Diabetes-Mellitus

Unit10DiabetesMellitusTextAProspectsforResearchinDiabetesMellitusTeachingSet-up1.GroupDiscussion2.BackgroundKnowledge3.UnderstandingtheText4.AssignmentWordFormation1.retin/o(retina)e.g.retinopathy2.nephr/o(kidney)e.g.nephropathy3.neur/o(nerve)e.g.neuropathy4.heter/o(different)e.g.heterogeneous5.glyc/o(sugar)6.pharmac/o(pharmacy)7.xeno-(different)e.g.xenograft8.pro-(before)e.g.progenitorGroupDiscussion1.Whatdoyouknowaboutdiabetes?2.Whyisdiabetesviewedasamodernepidemic?3.Howtopreventdiabetesasearlyaspossible?IntroductionDiabetesmellitusisoftenreferredtosimplyasdiabetes(Greek:‘topassthrough’).AndMellitus(Latin,meaning‘honey’,isareferencetothesweettasteoftheurine.)Diabetesmellitusisasyndromeofdisorderedmetabolism,usuallyduetoacombinationofhereditaryandenvironmentalcauses,resultinginabnormallyhighbloodsugarlevels(hyperglycemia).Bloodglucoselevelsarecontrolledbyacomplexinteractionofmultiplechemicalsandhormonesinthebody,includingthehormoneinsulinmadeinthebetacellsofthepancreas.Diabetesmellitusreferstothegroupofdiseasesthatleadtohighbloodglucoselevelsduetodefectsineitherinsulinsecretionorinsulinactioninthebody.Diabetesdevelopsduetoadiminishedproductionofinsulin(intype1)orresistancetoitseffects(intype2andgestational).Bothleadtohyperglycemia,whichlargelycausestheacutesignsofdiabetes:excessiveurineproduction,resultingcompensatorythirstandincreasedfluidintake,blurredvision,unexplainedweightloss,lethargy,andchangesinenergymetabolism.Allformsofdiabeteshavebeentreatablesinceinsulinbecamemedicallyavailablein1921,butthereisnocure.Theinjectionsbyasyringe,insulinpump,orinsulinpendeliverinsulin,whichisabasictreatmentoftype1diabetes.Type2ismanagedwithacombinationofdietarytreatment,exercise,medicationsandinsulinsupplementation.SignsandsymptomsTheclassicaltriadofdiabetessymptomsispolyuria,polydipsiaandpolyphagia,whichare,respectively,frequenturination,increasedthirstandconsequentincreasedfluidintake,andincreasedappetite.Symptomsmaydevelopquiterapidly(weeksormonths)intype1diabetes,particularlyinchildren.However,intype2diabetessymptomsusuallydevelopmuchmoreslowlyandmaybesubtleorcompletelyabsent.Type1diabetesmayalsocausearapidyetsignificantweightloss(despitenormalorevenincreasedeating)andirreduciblementalfatigue.Allofthesesymptomsexceptweightlosscanalsomanifestintype2diabetesinpatientswhosediabetesispoorlycontrolled.Overviewofthemostsignificantsymptomsofdiabetes.Bothtype1andtype2diabetessharesimilarsymptomscausedbychronicallyhighbloodglucoselevels.Symptomsofbothtype1andtype2diabetesinclude:excessivethirstfrequenturinationweightlossincreasedappetiteunexplainedfatigueslowhealingcuts,bruises,andwoundsfrequentorlingeringinfections(e.g.,urinarytractinfection)moodswingsandirritabilityblurredvisionheadachehighbloodpressuredryanditchyskintingling,numbness,orburninginhandsorfeetManyPatientsareasymptomaticSymptomswhenpresentare:•Polydipsia•Polyphagia•Polyuria•weightloss•Tiredness•RecurrentskininfectionsComplicationsDiabetesanditstreatmentscancausemanycomplications.Acutecomplications(hypoglycemia,ketoacidosis,)mayoccurifthediseaseisnotadequatelycontrolled.Seriouslong-termcomplicationsincludecardiovasculardisease,chronicrenalfailure,retinaldamage(whichcanleadtoblindness),nervedamage(ofseveralkinds),andmicrovasculardamage,whichmaycauseerectiledysfunctionandpoorwoundhealing.Poorhealingofwounds,particularlyofthefeet,canleadtogangrene,andpossiblytoamputation.DiabetesComplicationsHavingdiabetesincreasesyourriskformanyseriouscomplications.HeartDiseaseBlindnessNerveDamageKidneyDamageHeartDisease(cardiovasculardisease)Blindness(retinopathy)NeovascularizationFiberproliferationRetinaldetachmentNerveDamage(neuropathy)KidneyDamage(nephropathy)INFECTIONMACROANGIOPATHYMICROCIRCULATORYDISTURBANCENEUROPATHYCATARACTACROMELICGANGRENEFootulcersareacommoncomplicationofthediabeticfoot.Theyallowaportalforinfectiontooccur.Adequatetreatmentofdiabetes,aswellasincreasedemphasisonbloodpressurecontrolandlifestylefactors(suchasnotsmokingandmaintainingahealthybodyweight),mayimprovetheriskprofileofmostofthechroniccomplications.Inthedevelopedworld,diabetesisthemostsignificantcauseofadultblindnessinthenon-elderlyandtheleadingcauseofnon-traumaticamputationinadults,anddiabeticnephropathyisthemainillnessrequiringrenaldialysisintheUnitedStates.EpidemiologyIn2000,accordingtotheWorldHealthOrganization,atleast171millionpeopleworldwidesufferfromdiabetes,or2.8%ofthepopulation.Itsincidenceisincreasingrapidly,anditisestimatedthatbytheyear2030,thisnumberwillalmostdouble.Diabetesmellitusoccursthroughouttheworld,butismorecommon(especiallytype2)inthemoredevelopedcountries.Thegreatestincreaseinprevalenceis,however,expectedtooccurinAsiaandAfrica,wheremostpatientswilllikelybefoundby2030.Theincreaseinincidenceofdiabetesindevelopingcountriesfollowsthetrendofurbanizationandlifestylechanges,perhapsmostimportantlyaWestern-stylediet.Thishassuggestedanenvironmental(i.e.,dietary)effect,butthereislittleunderstandingofthemechanismatpresent,thoughthereismuchspeculation,someofitmostcompellingl