Facts about Type I Diabetes Mellitus

1. Facts about Type IDiabetes Mellitus

2. “ Diabetes was long thought to be a kidney disease (Greek & Arabic Methodology).

3. “ Thomas Willis (1621 - 1679), discovered the sweetness of urine, hence, the name Diabetes Mellitus arised”

4. “Mathew Dobson (1776), identified glycosuria.

5. “Claude Bernard and Von Mering (1889), discovered in the same year that pancreatectomy causes diabetes”

6. “Fredrick Banting (1921), successfully, extracted insulin, gaining the Nobel prize for this great discovery”.

7. “Leonard Thompson (14 year old boy) & Elizabeth Hughes (aged 14 years), were the first patients to be treated with insulin in 1922.

8. Dear Mom, .. I look entirely different gaining every hour strength & weight....it is truly miraculous.. ..I wish you could see the expression on there faces, they are so astounded in my unheard of progress.. Leonard, April, 1922

10. Insulin Secretion • Site : B cells (Pancreatic Islets of Langerhan’s). • Mechanism : from secretory granules of Proinsulin (in the Golgi complex of B cells). • Factors Related : glucose, gut hormones, A. As., F.As., ketone bodies, nerve supply& glucagon.

11. Insulin Secretion

12. Glu t2 Blood Glucose GLUCOSE GK G-6-P PK PYRUVATES B-Cell + K ATP + INSULIN _ _ + + _ DEPOLARIZATION Ca2+ INSULIN SECRETION

13. Biphasic Glucose Stimulation 1st phase: Rapid onset (with peak level after 1-2 minutes) & Short duration. 2nd phase:Delayed onset & Longer duration.

14. Insulin Secretion Curve Biphasic insulin response to a constant glucose stimulation (IVGTT - hyperglycemic Clamp) Insulin rate Basal Time (min) 4 60

17. Response to I.V. Glucose

18. Insulin Mechanism of action Carbohydrate metabolism Lipid metabolism Protein metabolism

19. Insulin Receptors • Receptor-mediated endocytosis. • Gene transcription. • Glucose transporters.

20. Insulin Receptors

21. Insulin HypoglycemicAction Glucose storage .. Anabolic effect & Anticatabolic effect.

22. Insulin Lack

23. Insulin Deficiency

24. Insulin Defect Complications

25. Sorbitol Pathway

26. Diabetes Mellitus “ A metabolic disorder, with high risk of complications & chronic hyperglycemia (with or without glycosuria) “.

27. Prevalence of Insulin Disorders “ The prevalence worldwide varies from 2-5% in developing countries, to 5-10% in developed countries”. N.B. ( A cross-sectional study revealed incidence of 7million cases in the Egyptian population at the year of 1992).

28. Diabetes: Clinical Features • Symptoms: • Polyuria • Polydypsia = thirst • Polyphagia = appetite • Asthenia & Loss of weight • Signs: • No specific signs may be signs of complications

29. Diagnosis of D. Mellitus American Diabetes Association

30. Investigation of Diabetes • Fasting Blood Glucose level • Post prandial blood glucose level • Glycosuria • Glycosylated haemoglobin.

31. Glycosylated Haemoglobin • Hb + G = HbA1 (non reversible) • In hyperglycemia up to 20% or more. • Occurs in the active life span of the RBCs. • Gives information about the state of BGL • during the previous 2 months.

32. Predisposing FactorsIDDM • Heredity. • Histocomptability. • Virus infection. • Sesonality. • Cell-mediated immunity.

33. Seasonality

34. Stages of IDDM development

35. Age and insulin content

36. Thank You