Diabetes mellitus

Dr. Essam H. Jiffri

Introduction
- Diabetes mellitus is a heterogeneous
group of disorders characterized by
hyperglycaemia, glycosuria and
associated abnormalities of lipid and
protein metabolism.
-It is common, affecting up to 2% of Westem
populations, 17% in Saudi Arabia.

Introduction
-Insulin metabolism is abnormal in diabetes, either
because of:
reduced secretion or
to insensitivity to its effects.
-Two main types of Diabetes:
Insulin-dependent (IDDM or type 1 diabetes
mellitus, formerly juvenile-onset)
Non-insulin-dependent (NIDDM or type 2
diabetes mellitus, formerly maturity onset)
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Classification of diabetes mellitus

- Insulin
Dependent
( Type I)
Diabetes

Malnutrition
Related
Diabetes
Mellitus

Secondary
Diabetes

-Non-Insulin
Dependent
( Type 2)
Diabetes

Gestational
Diabetes
Mellitus

Impaired
Glucose
Tolerance

Insulin- Dependent )Type I(- 1

Diabetes
-Insulin secretion is absent or severely
reduced in IDDM as a result of
immunological destruction of beta- cells in
the islets of Langerhans.
-Circulating islet cell antibodies are found in
the majority of patients at presentation and
infiltration of the islets by T lymphocytes
also occurs.
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Insulin- Dependent )Type I(- 1

Diabetes
-Genetic factors are important in the
development of IDDM-individuals with
human leukocyte antigen (HLA) system
antigens DR3 and DR4 have increased
susceptibility for IDDM.
-The environmental event effects, usually a
viral infection, particularly with:
Coxsackie B4 or
mumps.
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Insulin- Dependent )Type I(- 1

Diabetes
-Most cases of IDDM present before 30
years of age.
-The clinical presentation is often acute, with
polyuria, polydipsia, polyphagia, weight
loss and tiredness developing over several
days and ketosis may be present.
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2-Non-Insulin-Dependent )Type 2(
Diabetes
-Non-insulin-dependent diabetes is a
heterogeneous group of disorders in which
several features contrast with those found
in IDDM.
-NIDDM has been divided by the World
Health Organization (WHO) into two main
groups:
Obese
Non-obese
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2-Non-Insulin-Dependent )Type 2(
Diabetes
- Insulin secretion is retained, although it is
inadequate to control blood glucose levels.
- There is resistance to the effects of insulin in due
to reduced insulin receptors
-Genetic factors are a more important aetiological
factor in NIDDM than IDDM.
-Identical twins have a near 100% chance and the
risk of developing NIDDM is higher than IDDM if
a parent has the disease.
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2-Non-Insulin-Dependent )Type 2(
Diabetes
-There are no HLA associations and no islet cell
antibodies are found.
- Not all patients with NIDDM are over weight,
there is a clear association with obesity.
- Obese patients develop NIDDM either have:
diminished pancreatic reserve or
a secretory defect in the pancreatic betacells
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2-Non-Insulin-Dependent )Type 2(
Diabetes
-Clinical onset is usually in middle age and
the prevalence increases with age.
- NIDDM is often detected by urine testing
during a routine medical examination.
- Patients may complain of polyuria and
polydipsia, ketosis is rare.
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3- Malnutrition-Related Diabetes
Mellitus
-Found mainly in developing countries due
to protein-deficient diabetes.
-The aetiology of these is not clear.

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4- Diabetes Associated with Other

Disorders )Secondary Diabetes(
- Diabetes may occur in association with
other conditions, particularly pancreatic
disorders such as:
chronic pancreatitis
haemochromatosis may cause destruction
of beta-cells.

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4- Diabetes Associated with Other

Disorders )Secondary Diabetes(
-Endocrinopathies (endocrine disorders)
which result in:
- increased secretion of counter-regulatory
hormones can induce insulin resistance.
-Diabetes occurs in association with several
genetic disorders, including:
Turner's syndrome
Down's syndrome
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5- Gestational Diabetes Mellitus

- Gestational diabetes occurs for the first time in
pregnancy.
- Glycosuria is common because the renal
threshold for glucose is exceeded.
- Complications can occur due to blood glucose
concentrations in both mother and fetus.
- Glucose tolerance reverts to normal after delivery
in most cases many later develop frank
diabetes.
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6- Impaired Glucose Tolerance

-Impaired glucose tolerance (IGT) is an
asymptomatic condition
-Diagnosed on the basis of the response of
blood glucose to the ingestion of a
standard oral glucose solution (oral
glucose tolerance test, OGTT; 75g
anhydrous sugar in 300 ml water, blood
and urine samples taken at 2h).
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KEY POINTS
Type 1 diabetes mellitus is characterized
by insulin deficiency
Type 2 diabetes mellitus is characterizedby insulin resistance-

Diabetes mellitus is diagnosed byclinical features and blood glucose. measurements or an oral glucose tolerance test 18