in non-identical twins), the ), the risk of developing disease is 5 to 10 risk of developing disease is 5 to 10 times higher than in age- and weight-times higher than in age- and weight-matched subjects without a family matched subjects without a family historyhistory

► ► Unlike type I diabetes, the disease is not Unlike type I diabetes, the disease is not linked to any HLA genes linked to any HLA genes

Phases of the clinical course of diabetes mellitus type 2Phases of the clinical course of diabetes mellitus type 2

Resistance Blood insulin Blood glucose to insulin concentration level

I phase moderately increased normal increased

II phase greatly increased hyperglycemia increased after meal

III phase greatly insufficiently hyperglycemia increased increased for in the fasting a particular state glucose level

CHRONIC COMPLICATIONS OF DIABETES MELLITUSCHRONIC COMPLICATIONS OF DIABETES MELLITUS

► Microvascular

● Eye disease

- retinopathy (nonproliferative/proliferative)

- macular edema

● Neuropathy

- sensory and motor (mono- and polyneuropathy)

- autonomic

● Nephropathy

CHRONIC COMPLICATIONS OF DIABETES MELLITUSCHRONIC COMPLICATIONS OF DIABETES MELLITUS

► Macrovascular ● Coronary artery disease

● Peripheral vascular disease

● Cerebrovascular disease

► Other

● Gastrointestinal (gastroparesis, diarrhea)

● Genitourinary (uropathy/sexual disfunction)

● Dermatologic (pigmented pretibial papules)

● Infectious

● Eye diseases (cataract, glaucoma)