Diabetes

1. Diabetes –PBL 2- HD
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2. What is diabetes?
Diabetes is a chronic, often debilitating and sometimes fatal disease, in
which the body either cannot produce insulin or cannot properly use the
insulin it produces.
Insulin is a hormone that controls the amount of glucose (sugar) in the
blood. Diabetes leads to high blood sugar levels, which can damage organs,
blood vessels and nerves.
• The pancreas is an organ that sits behind the stomach and releases
hormones into the digestive system.
• In the healthy body, when blood sugar levels get too high, special cells in
the pancreas (called beta cells) release insulin.
• Insulin is a hormone and it causes cells to take in sugar to use as energy
or to store as fat. This causes blood sugar levels to go back down.

3. Types of diabetes
• There are two main types of diabetes mellitus: type 1 (caused
by beta cell destruction, leading to absolute insulin deficiency)
and type 2 (caused by insulin resistance and relative insulin
deficiency).
• Table 3 lists the classification of diabetes mellitus according to
aetiology.

6. Signs and symptoms

7. Complications of Diabetes –
• – Atherosclerosis – Condition characterized by hardening or loss of
elasticity of the arterial blood vessels leading to insufficient blood
supply to organs.
• – Diabetic Microangiopathy – Condition characterized by thickening
and weakening of walls of blood vessels in different areas including
eyes, resulting in slowing down of the blood flow, leakage of
proteins and bleeding from these blood vessels.
• – Diabetic Nephropathy – Characterized by disfunctioning of the
filtering system in the kidneys and later resulting in kidney failure.
• – Diabetic Neuropathy – Characterized by damage to nerves all over
the body and in later stages resulting in dysfunction to organs and
organ systems.
• – Diabetic Retinopathy – Condition characterized by damage to the
blood vessels in the retina
• – Diabetic Ketoacidosis – Condition characterized by large
concentration of Ketoacidosis, which on later stages may lead to
many fatal complications.

8. Family Health History and Diabetes
• Type 1 Diabetes: In general, if you are a man with type 1 diabetes, the
odds of your child developing diabetes are 1 in 17.
• If you are a woman with type 1 diabetes and your child was born
before you were 25, your child's risk is 1 in 25; if your child was born
after you turned 25, your child's risk is 1 in 100.
• Type 2 Diabetes:
• In general, if you have type 2 diabetes, the risk of your child getting
diabetes is 1 in 7 if you were diagnosed before age 50 and 1 in 13 if
you were diagnosed after age 50. –
• child's risk is greater when the parent with type 2 diabetes is the
mother. If both you and your partner have type 2 diabetes, your child's
risk is about 1 in 2.

9. Insulin autoantibodies
• RIA: Anti-GAD, Anti-IA2, Anti-Insulin; Insulin Antibodies -
These tests are also used in early diagnosis for type 1
diabetes, and for differential diagnosis between LADA and
type 2 diabetes, as well as for differential diagnosis of
gestational diabetes, risk prediction in immediate family
members for type 1, and to monitor prognosis of the clinical
progression of type 1 diabetes.
• Persons with LADA may test positive for autoantibodies (GAD,
ICA, IA-2, ZnT8); autoantibodies are not present in persons
with type 2 diabetes.

10. Glycated hemoglobin
hemoglobinA1c,HbA1c,A1C,orHb1c;sometimesalsoHbA1corHGBA1C)
• is a form of hemoglobin that is measured primarily to identify the
average plasma glucose concentration over prolonged periods.
• Hemoglobin is found in red blood cells, which carry oxygen throughout
your body.
• When your diabetes is not controlled (meaning that your blood sugar is
too high), sugar builds up in your blood and combines with your
hemoglobin, becoming "glycated."
• The average amount of sugar in your blood can be found by measuring
your hemoglobin A1c level.
• If your glucose levels have been high over recent weeks, your
hemoglobin A1c test will be higher.

11. What's a Normal Hemoglobin A1c
Test?
• For people without diabetes, the normal range for the hemoglobin
A1c test is between 4% and 5.6%.
• Hemoglobin A1c levels between 5.7% and 6.4% indicate increased
risk of diabetes
• and levels of 6.5% or higher indicate diabetes.
• People with diabetes should have this test every 3 months .
• People with diseases affecting hemoglobin, such as anemia, may get
abnormal results with this test. Other abnormalities that can affect
the results of the hemoglobin A1c include supplements such as
vitamins C and E and high cholesterol levels. Kidney disease and liver
disease may also affect the result of the hemoglobin A1c test.

12. Autoimmune diabetes:the role of T cells,
MHC moleculesand autoantigens.
• HLA types are inherited, and some of them are connected
with autoimmune disorders and other diseases. People with
certain HLA antigens are more likely to develop certain
autoimmune diseases, such as type I diabetes .
• human leukocyte antigen (HLA) system is the locus of genes
that encode for proteins on the surface of cells that are
responsible for regulation of the immune system in humans.
• The HLA genes are the human versions of the major
histocompatibility complex (MHC) genes that are found in
most vertebrates (and thus are the most studied of the MHC
genes)

13. • Type 1 diabetes (IDDM) is a T cell mediated autoimmune disease which in
part is determined genetically by its association with major
histocompatibility complex (MHC) class II alleles.
• The major role of MHC molecules is the regulation of immune responses
through the presentation of peptide epitopes of processed protein antigens
to the immune system .
• The strongest gene, IDDM1, is located in the MHC Class II region on
chromosome 6 . Certain variants of this gene increase the risk for decreased
histocompatibility characteristic of type 1.
• Recently it has been demonstrated that MHC molecules associated with
autoimmune diseases preferentially present peptides of other endogenous
MHC proteins, that often mimic autoantigen-derived peptides.
• Hence, these MHC-derived peptides might represent potential targets for
autoreactive T cells.
• It has consistently been shown that humoral autoimmunity to insulin
predominantly occurs in early childhood. The cellular immune response to
insulin is relatively low in the peripheral blood of patients with IDDM.

14. Environmental
• Environmental factors can influence expression of type 1.
• For identical twins, when one twin has type 1 diabetes, the other
twin only has it 30%–50% of the time.
• Thus for 50%-70% of identical twins where one has the disease, the
other will not, despite having exactly the same genome; this
suggests environmental factors, in addition to genetic factors, can
influence the disease's prevalence.
• Other indications of environmental influence include the presence
of a 10-fold difference in occurrence among Caucasians living in
different areas of Europe, and that people tend to acquire the rate
of disease of their particular destination country.

15. Diabetic ketoacidosis
• ketoacidosis is a potentially life-threatening complication in patients with
diabetes mellitus. It happens predominantly in those with type 1 diabetes .
• DKA results from a shortage of insulin; in response the body switches to
burning fatty acids and producing acidic ketone bodies that cause most of
the symptoms and complications.
• Management
• Potassium levels can fluctuate severely during the treatment of DKA,
because insulin decreases potassium levels in the blood by redistributing it
into cells.
• A large part of the shifted extracellular potassium would have been lost in
urine because of osmotic diuresis.
• Hypokalemia (low blood potassium concentration) often follows treatment.
This increases the risk of dangerous irregularities in the heart rate.

16. • Thanks