Diabetes Mellitus

Segun Mojiminiyi
DIABETES PREVALENCE
MILLION 30-YR
DIABETICS 1995 2000 2025
%Chng

WORLD 135 154 300 122

INDIA 19.4 22.9 57.2 195
MIDDLE EAST 18.3 22.0 53.5 193
AFRICA 2.9 3.5 8.4 185
OTHER ASIAN CNTR 12.2 14.4 31.7 160
LATIN AMERICA 15.5 18.3 39.3 154
CHINA 16.0 18.6 37.6 134
SOCIALIST EUROPE 16.9 18.1 22.4 33

DEVELOPED (REST) 34.1 36.7 49.8 46

What Will Be Covered in
histopathology lecture…

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What we will talk about…..
Clinical Biochemistry of Diabetes
◗ What is diabetes mellitus?
◗ Classification of diabetes mellitus
◗ Metabolic and biochemical changes in
diabetes mellitus
◗ Diagnosis and monitoring of diabetes
mellitus
◗ Diabetic Complications
What is diabetes mellitus?
■ Disorder of carbohydrate, protein, and fat
metabolism
Results from defects in insulin secretion and/or
insulin action
■ Can represent:
An absolute insulin deficiency
Impaired release of insulin by the pancreatic
beta cells
Inadequate or defective insulin receptors
Production of inactive insulin or insulin that is
destroyed before it can carry out its action

Clinically : Polyuria, Polydypsia, Polyphagia

Classification of diabetes
mellitus
Etiological Classification

I. Type 1 diabetes
A. Immune mediated
B. Idiopathic

II. Type 2 diabetes

Etiological classification (Cont.)
III. Other specific types
a. Genetic defects of B cell function
b. Genetic defects in Insulin action
c. Diseases of the exocrine pancreas
d. Endocrinopathies
e. Drug or chemical –Induced
f. Uncommon forms immune-mediated diabetes
IV. Other genetic syndromes associated with diabetes
V. Gestational diabetes mellitus
 Metabolic and Biochemical
Changes in Diabetes Mellitus
 Excessive Impaired
glucose production glucose clearance
Hyperglycemia

Tissue
injury
 Normal Insulin Action
Net
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Result:
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Without Insulin:
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Metabolic and Mechanism
Biochemical
Changes
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Metabolic and Mechanism
Biochemical
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 Metabolic and Mechanism
Biochemical Changes
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Metabolic and Mechanism
Biochemical
Changes
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Diagnosis and monitoring of
diabetes mellitus
 Criteria for Diagnosis of Diabetes Mellitus
(American Diabetes Association)
1. Symptoms of diabetes plus casual plasma glucose
concentration ≥11.1 mmol/l. Casual is defined as any time
of day without regard to time since last meal. The classic
symptoms of diabetes include polyuria, polydipsia and
unexplained weight loss.
Or
2. FPG ≥7.0 mmol/l. Fasting is defined as no food intake for
at least 8 h.
Or
3. 2-h Post Glucose intake ≥11.1 mmol/l during an OGTT.
The test should be performed as described by WHO using
a glucose load containing the equivalent of 75-g anhydrous
glucose dissolved in water.
 Diagnostic Protocol

SYMPTOMATIC ASYMPTOMATIC
PATIENTS
PATIENTS

Casual Plasma Casual Plasma

Glucose ≥ 11.1 Glucose < 11.1 mmol/l
mmol/L

Fasting Plasma
Diabetes Confirm
Glucose
 Fasting Plasma

Glucose

FPG < 6 mmol/L FPG 6 – 6.9 mmol/L FPG ≥ 7.1 mmol/L

(at least 2 times)
Impaired Fasting Glucose
Normal
Diabetes
Oral Glucose
(no further testing)
Tolerance Test

Plasma Glucose Plasma Glucose Plasma Glucose

≥ 11 mmol/Lat 2 7.8 – 11 mmol/L at 2 hrs < 8 mmol/al at 2 hrs
hrs
Diabetes Impaired Glucose Impaired Fasting
Monitoring Diabetes Control
• Random plasma glucose
(RPG)—without regard to
time of last meal
• Fasting plasma glucose (FPG)
—before breakfast
• Postprandial plasma glucose
(PPG)—2 hours after a meal
• Hemoglobin A1c (A1C)—
reflects mean glucose over 2–
3 months
• Fructosamine/glycated serum
protein—reflects mean
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Tests used for Assessment of risk
factors for complications …….
 Use of Urine microalbuminuria:

Used for Screening for Diabetic

Nephropathy
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Diabetic Complications
 Short term (Acute) Complications: (metabolic)
Hypoglycemia
Diabetic Ketoacidosis

 Long term Complications:(Angiopathy)

Microangiopathy - Retinopathy, Nephropathy,
Neurophathy, dermatopathy.
Macroangiopathy – Atherosclerosis.
Acute Complications of
Diabetes Mellitus
 Hypoglycemia
Most common complication of diabetes
100% of Type 1 patients affected
much less common in Type 2
Multiple causes:
exercise/activity Insulin overdose
reduced food intake alcohol use
delayed meal
 Laboratory Findings in hyperglycaemic
hyperosmolar state (HHS) and DKA
Investigation DKA HHS
Screening For Diabetes
Screening Criteria for Diabetes
Age > 45, repeat every 3 years
Obesity: > 120% IBW or BMI > 27
First degree relative with DM
High risk ethnic group eg Pima Indians, ??
Kuwaitis
Woman with previous baby > 4 kg
Hypertension, hyperlipidemia
Previous Impaired Glucose Tolerance or
Impaired Fasting Glucose.