Diabetes Mellitus

Diabetes Mellitus
Dr. Muhammad Asif Shaheen

Lecturer Pathology
BS Hons. MLT
PGD Clinical Pathology
MS Microbiology and Molecular Genetic
PhD Microbiology and Molecular Genetic
Diabetes mellitus
• Diabetes mellitus is a group of metabolic diseases
characterized by hyperglycemia resulting from defects in insulin
secretion, insulin action, or both.
• Hyperglycemia
• Increase in plasma glucose level
Insulin
• Insulin is a peptide hormone produced by beta cells of the pancreatic islets; it is considered to
be the main anabolic hormone of the body.
• It regulates the metabolism of carbohydrates, fats and protein by promoting the absorption
of glucose from the blood into liver, fat and skeletal muscle cells.
• In these tissues the absorbed glucose is converted into
either glycogen via glycogenesis or fats (triglycerides) via lipogenesis, or, in the case of the liver,
into both.
• Glucose production and secretion by the liver is strongly inhibited by high concentrations of
insulin in the blood.
• Circulating insulin also affects the synthesis of proteins in a wide variety of tissues. It is therefore
an anabolic hormone, promoting the conversion of small molecules in the blood into large
molecules inside the cells.
• Low insulin levels in the blood have the opposite effect by promoting widespread catabolism,
especially of reserve body fat.
Signs and symptoms of DM
• Polydipsia (excessive thirst),
• Polyphagia (increased food intake),
• Ppolyuria (excessive urine production),
• Rapid weight loss in type 1,
• Mental confusion,
• Blurred vision
• Non-or delayed healing scars
• Possible loss of consciousness (due to increased glucose to
brain).
Classification
• Diabetes can be classified into the following general categories:
• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes mellitus (GDM)
• Other Specific types of diabetes due to other causes, e.g.,
• monogenic diabetes syndromes (such as neonatal diabetes and
maturity-onset diabetes of the young [MODY]), diseases of the
exocrine pancreas (such as cystic fibrosis), and drug- or chemical-
induced diabetes (such as in the treatment of HIV/AIDS or after organ
transplantation)
Type 1
• This form, previously called “insulin-dependent diabetes” or “juvenile-onset
diabetes,” accounts for 5–10% of diabetes and is due to cellular-mediated
autoimmune destruction of the pancreatic β-cells. Autoimmune markers include
• islet cell autoantibodies,
• autoantibodies to insulin, autoantibodies to GAD (GAD65),
• autoantibodies to the tyrosine phosphatases IA-2 and IA-2β,
• autoantibodies to zinc transporter 8 (ZnT8).
• Type 1 diabetes is defined by the presence of one or more of these autoimmune
markers.
• The disease has strong HLA associations, with linkage to the DQA and DQB genes.
• Characteristics of type 1 diabetes include
• Abrupt onset,
• insulin dependence,
• ketosis tendency .
Type 2
• This form, previously referred to as “non-insulin-dependent diabetes”
or “adult-onset diabetes,” accounts for ∼90–95% of all diabetes.
• Type 2 diabetes encompasses individuals who have insulin resistance
and usually relative (rather than absolute) insulin deficiency. At least
initially, and often throughout their lifetime, these individuals may not
need insulin treatment to survive.
• Ketoacidosis seldom occurs spontaneously in type 2 diabetes; when
seen, it usually arises in association with the stress of another illness
such as infection.
• Type 2 diabetes frequently goes undiagnosed for many years because
hyperglycemia develops gradually and at earlier stages is often not
severe enough for the patient to notice the classic diabetes
symptoms.
• these patients are more likely to go into a hyperosmolar coma
• Nevertheless, such patients are at an increased risk of developing
macrovascular and microvascular complications.
Risk factors of type 2
• The risk of developing type 2 diabetes increases with
• age,
• obesity,
• lack of physical activity.
• women with prior GDM,
• in those with hypertension or dyslipidemia,
• in certain racial/ethnic subgroups (African American, American Indian,
Hispanic/Latino, and Asian American).
• It is often associated with a strong genetic predisposition,
Gestational diabetes mellitus (GDM)
• Gestational diabetes mellitus (GDM)
• diabetes diagnosed in the second or third trimester of pregnancy that
is not clearly overt diabetes
• GDM carries risks for the mother and neonate.
• There is increased risk of overt diabetes in latter life
What is Prediabetes or Impaired glucose tolerance?
• Before people develop type 2 diabetes, they almost always have

"prediabetes" — blood sugar levels that are higher than normal but
not yet high enough to be diagnosed as diabetes.
• Doctors sometimes refer to prediabetes as impaired glucose tolerance
(IGT) or impaired fasting glucose (IFG), depending on what test was
used when it was detected.
• This condition puts you at a higher risk for developing type 2 diabetes
and cardiovascular disease.
Diagnosis of DM
• HbA1C
• The HbA1C test measures your average blood sugar for the past 2 to 3
months.
• The advantages of being diagnosed this way are that you don't have
to fast or drink anything.
• Diabetes is diagnosed at an A1C of greater than or equal to 6.5%
Result A1C
Normal less than 5.7%
Prediabetes 5.7% to 6.4%
Diabetes 6.5% or higher
Fasting Plasma Glucose (FPG)
• This test checks your fasting blood sugar levels.
• Fasting means after not having anything to eat or drink (except water)
for at least 8 hours before the test. This test is usually done first thing
in the morning, before breakfast.
• Diabetes is diagnosed at fasting blood sugar of greater than or equal
to 126 mg/dl Result Fasting Plasma
Glucose (FPG)
Normal less than 100 mg/dl
Prediabetes 100 mg/dl to 125
mg/dl
Diabetes 126 mg/dl or higher
Random Plasma Glucose Test
• This test is a blood check at any time of the day when you have severe
diabetes symptoms.
• Diabetes is diagnosed at blood sugar of greater than or equal to 200
mg/dl
Oral Glucose Tolerance Test (also called the OGTT)
• The OGTT is a two-hour test that checks your blood sugar levels
before and 2 hours after you drink a glucose solution of 75g. It tells
the doctor how your body processes sugar.
• Diabetes is diagnosed at 2 hour blood sugar of greater than or equal
to 200 mg/dl
Result Oral Glucose Tolerance Test
(OGTT)
Normal less than 140 mg/dl
Prediabetes 140 mg/dl to 199 mg/dl
Diabetes 200 mg/dl or higher
Diagnosis of GDM
• The ADA has recommended the use of either the one- or two-step approach at 24–
28 weeks of gestation in pregnant women not previously known to have diabetes.
• The one-step approach involves performing a 75-g OGTT, with plasma glucose
measurement when the patient is fasting and at 1 and 2 hours in this group of
gravida at 24-28 weeks' gestation.
• Optimally, perform the OGTT in the morning after an overnight fast of at least 8
hours. The diagnosis of GDM is made when any of the following is met or exceeded :
• Fasting: 92 mg/dL (5.1 mmol/L)
• 1 hour: 180 mg/dL (10.0 mmol/L)
• 2 hour: 153 mg/dL (8.5 mmol/L)
• The two-step approach is a 1-hour (nonfasting) plasma glucose
measurement after a 50-g oral glucose load in women at 24-48 weeks'
gestation who were not previously diagnosed with diabetes. If the plasma
glucose level after 1 hours is ≥140 mg/dL perform a fasting 100-g OGTT.
• The diagnosis of GDM is made if at least two of the following four plasma
glucose levels (measured during OGTT) are met or exceeded :
• Fasting: 95 mg/dL (5.3 mmol/L)
• 1 hour: 180 mg/dL (10.0 mmol/L)
Preventing Type 2 Diabetes
• You will not develop type 2 diabetes automatically if you have
prediabetes. For some people with prediabetes, early treatment can
actually return blood sugar levels to the normal range.
• Research shows that you can lower your risk for type 2 diabetes by 58%
by:
• Losing 7% of your body weight (or 15 pounds if you weigh 200 pounds)
• Exercising moderately (such as brisk walking) 30 minutes a day, five
days a week
• Don't worry if you can't get to your ideal body weight. Losing even 10
to 15 pounds can make a huge difference.
Long-term complications of diabetes
• Long-term complications of diabetes develop gradually. The longer you have diabetes — and
the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes
complications may be disabling or even life-threatening. Possible complications include:
• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular
problems, including coronary artery disease with chest pain (angina), heart attack, stroke and
narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart
disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels
(capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness,
burning or pain that usually begins at the tips of the toes or fingers and gradually spreads
upward.
• Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves
related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For
men, it may lead to erectile dysfunction.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel
clusters (glomeruli) that filter waste from your blood. Diabetes can damage this
delicate filtering system. Severe damage can lead to kidney failure or irreversible
end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina
(diabetic retinopathy), potentially leading to blindness. Diabetes also increases
the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases
the risk of various foot complications. Left untreated, cuts and blisters can
develop serious infections, which often heal poorly. These infections may
ultimately require toe, foot or leg amputation.
• Skin conditions. Diabetes may leave you more susceptible to skin
problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people
with diabetes.
• Alzheimer's disease. Type 2 diabetes may increase the risk of dementia,
such as Alzheimer's disease. The poorer your blood sugar control, the
greater the risk appears to be. Although there are theories as to how
these disorders might be connected, none has yet been proved.
• Depression. Depression symptoms are common in people with type 1
and type 2 diabetes. Depression can affect diabetes management.
Test to detect Complication of DM
• Microalbumin level-to check check early sign of kidney damage
Hypoglycemia
• Decrease in blood glucose level below 70 milligrams per deciliter (mg/dL)
• Causes
• Medications. Taking someone else's oral diabetes medication accidentally is a possible
cause of hypoglycemia. ...
• Excessive alcohol drinking. ...
• Some critical illnesses. ...
• Insulin overproduction. ...
• Hormone deficiencies.
• Not eating enough
• Postponing or skipping a meal or snack
• Increasing exercise or physical activity without eating more or adjusting your medications
Early warning signs and symptoms of hypoglycemia
• Initial signs and symptoms of diabetic hypoglycemia include:

• Shakiness
• Dizziness
• Sweating
• Hunger
• Fast heartbeat
• Inability to concentrate
• Confusion
• Irritability or moodiness
• Anxiety or nervousness
• Headache
Severe signs and symptoms of
hypoglycemia
• If diabetic hypoglycemia isn't treated, signs and symptoms of severe hypoglycemia can occur.
These include:
• Clumsiness or jerky movements
• Inability to eat or drink
• Muscle weakness
• Difficulty speaking or slurred speech
• Blurry or double vision
• Drowsiness
• Confusion
• Convulsions or seizures
• Unconsciousness
• Death, rarely
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Diabetes Mellitus

Dr. Muhammad Asif Shaheen

• Before people develop type 2 diabetes, they almost always have

• Initial signs and symptoms of diabetic hypoglycemia include:

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