8/13/2019 Diabetes Preventive Medicine
1/33
8/13/2019 Diabetes Preventive Medicine
2/33
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
8/13/2019 Diabetes Preventive Medicine
3/33
Type 1 DM
INSULIN DEPENDENT DIABETES MELLITUS
8/13/2019 Diabetes Preventive Medicine
4/33
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
8/13/2019 Diabetes Preventive Medicine
5/33
8/13/2019 Diabetes Preventive Medicine
6/33
8/13/2019 Diabetes Preventive Medicine
7/33
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
8/13/2019 Diabetes Preventive Medicine
8/33
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
8/13/2019 Diabetes Preventive Medicine
9/33
Natural History of the
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)
8/13/2019 Diabetes Preventive Medicine
10/33
Natural History of the
Disease
STAGE 3: Clinical Stage
Polyuria, Polydipsia,
Polyphagia
Lightheadedness,Irritability, Blurred Vision
Recurring Infections
Wounds that dont healnormally
8/13/2019 Diabetes Preventive Medicine
11/33
Natural History of the
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.)
8/13/2019 Diabetes Preventive Medicine
12/33
GANGRENOUS FOOT
8/13/2019 Diabetes Preventive Medicine
13/33
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
8/13/2019 Diabetes Preventive Medicine
14/33
Diabetes Mellitus Type 2
Also known asNon-Insulin DependentDiabetes Mellitus (NIDDM)orAdult Onset
Diabetes Mellitus (AODM), Obesity-RelatedDiabetes
8/13/2019 Diabetes Preventive Medicine
15/33
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
8/13/2019 Diabetes Preventive Medicine
16/33
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
8/13/2019 Diabetes Preventive Medicine
17/33
History
early part of the 20th century, when Canadians Frederick
Banting and Charles Herbert Best developed insulin in
1921 and 1922
8/13/2019 Diabetes Preventive Medicine
18/33
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
8/13/2019 Diabetes Preventive Medicine
19/33
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
8/13/2019 Diabetes Preventive Medicine
20/33
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
8/13/2019 Diabetes Preventive Medicine
21/33
Prevalence
prevalence of diabetes in persons 65 years of age and
older is around 27%
8/13/2019 Diabetes Preventive Medicine
22/33
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)-
8/13/2019 Diabetes Preventive Medicine
23/33
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
8/13/2019 Diabetes Preventive Medicine
24/33
Cause of DM Type 2
Hormonal Disturbance
Acromegalyincrease growth hormoneleading tohyperglycemia
Cushing Syndromeincrease cortisolincrease bloodsugar elevation
Infectious diseases
Immune-mediated disease
Pancreatitis
8/13/2019 Diabetes Preventive Medicine
25/33
4 Classic Signs of DM
Polyuria (frequent urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger)
Weight Loss
8/13/2019 Diabetes Preventive Medicine
26/33
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
8/13/2019 Diabetes Preventive Medicine
27/33
Sudden onset of cataracts
Blindness secondary to degeneration of the retina in theeye
Coma and death
Unusual hind limb gait
8/13/2019 Diabetes Preventive Medicine
28/33
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
8/13/2019 Diabetes Preventive Medicine
29/33
Diagnostic Test
Oral Glucose Tolerance Test
8/13/2019 Diabetes Preventive Medicine
30/33
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.
8/13/2019 Diabetes Preventive Medicine
31/33
be classified into 4 main
areas Intensive Care Treatment
Diet
Activity
Insulin
8/13/2019 Diabetes Preventive Medicine
32/33
Inci and preva (mortali and morbi)
Natural history
4 stages
additional
S C i f t 1 d 2 di b t
8/13/2019 Diabetes Preventive Medicine
33/33
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