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Diabetes Mellitus - In Terms of Biochemistry
Diabetes mellitus is a chronic metabolic disorder characterized by insulin deficiency or abnormal insulin use, leading to elevated blood glucose levels and severe health complications such as blindness and renal failure. It affects 2-3% of the population globally and is linked to lifestyle changes that include obesity and reduced physical activity. Effective management requires healthy eating, regular physical activity, and regular medical check-ups to prevent serious complications.
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Diabetes Mellitus - In Terms of Biochemistry
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- 2. 2 of 75Ashok Katta DiabetesMellitus But..we have changed from a primitive hunter- caveman to a sophisticated modern man, especially in the urban areas
- 3. 3 of 75Ashok Katta DiabetesMellitus Gains • Better living conditions • Variety of foods • Better transportation • Better communication Losses • More eating • Less physical activity • More stress
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- 5. Obesity Diabetes Cancer Leading to…. Oxidative Stress Hypertension& cardiovascular diseases
- 6. 6 of 75Ashok Katta DiabetesMellitus Diabetes mellitus is the third leading cause of death (after heart disease & cancer) in many developed countries. It affects about 2 to 3% of the general population. The complications of diabetes affect the eye, kidney and nervous system. Diabetes is a major cause of blindness, renal failure, amputation,heart attacks & stroke. Diabetes mellitus Mellitus
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- 8. 8 of 75Ashok Katta DiabetesMellitus Diabetes Mellitus is a chronic disorder of carbohydrate, protein, & fat metabolism resulting from insulin deficiency or abnormality in the use of insulin. Diabetes is sometimes described as: “STARVATION IN THE MIDST OF PLENTY” There is plenty of glucose circulating in the blood but it cannot get into the cells that need it. It characterised by increased blood glucose level (hyperglycemia) Definition
- 9. Diabetes: A globalemergency
- 10. Diabetes around theworld
- 11. … and thecosts to society are high & escalating Diabetes is a human and economic burden 4.9 million deaths per year 50% of deaths under 60 years of age Intersects with all dimensions of development US$612 billion 11% of worldwide healthcare expenditure
- 12. Diabetes around theworld
- 14. Diabetes around theworld
- 15. Diabetes around theworld
- 16. Diabetes around theworld
- 18. Diabetes around theworld
- 19. 21 of 75Ashok Katta DiabetesMellitus Top 3 countries number of adults with diabetes, 2009 69.2 109.6 29.3 INDIA CHINA US
- 20. 22 of 75Ashok Katta DiabetesMellitus Insulin is the principal hormone in the body – It plays a key role in all forms of diabetes mellitus. – It regulates uptake of glucose from the bloodstream into every muscle and fat cell, – But not into the cells of the central nervous system. • Deficiency of insulin or insensitivity of its receptors Causes Diabetes Miletus
- 21. 23 of 75Ashok Katta DiabetesMellitus • food is converted to glucose before it is used by the blood and body as fuel. • As a result, blood glucose levels in the body rise. • In response to this, the Pancreas release Insulin into the blood. When our body functions normally …
- 22. 24 of 75Ashok Katta DiabetesMellitus When our body functions normally … • about two-thirds of the body's cells use Insulin to • Absorption glucose from the blood • To use as fuel • To convert to other needed chemicals, • for storage.
- 23. 25 of 75Ashok Katta DiabetesMellitus Normal Glucose Absorption Insulin binds to receptors on the cell membrane, much as a key fits into a lock, signal glucose transporters Glucose transporters move to the cell membrane and bind to glucose. Glucose enters the cell.
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- 27. 29 of 75Ashok Katta DiabetesMellitus Classification of DIABETES MELLITUS Type 1 β-Cell destruction Absolute insulin deficiency Autoantibodies Type 2 Other Gestational Islet cell autoantibodies Insulin autoantibodies Glutamic acid decarboxylase autoantibodies Tyrosine phosphatase IA-2 and IA-2B b autoantibodies
- 28. 30 of 75Ashok Katta DiabetesMellitus Classification of DIABETES MELLITUS Type 1 Type 2 Insulin resistance with an insulin secretary defect Relative insulin deficiency Other Gestational
- 29. 31 of 75Ashok Katta DiabetesMellitus Classification of DIABETES MELLITUS Type 1 Type 2 Other Gestational Associated with secondary conditions Genetic disease of β-cell function and insulin action Pancreatic disease Endocrine disease Drug or chemical induced Insulin receptor abnormalities Other genetic syndromes
- 30. 32 of 75Ashok Katta DiabetesMellitus Classification of DIABETES MELLITUS Type 1 Type 2 Other Gestational Glucose intolerance during pregnancy due to metabolic and hormonal changes
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- 32. 35 of 75Ashok Katta DiabetesMellitus Prevalence
- 33. 36 of 75Ashok Katta DiabetesMellitus % of diabetic pop 5-10% 90% Previous names Insulin Dependent DM (IDDM), Juvenile onset DM Non insulin dependent DM (NIDDM), Maturity onset DM Treatment Insulin is always needed Diet, exercise, oral hypoglycemic drugs & insulin in severe cases Frequency of ketosis Very common Rare Acute Complications Hypoglycemia & ketoacidosis Hyperosmolar non ketotic coma Insulin sensitivity Normal Reduced Plasma insulin Low to absent Normal to High Body weight Low to normal Obese Genetic predisposition Moderate Very strong Pattern of onset Symptoms develop rapidly Symptoms appear gradually Age of onset early during childhood or puberty, usually <20yrs Frequently after the age of 35-40 yrs Features Type 1 DM Type 2 DM
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- 35. 38 of 75Ashok Katta DiabetesMellitus Cause and Onset It is caused by lack of Insulin secretion due to destruction of pancreatic beta cells. The cause of beta-cell destructions may be due to…. Viral infection Autoimmune disorder or There may be inhereditary tendency for beta-cell degeneration. Onset The onset of type- I DM occur early during childhood or puberty, usually <20yrs
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- 38. 41 of 75Ashok Katta DiabetesMellitus Polyuria Polydipsia Polyphagia Weight loss Weakness Dry skin Ketoacidosis
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- 40. 43 of 75Ashok Katta DiabetesMellitus Cause and Onset It is caused by decreased sensitivity of target tissues to insulin. This reduced sensitivity of insulin is referred to as insulin resistance. Onset The onset of type- II DM occur after the age of 40 yrs The disorder develops gradually. Therefore this syndrome is referred to as adult onset diabetes.
- 41. 44 of 75Ashok Katta DiabetesMellitus Risk factor Family history of diabetes Obesity (BMI >25 kg/m2) Habitual physical inactivity Race (e.g., African American, Latino, Native American, Asian American,) Previously identified IFG or IGT History of GDM or delivery of baby >4 kg Hypertension (BP >140/90 mmHg) HDL cholesterol level <35 mg/dL and/or a triglyceride level >250 mg/dL Polycystic ovary syndrome
- 42. 45 of 75Ashok Katta DiabetesMellitus Patients can be asymptomatic Polyuria Polydipsia Polyphagia Fatigue Weight loss
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- 46. 49 of 75Ashok Katta DiabetesMellitus Individuals are at much higher risk for developing type 2 diabetes than insulin-sensitive persons also elevated plasma triglycerides, lower (HDLs), and higher blood pressure 25 % of the general obese nondiabetic population has insulin resistance of a magnitude similar to that seen in type 2 diabetes.
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- 48. 51 of 75Ashok Katta DiabetesMellitus Occurs during pregnancy as a result of hormonal influences causing insulin resistance
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- 51. 54 of 75Ashok Katta DiabetesMellitus DIABETES MELLITUS Insulin↓ and glucagon↑ ↓Glucose uptake Hyperglycemia Glucosuria • Osmotic diuresis • Polyuria • Dehydration • Coma • Death ↑Protein catabolism ↑Plasma amino acids ↑Nitrogen loss in urine ↑Gluconeogenesis ↑Lipolysis ↑FFA oxidation ↑Ketogenesis • Ketosis • Coma • Death Metabolic events occurring in diabetes mellitus
- 52. 55 of 75Ashok Katta DiabetesMellitus Acute Metabolic Complications Diabetic Keto Acidosis Ketosis is more common in type 1 diabetes mellitus. Normally the blood level of ketone bodies is less than 1 mg/dl and only traces are excreted in urine (not detectable by usual tests). But when the rate of synthesis exceeds the ability of extrahepatic tissues to utilize them, there will be accumulation of ketone bodies in blood. This leads to ketonemia, excretion in urine (ketonuria) and smell of acetone in breath. All these three together constitute the condition known as ketosis. Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
- 53. Stroke Neuropathy Cardiomyopathy Retinopathy Chronic Complications of DiabetesMellitus Nephropathy
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- 58. 61 of 75Ashok Katta DiabetesMellitus Clinical features of diabetes at diagnosis. Type 1 Diabetes Type 2 Diabetes Polyuria and thirst ++ + Weakness or fatigue ++ + Polyphagia with weight loss ++ – Recurrent blurred vision + ++ Vulvovaginitis or pruritus + ++ Peripheral neuropathy + ++ Nocturnal enuresis ++ – Often asymptomatic – ++
- 59. 62 of 75Ashok Katta DiabetesMellitus Diagnosis of Diabetes Mellitus The following investigations are helpful in diagnosis of DM – Blood glucose estimation – Urine testing for glucose – GTT (Glucose tolerance Test) – HbA1c (Glycated hemoglobin estimation)
- 60. 63 of 75Ashok Katta DiabetesMellitus Fasting blood Glucose Fasting blood glucose is measured after an overnight fast of 8 - 10 hrs. o Fasting blood glucose estimation is better than random blood glucose. o FPG < 100 mg/dL is considered normal; o FPG = 100–125 mg/dL is defined as IFG; and o FPG >126 mg/dL warrants the diagnosis of DM.
- 61. 64 of 75Ashok Katta DiabetesMellitus Detection of urinary glucose (Glucosuria) First-line screening test for diabetes mellitus o Normally glucose does not appear in urine until the plasma glucose rises above 160- 180 mg/dl. o In certain individuals due to low renal threshold glucose may be present despite normal blood glucose levels. o Conversely renal threshold increases with age so many diabetics may not have Glycosuria despite high blood sugar levels. Positive Benedict’s test
- 62. 65 of 75Ashok Katta DiabetesMellitus Paper strip impregnated with glucose oxidase and a chromogen system Sensitive to as little as 0.1% glucose in urine. Urinalysis
- 63. 67 of 75Ashok Katta DiabetesMellitus By nitroprusside tests (Acetest or Ketostix). Do not detect β- hydroxybutyric acid Urinalysis
- 64. 68 of 75Ashok Katta DiabetesMellitus c) Microalbuminuria o May be defined as an albumin excretion rate intermediate between (2.5-25 mg/day). o It is a predictor of progressive renal damage. o Albumin more than 300 mg/day indicates overt diabetic nephropathy. o Microalbuminuria is to be checked at least once in an year. Gradation of turbidity is linked to protein concentration
- 65. 69 of 75Ashok Katta DiabetesMellitus Blood testing procedures Normal carbohydrate diet for 3 days Overnight fast on the day of the test FPG is drawn Give 75gm of anhydrous glucose in about 300ml of water Blood & urine specimens are collected at half hourly for 2hours A curve is plotted for time against blood glucose
- 66. 70 of 75Ashok Katta DiabetesMellitus The Diabetes Expert Committee criteria for evaluating the standard oral glucose tolerance test.1 Normal Glucose Tolerance Impaired Glucose Tolerance Diabetes Mellitus Fasting plasma glucose (mg/dL) < 110 110–125 ≥126 Two hours after glucose load (mg/dL) < 140 ≥140–199 ≥200 Criteria for laboratory confirmation of diabetes mellitus
- 67. 71 of 75Ashok Katta DiabetesMellitus Estimation of Glycated hemoglobin (HbA1c) levels in blood is used as a guide to the degree of control over a long period. Glucose in the blood reacts with the Hemoglobin A to form Glycated Hb. The RBCs of all the people contain a small proportion of HbA1c. The rate of formation is proportional to the glucose levels. So, persons with diabetes have higher proportion of HbA1c than the normal individual. Once formed, glycated Hb, stays within the RBC for its lifetime (120 days). An elevated HbA1c indicates poor control of bl glucose level in the previous 2-3 months, Glycated hemoglobin (HbA1c)
- 68. 72 of 75Ashok Katta DiabetesMellitus (HbA1c)
- 69. 73 of 75Ashok Katta DiabetesMellitus
- 70. 74 of 75Ashok Katta DiabetesMellitus WHO Criteria for Diagnosing DM • A1C ≥ 6.5% OR • FBG ≥126mg/dL OR • 2 hr plasma glucose ≥200mg/dL during OGTT OR • Classic signs of HYPERGLYCEMIA with RBG ≥200mg/dL
- 71. 75 of 75Ashok Katta DiabetesMellitus Management of Diabetes Mellitus Promote healthy eating Promote regular physical activity Having regular check ups
- 72. 76 of 75Ashok Katta DiabetesMellitus Healthy eating plan Stop eating excessive amounts of fats, oils, sugars, salt and limit alcohol intake Eat some but not to much of starchy vegetables, breads, cereals, rice, pasta, dairy products and protein Eat lots of non starchy vegetables and fruit, drinks (Diet soft drinks, water, trim milk)
- 73. 77 of 75Ashok Katta DiabetesMellitus Regular physical activity plan Encourage any kind of physical activity that elevates heart rate e.g. walking, swimming, running, sporting activities for 20-30 minutes per day at least 3 times per week. Taking children to the park or bike riding around the neighbourhood can be a cost free activity.
- 74. 78 of 75Ashok Katta DiabetesMellitus Regular check ups Consistent check ups with health professionals Self-monitoring of blood glucose Capillary blood glucose measurements performed by patients themselves, as outpatients, are extremely useful
- 75. 79 of 75Ashok Katta DiabetesMellitus DexCom system MiniMed system Glucowatch system
- 76. 80 of 75Ashok Katta DiabetesMellitus How to prevent/control diabetes Prevention all starts with a better lifestyle eating healthier being active taking medicine as directed control blood pressure no smoking! check in with your doctor at least once a month have your blood sugar checked along with weight, blood pressure, and feelings Check blood sugar levels daily by using home monitoring device
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- 78. 83 of 75 Contactno. – 07418831766 E mail – [email protected] For more presentation visit - http://www.slideshare.net/ashokktt Dept. of Biochemistry, Dhanalakshmi Srinivasan Medical College, Perambalur Thankyou