M3L1 Diabetes Overview and Type 1

San Diego State University ENS 332/333 Pathophysiology Diabetes Lecture 1

Abbreviations

  • T1DM – Type 1 Diabetes Mellitus

  • T2DM – Type 2 Diabetes Mellitus

  • OGTT – Oral Glucose Tolerance Test

  • HbA1c – Glycosylated Hemoglobin

  • BG – Blood Glucose

  • PBG – Postprandial Blood Glucose

  • FBG – Fasting Blood Glucose

  • CGM – Continuous Glucose Monitor

Historical Introduction

Early Observations of Diabetes

  • 1,552 B.C.: Egyptian physician Hesy-Ra noted symptoms like frequent urination and emaciation as indicators of a mysterious disease.

  • 500 B.C.: Indian surgeon Sushruta utilized ants to detect diabetes through patient urine; noted higher prevalence among the wealthy.

  • Ebers Papyrus (c. 1550 B.C.): Early evidence of diabetes in Egyptian texts.

Development of Understanding

  • 150 A.D.: Aretaeus of Cappadocia described the disease, emphasizing incessant urination and chronic thirst.

  • 200 A.D.: Zhang Zhongjing highlighted polyuria, polydipsia, and weight loss as key symptoms.

  • 1,600's: Thomas Willis referred to diabetes as the “pissing evil” and noted the sweetness of urine, establishing the term "mellitus".

Advances in Diabetes Understanding

Significant Discoveries

  • 1700s: Matthew Dobson demonstrated sugar presence in urine through boiling methods.

  • 1857: Claude Bernard discovered glycogen through experimental methods in canines.

  • 1889: Oskar Minkowski and Joseph Von Mering established the pancreas's critical role in diabetes through further canine studies.

  • 1923: Frederick Banting and John MacLeod's discovery of insulin won them Nobel Prize in Medicine.

Insulin Use

  • 1922: Insulin treatment began in a diabetes ward for children, focusing on those experiencing diabetic ketoacidosis.

Summary of Technological Progress in Diabetes Care

  • 1920s: Introduction of NOVO insulin by Frederick Banting and Charles Best.

  • 1960s: Development of the first self-monitoring blood glucose devices.

  • 1990s: Enhanced focus on continuous glucose monitoring (CGM) systems.

  • 2020s: Ongoing advancements in automated insulin delivery systems and smart insulins.

Current Diabetes Landscape

Prevalence Data

  • CDC: Reports state 53% of US adults are diagnosed with diabetes, with undiagnosed cases at 23% and 38% having pre-diabetes.

  • UCLA: Indicates that approximately 55% of Americans have diabetes, with older age demographics showing greater prevalence.

  • Projected Costs: Diabetes and pre-diabetes costs the US $322 billion annually, significantly impacting healthcare systems and patient quality of life.

Understanding the Pathophysiology of Type 1 Diabetes

Etiology and Mechanism

  • T1DM: An autoimmune condition leading to the destruction of insulin-producing beta cells in the pancreas.

  • Diagnosis: Involves symptoms of hyperglycemia, laboratory testing, and family history assessments.

Complications Associated with T1DM

Acute Complications

  • Hypoglycemia: Blood glucose levels drop below 70 mg/dl, requiring immediate treatment with quick-acting carbs.

  • Diabetic Ketoacidosis (DKA): Characterized by hyperglycemia (BG > 250 mg/dL), ketosis, and metabolic acidosis. Symptoms include polyuria, nausea, and fatigue.

Chronic Complications

  • Macrovascular: Leading causes of death include cardiovascular diseases with associated risks of myocardial infarctions and strokes.

  • Microvascular: Involves complications like neuropathy, nephropathy, and retinopathy leading to severe health implications.

  • Additional Complications: Hearing issues, depression, erectile dysfunction, reduced immune response, and oral health problems.

Conclusion

  • Diabetes remains a vast public health challenge, necessitating ongoing research and advancements in treatment strategies. Effective management of T1DM is crucial for enhancing patient outcomes and preserving quality of life.