Understanding Diabetes Mellitus: Pathophysiology, Diagnosis, and Treatment

2. Endocrine Diseases Dr/Abd Elghany Hefnawy

3. Anterior Posterior PAO PTH Adrenalin,Noradrenalin Corticosteriods T3&T4 Insulin Glucagon

4. Diabetes Mellitus (DM) Dr/Abd Elghany Hefnawy

5. Pathophysiology

6. Sources & control of plasma glucose

7. Sources Fat Glycerol Glycogen Gluconeogenesis Alanin (AA) Glycogen Glycogenolysis Glucose Intestine

8. Control Hormonal control of blood glucose Promotes glycogenesis (formation of glycogen) Insulin (Beta cells) Activation of Acetyl carboxylase enzyme Essential for FFA (Free fatty acids) Triglycerides + Fat (Lipogenesis)

9. Insulin Activation of hexokinase enzyme Essential for Phosphorylation Essential for Glucose entrance and metabolism inside the cells

10. Glucagon (A cells) Stimulates the process of glycogenolysis for formation of glucose Promotes the mobilization of the hepatic storage of glucose to the blood (i.e it has hyperglycemic action)

12. Brain tissue is very sensitive to low glucose level causing secretion of ACTH Growth Hormone Cortisol Lipolysis Increase mobilization of amino acids From the muscles to be converted into Glucose in the liver (Gluconeogenesis) Antagonism of Insulin actions

13. Lipolysis Production of keton bodies Acetone Adour of the breath (Ketoacidotic stage)

14. Definition It is a chronic complex disorder of carbohydrates, lipid and protein metabolism as a result of Inability to produce or utilization of an adequate amount of insulin.

15. Etiology Damage or destruction of pancreatic β-cells due to Trauma or neoplasm Pancreatitis Hereditary Depletion or aplasia Of β-cells (Idiopathic) (I) Insulin dependent DM

16. Overeating causing obesity Excess of growth hormone Excess of Glucagon hormone Excess of Glucocorticoides or cortisol therapy Hyperthyroidism (II) Insulin independent DM

17. Predisposing factors Sex (more in females) Old age (8 years) Adrenalin and nor adrenalin Obese animal

18. Pathogenesis

19. Etiology and predisposing factors Pathogenesis Clinical findings

20. Etiology and predisposing factors Disturbances of entrance of glucose intracellular Low insulin level Hyperglycemia DM

21. When Glucose level more than 180-220 mg/dl Kidney cannot reabsorb glucose Loss of glucose (Energy) Glucosueria Glucose in urine increases the osmotic pressure Dehydration and Thirst Polyueria

22. Polyphagia Loss of glucose (Energy) Glucosueria Dehydration and Thirst Polyueria Polydepsia

23. Clinical signs

24. Polyueria Polyphagia Polydepsia Thirst Dehydration Weakness and emaciation

26. Polyphagia

27. Vomiting Neuropathy Corneal opacity

28. Renal failure Coma & Death Emaciation

29. Diagnosis Case history (Etiology and predisposing factors) Clinical signs Laboratory diagnosis

30. Laboratory diagnosis Glucose GTT (Glucose Tolerant Test) Blood glucose Urine glucose (Glucoseueria) Fasting (60-100 mg/dl) Random (up to 150 mg/dl) When Blood glucose more 180-220 mg/dl

31. GTT (Glucose Tolerant Test)

32. Laboratory diagnosis High Keton bodies High GOT GPT Lipase & Amylase High urine Sp Gravity (N= 1.025) Low Insulin

34. Problems of diabetic dog

35. Treatment and control

36. Mild Moderate Sever Dangerous Restricted Feeding System 80% protein 20% carbohydrate Mild + Oral insulin Or Hypoglycemic drug as chloropamide Mild + S/C Insulin 2IU/Kg Sever + Fluid therapy

37. كفااااااااااااااايه

38. QUESTIONS

39. وسائل التواصل Email: abdelghani72@yahoo.com Abdelghany.hefnawy@bu.edu.eg Facebookabdelghanyhefnawy د.عبد الغني حفناوي Web site to download lectures www.bu.edu.eg/staff/abdelghanyhefnawy (Courses) Tel 01011676482