Diabetes mellitus
Dr. Kovács Tibor
II.sz. Belgyógyászati Klinika
2012
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Worldwide prevalence of diabetes in 2000 and 2010
Population (million)
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Prevalence of diabetes 8,6% in people
> 20 ys; 20,1% in people > 65ys
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Diabetes mellitus
metabolic disorders,
leading symptom hyperglycaemia
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Criteria for the diagnosis of
diabetes mellitus
1.
Symptoms of diabetes plus random blood glucose
conc. ≥ 11,1 mol/l (200 mg/dl)
2.
Fasting plasma glucose ≥7 mmol/l (126 mg/dl)
3.
Two-hour plasma glucose ≥ 11,1 mmol/l (200 mg/dl)
during an oral glucose tolerance test (with 75g
glucose)
Fasting is defined as no caloric intake for at least 8 h.
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Symptoms of diabetes
first of all ...
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Glucose transport in the kidney
Glucose reabsorption in proximal tubules by SodiumGlucose-cotransporter
high blood glucose level → glucosuria
Threshold for maximal glucose reabsorbing capacity
10 mmol/l (180 mg/dl).
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...symptoms of diabetes
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polyuria
polydipsia
polyphagia
weight loss
dry mouth
itching
recurrent infection
poor wound healing
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Characteristic of type 1 diabetes
Rapid onset,
Typical symptoms
No sign of late complications at diagnosis
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Model of pathogenesis and natural history of type 1 diabetes.
Islet cell autoantibodies (ICA)
Glutamic aciddecarboxylase (GADA)
Devendra D et al. BMJ 2004;328:750-754
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©2004 by British Medical Journal Publishing Group
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Natural history of insulin resistance and insulin
secretion in type 2 diabetes.
Holt R I G BJP 2004;184:s55-s63
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Impaired insulin secretion in
type 2 diabetes
NGT
1st
2nd phase
early diabetes
2nd phase
IGT
1st
2nd phase
late diabetes
2nd phase
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Comparison of type 1 and type 2 diabetes
Type 1 diabetes
Type 2 diabetes
Pathogenesis
Insulin lack
Insulin resistance
(relative insulin lack)
Age at onset
Children / young
BUT LADA
Adult (> 40 ys)
BUT MODY
Body weight
Normal
Obes
Onset
Rapid
Slow
Beta cell mass
<10%
at onset: normal
Later: decrease
Blood insulin level
Low/absent
At onset: high
Autoantibodies
Predispose for
ketosis
Yes
No
Yes
Not specific
Insulin therapy
Necessary
Not absolutely
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Acute complications
• Diabetic coma
– Diabetic ketoacidosis (DKA)
– Hyperglycemic hyperosmolar state (HHS)
• Hypoglycemic state
• Hyperglycemic state
• Somogyi rebound or Dawn phenomen
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Chronic complications
of diabetes
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Diabetic foot
Pathogenic factors are:
autonomic neuropathy,
sensory neuropathy,
motor neuropathy,
peripherial artery disease.
microangiopathy,
infections.
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Diabetic nephropathy
Stage
GFR
Urine protein
RR
1
norm.
neg
norm
2
high
neg
norm v. ↑
3
norm or high
microlbumin
↑
4
decreased
proteinuria
high
5
< 10 ml/min
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high
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Therapy
Life style modification
Drugs
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Life style modification
• Regular physical activity,
• Weight loss,
• Regulate calory intake
– Weak physical activity 20 kcal/bwkg/day
– Medium physical activity 25 kcal/bwkg/day
– Haevy physical activity 30 kcal/bwkg/day.
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Characteristic of diabetic diet
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Glycemic index
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Drug therapy
"Orally given antidiabetics”
Insulin
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Discover of
GLP-1 action
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Another ways:
Bed time regime
Insulin pump
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Kezelés, gondozás célja
• Jó szénhidrát anyagcsere helyzet.
• Céltartományba kerülő vércukor
• Céltartományon belüli HbA1c érték
• Szövődmények elkerülése
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Köszönöm a figyelmet!!
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Krónikus szövődmények ...
• Diabetes neuropathia
– sensomotoros neuropathia (perifáriás)
• tapintás, fájdalom, vibráció, reflex
– autonóm neuropathia
• keringési rendszer
• gyomor-bé rendszer
• hugyúti rendszer
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Megállapításának szempontjai
Ismételten magas éhomi vércukorszint:
≥ 7 mmol/l
(126 mg/dl)
→
6,1-6,9 mmol/l
→
(110-125 mg/dl)
Diabetes mellitus
károsodott glükóztolerancia
(IFG)
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Diabeteszes retinopathia
• Nem proliferatív retinopathia
– microaneurizmák
– kevés intraretinalis vérzés
– kaliberingadozás
• Proliferatív retinopathia
– érújdonképződés
– papillaproliferatio
– preretinális vérzések
– retinaleválás
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Transport mechanisms in tubules
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