Documente Academic
Documente Profesional
Documente Cultură
Prof Seamus Sreenan Dept of Diabetes and Endocrinology, Connolly Hospital, Blanchardstown
Learning Objectives
What diabetes mellitus means The difference between types-1 and -2 diabetes How the different types are treated The reasons for the current epidemic of diabetes and how it can be prevented What the complications of diabetes are and how they can be prevented
What is Diabetes?
Diabetes Mellitus (sugar diabetes) is a disease characterized by high levels of sugar (glucose) in the blood
Insulin keeps blood sugar level within the normal range for health
Islet of Langerhans:
Pancreas contains insulin-making cells in islets
Insulin b-cells
Diabetes in a nutshell
Insufficient insulin to meet the bodys needs Either a complete lack (type 1) or relative lack (type 2)
Treatment aims to keep blood glucose levels as close to the normal range as safely possible
Complications of Diabetes
Short term:
Symptoms of diabetes Dehydration Diabetic Coma Infections Kidney Eye Heart Circulation Amputation
Long term:
Symptoms of Diabetes
People with diabetes often have typical complaints (symptoms): Thirst and frequent drinking More frequent urination, particularly at night
Case 1
JN 32 year old male Referred to Emergency Dept by GP Complaining of thirst, excessive urination, half stone weight loss in the last 6 weeks No relevant past history First cousin has diabetes on insulin On no regular medications Thin man Blood sugar level = 24.7 mmol/L
Type 1 (15%): Due to total lack of insulin insulin treatment is required for life
Type 2 (85%): Plenty of insulin which does not work very well in the body. Insulin treatment may be required at some stage but is not required in all patients
Type 1 Young age Normal BMI, not obese No immediate family history Short duration of symptoms (weeks) Can present with diabetic coma (diabetic ketoacidosis) Insulin required
Type 2 Middle aged, elderly Usually overweight/obese Family history usual Symptoms may be present for months/years Do not present with diabetic coma Insulin not necessarily required Previous diabetes in pregnancy
JN
Insulin must be administered into the subcutaneous pocket between fat & muscle & avoid injection into fat or muscle. Can be administered by needle and syringe or by pen device
Aim to replace the need for insulin treatment (Kidney) Pancreas transplantation Islet transplantation not available in Ireland Anti-rejection drugs required Stem cell transplantation - experimental
Case 2
Ms AJ, a 45 year old woman is concerned she may have diabetes She had diabetes during her last pregnancy managed with diet Lately she has been feeling tired but otherwise has no complaints Her mother and one of her two sisters already have diabetes treated with tablets She has been overweight since her last pregnancy and has taken a tablet for blood pressure for the last 2 years She is obese, body mass index 34.5 Blood pressure is 140/90 but otherwise her examination is normal She undergoes a testing and her fasting glucose is 9.4 mmol/L Obese, strong family history, aged in 40s, previous history of diabetes in pregnancy all point to type-2 diabetes
Increasing insulin resistance Hyperinsulinemia, then islet cell failure Abnormal glucose tolerance High sugar levels
Diet and exercise my control condition for some time Variety of tablets available when diet exercise no longer work
Prevalence of Diabetes
Overweight and obesity are diagnosed by measuring weight and height (Body Mass Index (BMI)):
BMI =
Weight in Kg
Height in metres2
Normal = 20-25
Overweight = 25-30
More fibre (fruit and vegetables, wholegrain alternatives for rice, bread)
Cutting down on alcohol consumption
Type-1
1993: Study showed for the first time that good sugar
Type-2
1998: Similar study showed same conclusion for type-2
Important therefore to know that sugar control is good and monitor frequently
Blood test that measures the amount of glucose that has been incorporated into the hemoglobin protein of the red blood cell (RBC). Reflects the lifespan of a RBC, so test will reveal the effectiveness of diabetes therapy for the preceding 8-12 weeks. HbA1c levels remain more stable than sugar levels. Not affected by short-term fluctuations in sugar Normal is 4-6% Evaluated periodically (1-2 per year if well controlled, more frequently if not)
13
11 9 7 5 3 1 6
A1c (%)
10
11
12
1. Adapted from Skyler JS. Endocrinol Metab Clin North Am. 1996;25:243-254. 2. DCCT. N Eng J Med. 1993;329:977-986. 3. DCCT. Diabetes. 1995;44:968-983.
Useful websites