DIABETES MELLITUS

DEFINITION

• Group of metabolic disease by hyperglycemia due to defect in

Insulin secretion or insulin action or both

• In short; disease of HIGH Glucose

BASIC OF GLUCOSE METABOLISM

• Cell plasma glucose level regulates up or down by

 Reduced by single hormone : INSULIN only
 Increased by x6 : Somatotropin, Adrenocorticotropin, Cortisol, Epinephrine, Glucagon,
Thyroxin

• THUS, insulin is the only hormone to decrease body glucose level

INSULIN

• Hormone Insulin is produced by pancreas beta cell

• Then it is send to body target cells with insulin receptors
• Once insulin receptor exposed to hormone insulin, it will reduce glucose level
by convert glucose to glycogen and stored in liver and muscle
TYPES OF DM

• Type I
• Due to pancreas beta cell mass reduced, insufficient insulin produced
• Insulin producing beta cell destruction by autoantibodies
• Type II
• Due to insulin receptor on surface of cell decreased, thus less sensitive to insulin
• Desensitization is secondary to long term glucose toxicity
• Others
• Genetic defect, drug/chemical, infection, autoimmune disorder, etc
TYPE II DM
Co-Relates with
• Obesity ( BMI > 25 kg/m2 )
• Genetics ( 90% ) ; especially 1st degree relatives with DM
• Hypertension
• Hyperlipidemia

• Ideal Weight and Risk of hyperglycemia

• x2 if > 20% ideal weight
• x4 if > 40%
• x8 if > 60%
CLINICAL PRESENTATION

• Polyuria : Increased urination frequency / amount

• Polydipsia : Increased thirst
• Polyphagia : Increased appetide / hunger

• Type II DM
• Obesity, HPT, arteriopathy, neuropathy, GIT abN, periodonatal disease, foot abN,
skin abN, unusual susceptibility to infection
DIAGNOSIS & SCREENING

1. FBS fasting blood sugar ( easier, faster, no need to drink sugar liquid )
2. OGTT ( more sensitive than FBS ) oral glucose tolerance test
3. HbA1c for monitoring of disease, not diagnosis
PREVENTION OF DM

• Diet : low fat, low cholesterol

• Exercise
TREATMENT

1. Diet and Exercise

2. Medication
3. Surgery
• Bariatric surgery : operation on stomach / intestine to decrease absorption
MEDICATION
Oral Agents
• Sulfonylureas
• Stimulate pancreatic insulin secretion
• Eg. Gliclazide ( side effect: hypoglycemia )
• Biguanides
• Improve insulin sensitivity
• Eg. Metformin ( side effect: metallic taste, nausea, diarrhea, NOT for renal failure )
• Alpha-glucosidase Inhibitor
• Delay digestion and absorption of carbohydrate ( complex carb not convert to monosaccharide )
• Eg. Acarbose ( side effect: flatulence, NOT for intestine prob )
• Others
• Thiazolidinediones with secretion stimulating function and insulin sensitization effect
• Eg. Rosiglitazone ( side effect: liver toxicity, weight gain, macular edema )
INSULIN INJECTION COMPLICATION

• Hypoglycemia
• Anxiety, palpitation, perspiration, pallor, tachycardiac, HPT, dilated pupil
• Headache, paresthesia, blurred vision, drowsy, irritability, mental confusion
• Lipo-atrophy
• Loss of fat generally
• Lipo-hypertrophy
• At site of injection
• Allergy
ACUTE COMPLICATION OF DM

Life threatening, can lead to death

1. HHS Hyperosmolarity-Hyperglycemic State

2. DKA Diabetic Ketoacidosis

• Both secondary to infection

CHRONIC COMPLICATION OF DM
Secondary to vascular disease
1. Nephropathy
• 40% of patient with DM > 20 years
2. Neuropathy
• 45% - 50% of patient with DM > 30 years
• Foot pain, paraesthesia, loss of sensation esp lower leg / feet
3. Peripheral vascular disease
4. Coronary artery disease
• x2 – 10 higher risk of heart disease
5. Retinopathy