diabetes slides

Diabetes Mellitus and Metabolic Syndrome

Definition of Diabetes Mellitus (DM)

Diabetes Mellitus (DM) refers to a group of metabolic disorders characterized by chronic high levels of blood glucose due to the body’s inability to produce sufficient insulin or effectively utilize the insulin produced. Persistent hyperglycemia is associated with long-term damage, dysfunction, and failure of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels.

Consequences of Diabetes Mellitus include:

• Cardiovascular Disease (CVD): Increased risk of heart attack and stroke due to damaged blood vessels and neuropathy.

• Renal Damage: Diabetic nephropathy is a common complication leading to kidney failure.

• Peripheral Vascular Disease: Poor circulation can lead to pain and critical limb ischemia.

• Neurological Disorders (Neuropathy): Nerve damage resulting in pain, tingling, and loss of sensation.

• Blindness: Diabetic retinopathy can lead to severe vision loss.

• Amputation: Diabetes is one of the leading causes of lower limb amputation due to infection and poor healing.

Major Categories of DM

1. Type 1 Diabetes Mellitus (T1DM)

Type 1 DM is predominantly an autoimmune disorder where the immune system attacks and destroys pancreatic beta cells, resulting in no insulin production. This type often manifests in childhood or adolescence but can occur at any age. Treatment necessitates lifelong insulin therapy administered via injections or an insulin pump. Complications often include Diabetic Ketoacidosis (DKA), an acute and potentially fatal condition characterized by hyperglycemia, ketonuria, and metabolic acidosis.

2. Type 2 Diabetes Mellitus (T2DM)

Type 2 DM is characterized by a gradual onset of insulin resistance, where cells fail to respond effectively to insulin, coupled with an eventual decline in insulin production. It is strongly correlated with obesity, sedentary lifestyles, and poor dietary habits. Management may involve lifestyle modifications, oral medications, and in some cases, insulin therapy.

3. Gestational Diabetes Mellitus (GDM)

GDM develops during pregnancy due to hormonal changes that enhance insulin resistance. It occurs in about 4% of pregnancies and can increase the risk of complications such as fetal macrosomia (excessive birth weight) and type 2 diabetes in mothers post-pregnancy. Close monitoring and dietary adjustments are vital to managing GDM effectively.

4. Other Specific Types of DM

These include secondary diabetes resulting from conditions like pancreatitis, cystic fibrosis, or due to hormonal disorders such as Cushing's syndrome or acromegaly.

Carbohydrate Metabolism Basics

Insulin plays a critical role in glucose metabolism by facilitating glucose uptake in various tissues, primarily the muscle and liver, via facilitated diffusion. Upon ingestion of carbohydrates, blood glucose levels rise, prompting a corresponding increase in insulin from pancreatic beta cells. This synchronization is crucial for maintaining energy homeostasis.

Carbohydrate metabolism terms

• glucose: Used for energy, stored as glycogen, or converted to component of lipid molecules

• Glycogenesis: glycogen formation primary in liver and muscle

• Glycogenolysis: glycogen breakdown occurs when blood glucose falls and body needs energy
  

Blood Glucose Maintenance During Starvation

During periods of starvation, the body maintains blood sugar levels through gluconeogenesis, where amino acids and glycerol are converted to glucose. Additionally, breakdown of fatty acids leads to the formation of ketones as an alternative energy source. Accumulation of ketones can potentially result in Diabetic Ketoacidosis (DKA), especially in T1DM patients.

Insulin and Its Functions

Insulin facilitates the uptake of glucose by cells for energy and stores excess glucose as glycogen in the liver. It also inhibits lipolysis, serving as a 'fat-sparing' hormone, and it suppresses hepatic gluconeogenesis and the degradation of proteins, thus preserving body protein stores during fasting.

Other Hormones Involved in Glucose Regulation

• Glucagon: Secreted by pancreatic alpha cells, glucagon raises blood glucose levels by promoting glycogenolysis and gluconeogenesis during fasting states.

• Somatostatin: Produced by delta cells, this hormone regulates the endocrine system by inhibiting the release of both insulin and glucagon, thus reducing gastrointestinal activity.

• Cortisol and Epinephrine: Stress hormones that increase blood glucose levels by promoting gluconeogenesis and glycogen breakdown in the liver.

Common Symptoms of DM: The Three P’s

• Polydipsia: An intense thirst that develops due to high blood sugar levels that cause excess moisture loss.

• Polyuria: Increased urine output due to glucose exceeding renal threshold, spilling into urine and leading to osmotic diuresis.

• Polyphagia: The sensation of increased hunger resulting from the body's inability to utilize glucose effectively, leading to energy deficits.

Long-Term Complications of DM

Acute Complications

• Hypoglycemia: Low blood sugar levels that can cause confusion, seizures, or loss of consciousness.

• Hyperglycemia: Sustained high blood sugar can lead to chronic complications over time.

• Diabetic Ketoacidosis (DKA): Severe metabolic condition resulting from lack of insulin, primarily affecting T1DM patients.

• Hyperosmolar Hyperglycemic Syndrome (HHS): Typically occurs in T2DM, featuring extremely high blood sugar (>600 mg/dL) without significant ketone production.

Long-term Complications

If not managed well, diabetes can lead to irreversible complications such as blindness, nephropathy leading to kidney failure, neuropathy affecting lower extremities, increased risk of cardiovascular diseases, and potential amputations due to severe infections or numbness.

Diagnostic Tests for Diabetes

1. Fasting and Random Blood Glucose Tests: Immediate measures of blood glucose levels, critical for diagnosing DM.

2. Oral Glucose Tolerance Test (OGTT): Evaluates how the body processes glucose after ingestion, identifying impaired glucose tolerance or diabetes.

3. Glycated Hemoglobin (A1c): Reflects average blood sugar levels over the preceding 2-3 months, useful in diagnosing and monitoring long-term glycemic control.

Treatment Strategies for Diabetes Management

Effective management of DM includes:

• Lifestyle Modifications: Maintaining an ideal body weight, engaging in regular physical exercise (recommended 150 minutes per week), and adopting a balanced diet.

• Dietary Recommendations: A balanced intake of macronutrients ideally consisting of 40%-50% carbohydrates, 25%-30% healthy fats, and fibers from low glycemic index foods.

• Self-Monitoring Blood Glucose (SMBG): Utilizing glucometers for daily assessments of blood glucose levels, helping in adjusting treatment strategies effectively.

• Medications and Insulin Therapy: Depending on individual needs, oral hypoglycemic agents and insulin therapy may be required to achieve optimal blood glucose control.

Diabetic Foot Care

Regular examination of the feet is crucial for individuals with diabetes to check for loss of sensation, injuries, and wounds. Proper foot care can significantly reduce the risk of complications such as infections or amputations and enhance overall quality of life.

blood glucose levels

• normal BG 70-100

• hypoglycemia less than 70mg

• hyperglycemia BG more than 200mg

• Fasting BG 100-125

• impaired glucose tolerance IGT 126 mg is diabetes

• 200 mg dl diabetes after eating