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 Diabetes Mellitus
 Diabetes is a group of metabolic disorders
characterized by abnormal fuel metabolism,
which results most notably in hyperglycemia and
dyslipidemia, due to defects in insulin secretion,
insulin action, or both. Diabetes is a serious
chronic disease without a cure, and it is
associated with significant morbidity and
mortality, both acute and chronic. Acute
complications are due to severe hyperglycemia.
Chronic complications are characterized by
damage, dysfunction, and eventual failure of
various organs, especially the eyes, kidneys,
nerves, heart, and brain. The common
denominator is vascular damage. See lecture on
Complications of diabetes.
 Type I
 Type 1: Results from the body's failure
to produce insulin. It is estimated that
5-10% of Americans who are diagnosed
with diabetes have type 1 diabetes.
Presently almost all persons with type 1
diabetes must take insulin injections.
 Type II
 Type 2: Results from Insulin resistance, a
condition in which cells fail to use insulin
properly, sometimes combined with relative
insulin deficiency. Most Americans who are
diagnosed with diabetes have type 2
diabetes. Many people destined to develop
type 2 diabetes spend many years in a
state of Pre-diabetes: Termed "America's
largest healthcare epidemic,", pre-
diabetes indicates a condition that occurs
when a person's blood glucose levels are
higher than normal but not high enough for
a diagnosis of type 2 diabetes. As of 2009
there are 57 million Americans who have
pre-diabetes.
 Type I

Figure 3. Pathogenesis of Type 1

Diabetes
 In Type I Diabetes, an autoimmune or idiopathic
process destroys the beta cells, rendering them
incapable of producing insulin. Auto antibodies to
beta cells or the insulin hormone develop in 40%
of patients with type I diabetes and are often
present before the clinical signs and symptoms.
With destruction of beta cells, a state of absolute
insulin deficiency results, requiring lifelong insulin
replacement. Although usually diagnosed in
children and young adults, this condition can
occur at any age- even affecting adults in their
60s and 70s.
Type II
 Type II
 In type 2, a secretory defect of the beta cells
initially results in excessive insulin production
(insulinemia). Insulin production dwindles overtime
and fails to meet the body·s needs. In addition,
insulin resistance develops, in which insulin binds to
the cellular receptors on the muscle, liver and
adipose tissue cells but resistance factors prevent
it from shuttling glucose into the cells where it·s
used for energy or stored as glycogen. This cycle of
impaired production and elevated blood glucose is
thought to contribute to beta cells destruction,
causing many patients with type 2 diabetes
developed only in middle age and beyond, but now
children and adolescents under 20 are being
diagnosed with this disease at an alarming rate, due
to obesity.
 kause of DM Type I
 Type 1 diabetes is believed to be an autoimmune disease. The body's
immune system attacks the cells in the pancreas that produce insulin.

 A predisposition to develop type 1 diabetes may run in families, but

genetic causes (a positive family history) is much more common for type
2 diabetes.

 Environmental factors, including common unavoidable viral infections,

may also contribute.

 Type 1 diabetes is most common in people of non-Hispanic, Northern

European descent (especially Finland and Sardinia), followed by African
Americans, and Hispanic Americans. It is relatively rare in those of
Asian descent.

 Type 1 diabetes is slightly more common in men than in women.

 Cause of
 
 
 DM2Type
Type II has strong
diabetes
genetic links, meaning that type 2 diabetes
tends to run in families. Several genes have
been identified and more are under study
which may relate to the causes of type 2
diabetes. Risk factors for developing type 2
diabetes include the following:
 High blood pressure
 High blood triglyceride (fat) levels
 Gestational diabetes or giving birth to a baby
weighing more than 9 pounds
 High-fat diet
 High alcohol intake
 Sedentary lifestyle
 Obesity or being overweight
 Ethnicity, particularly when a close relative
had type 2 diabetes or gestational diabetes:
certain groups, such as African Americans,
Native Americans, Hispanic Americans, and
Japanese Americans, have a greater risk of
developing type 2 diabetes than non-Hispanic
whites.
 Aging: Increasing age is a significant risk
factor for type 2 diabetes. Risk begins to
rise significantly at about age 45 years, and
rises considerably after age 65 years.
 
  


Àender Males and females Increased among

females
Ethnicity Increased rates among Increased rate among
persons with Northern persons with heritage
European heritage from equatorial
countries

Age of Onset Àenerally under 30 Àenerally over 40

years with peak onset years, although the
before puberty genetic predisposition
is inherited and onset
may be seen at
younger ages
 
 
eta kell functioning: Totally absent (no insulin is
produced) after the
͞honeymoon period͟: residual
insulin is produces for about 1
year after diagnosis
Weight Usually normal or
underweight; unintentional
weight loss often precedes
diagnosis.
Treatment Insulin injections necessary to
prevent death. Food and
exercise have top be balanced


Excess insulin production
usually evident
(hyperinsulinemia), but due to
insulin resistance at the cell
level, there is relative insulin
insufficiency. Insulin
production may also be
normal or below normal
Usually overweight, but may
be of normal weight
Weight loss is usually the first
goal. Reduction of sugar at fat
and increase of fiber (soluble)
helpful. Oral hypoglycemic
agents or insulin or both may
be necessary for good blood
sugar management but are
necessary to prevent
imminent death. Exercise is
important