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E tiopathogenesis of Diabetes Mellitus. Dr Shahjada Selim Assistant Professor Department of Endocrinology Bangabandhu Sheikh Mujib Medical University, Dhaka Email: selimshahjada@gmail.com , info@shahjadaselim.com. Diabetes mellitus. Definition: Diabetes mellitus (DM) is a state of
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Etiopathogenesis of Diabetes Mellitus Dr Shahjada SelimAssistant ProfessorDepartment of EndocrinologyBangabandhu Sheikh Mujib Medical University, DhakaEmail: selimshahjada@gmail.com, info@shahjadaselim.com
Diabetes mellitus Definition: Diabetes mellitus (DM)is a state of chronic hyperglycemia due to defect in insulin secretion and or its action. Etiopathogenesis of diabetes by Dr Shahjada Selim
Cell types in pancreatic islets of Langerhans Etiopathogenesis of diabetes by Dr Shahjada Selim
Insulin • Molecular weight of this peptic substance is 6000. • It consists of 51 aminoacidic parts from 16 differentaminoacids Etiopathogenesis of diabetes by Dr Shahjada Selim
Insulin • The most important biologic stimulator of insulin secretion is glucose Etiopathogenesis of diabetes by Dr Shahjada Selim
Insulin is an anabolic hormone (promotes the synthesis of carbohydrates, proteins, lipids and nucleic acids). The most important target organs for insulin action are: Etiopathogenesis of diabetes by Dr Shahjada Selim
Absolute 1. Genetic disorders 2. Autoimmune damaging of β-cells 3. Damaged caused by virusessuch as mumps, or Coxsackie B4 4. Toxic influence on β-cells 5. Diseases of pancreatic gland Relative β-cells Insulin transport Receptors (tissue insensitivity) Insulin insufficiency Etiopathogenesis of diabetes by Dr Shahjada Selim
Etiologic classification of DM (1999) I. Type 1 of DM (destruction of β-cells which mostly leads to absolute insulin insufficiency): autoimmune; idiopathic. II. Type 2 of DM (resistance to insulin and relative insulin insufficiency or defect of insulin secretion with or without resistance to insulin). III. Other specific types: • genetic defects of β-cells function; • genetic defects of insulin action; • pancreatic diseases (chronic pancreatitis; trauma, pancreatectomy; tumor of pancreatic gland; fibrocalculosis; hemochromatosis); • endocrine disease (acromegaly, thyrotoxicosis, Cushing’s syndrome); • drug exposures ; • infections and others. IV. Gestation diabetes. Etiopathogenesis of diabetes by Dr Shahjada Selim
Type 1 • is characterized by pancreatic islet beta -cell destruction and absolute deficiency. • The onset of the disease is generally in youth, but it can occur at any age. Patients have dependence on daily insulin administration for survival. Etiopathogenesis of diabetes by Dr Shahjada Selim
Pathogenesis of type 1 DM Etiopathogenesis of diabetes by Dr Shahjada Selim
Type 2, or noninsulin-dependent diabetes mellitus (NIDDM) • Type 2 is the most common form of diabetes, accounting for 95 – 90 % of the diabetic population. Most investigators agree that genetic factors underlie Type 2 DM, but it is probably not caused by defects at a single gene locus. Etiopathogenesis of diabetes by Dr Shahjada Selim
Pathophysiology of type 2 diabetes GI tract Skeletal Muscle Pancreas Adipocyte Muscle α cells cells Incretin deficiency Altered fat metabolism Hyperglucagonaemia ↑ hepatic sensitivity to glucagon INSULIN RESISTANCE INADEQUATE INSULIN SECRETION ↑ HEPATIC GLUCOSE PRODUCTION CNS Kidney ↑ BLOOD GLUCOSE Enhanced glucose reabsorption CNS, central nervous system; GI, gastrointestinal; T2DM, type 2 diabetes mellitus Cernea S & Raz I. Diabetes Care 2011;34(suppl 2):S264–S271
Pathogenetic and clinical difference oftype I and type II DM Etiopathogenesis of diabetes by Dr Shahjada Selim
Pathogenetic and clinical difference oftype I and type II DM Etiopathogenesis of diabetes by Dr Shahjada Selim
Pathogenetic and clinical difference oftype I and type II DM Etiopathogenesis of diabetes by Dr Shahjada Selim
Pathophysiology of DM Etiopathogenesis of diabetes by Dr Shahjada Selim
Stages of DM development I. Prediabetes (risk factors or predispose factors). II. Impaired glucose tolerance (latent DM). III. Clinical manifestation of DM. Etiopathogenesis of diabetes by Dr Shahjada Selim
Insulin Secretion in Non-Diabetics and Type 2 Diabetics 800 Normal 700 Type 2 DM 600 500 400 Insulin Secretion (pmol/min) 300 200 100 06:00 10:00 14:00 18:00 22:00 02:00 06:00 Clock Time (Hours) O'MEARA et al. Am. J. Medicine, 1990;89 Etiopathogenesis of diabetes by Dr Shahjada Selim
Prediabetes (risk factors or predispose factors) • obesity • positive family history of DM • persons which were born with weight more than 4,0 kg • women who had-children with weight more than 4kg, abortions and dead child in anamnesis; Etiopathogenesis of diabetes by Dr Shahjada Selim
Prediabetes (risk factors or predispose factors) • persons with: atherosclerosis, hypertension • auto-immune diseases • Furunculosis • rubella, mumps, Coxsackie virus, infectious hepatitis, cytomegalovirus, infection mononucleosis; • endocrine disorders Etiopathogenesis of diabetes by Dr Shahjada Selim
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