DIABETES

DIABETES1

A.Vikas Reddy3rd year M.B.B.S.SSIMS & RC.

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DEFINITIONDiabetes is not a single disease rather it is a heterogeneous group of Syndromes characterized by elevation of blood glucose caused by a relative or absolute deficiency of Insulin.(Lippincotts )

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1.Diabetesis one of the first diseases describedwith an Egyptian manuscript from1500BCEmentioning too great emptying of the urine. The first described cases are believed to be of type 1 diabetes.2.Indian physicians around the same time identified the disease and classified it asmadhumehaorhoney urinenoting that the urine would attract ants.

3.The term "diabetes" or "to pass through" was first used in 250BCE by the GreekApollonius of Memphis.

4.Type 1 andtype 2 diabeteswere identified as separate conditions for the first time by the Indian physiciansSushruta andCharaka with type 1 associated with youth and type 2 with obesity.History of Diabetes3

SEVERITY OF THE PROBLEMThe worldwide prevalence of DM has risen dramatically over the past 2 decades, from an estimated 30 million cases in 1985 to 388 million cases in 2015.4

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6 1.MICROANATOMY AND PHYSIOLOGY OF ENDOCRINE PANCREAS

2.PATHOGENESIS

3.MANAGEMENT

The islets of Langerhans Paul Langerhans7

Frederick Banting, MD, and his then student assistant, Charles Best, MD, extracted insulin from dog pancreas in laboratory space provided by Professor J.J.R. Macleod. They inject the insulin into dogs whose pancreases have been removed, and the animals bloodsugarlevels go down. James Collip purifies the extract so that it can be used in humans. Banting and Macleod were awarded the 1923 Nobel Prize in Physiology.

DISCOVERY OF INSULIN8

9PHYSIOLOGY OF INSULIN SYNTHESIS, SECRETION AND ITS ACTION SYNTHESIS OF INSULIN :-

1.GLUCOSE LEVELS >70mg/dl stimulate insulin synthesis primarily by enhancing protein translation and processing(HNF 4-,HNF 1-,NeuroD1).

2.PRE PROINSULIN(86 A.A)PROINSULIN(84 A.A)INSULIN(A chain-21 A.A,B chain-30 A.A)+C PEPTIDE(31 A.A).

3.Clinical implication:-As C-peptide is cleared more slowly than insulin:-

a)it acts as a useful marker for insulin secretion.

b)allows discrimination of endogenous and exogenous sources of insulin in evaluation of hypoglycaemia.

10MECHANISM OF GLUCOSE STIMULATED INSULIN SECRETION

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12MECHANISM OF ACTION OF INSULIN

DIABETES - AN ICEBERG DISEASE13

Classification of DM14

1.Since chronic DM 2 eventually require insulin treatment for control of hypoglycemia,the use of the term NIDDM created considerable confusion. Thus the terms IDDM & NIDDM are obsolete.

2.A second difference is that age or treatment modality is not a criterion:1.DM 1 common in