Diabetes mellitus:

Diabetes mellitus:
It is a state of chronic hyperglycemia due to an absolute/relative deficiency of
insulin.

Definition:
After at least 8 hrs. of fasting, the venous glucose is measured. Now the patient
is fed 75g glucose (300 kCal)—For children or anybody below 50 kg, the dose
is adjusted as 1.75 g/kg. After 2 hrs. of the meal, a postprandial venous glucose is
measured.

Condition Venous plasma glucose:
Diabetes mellitus Fasting > 126
Or postprandial > 200
Or random > 200
Impaired fasting glucose Fasting 110 –125
Impaired glucose tolerance PP 140 –199
Types:
1. Type I—Autoimmune, early onset, fatal without treatment, ketosis is common.
2. Type II—Insulin resistant, slow process, associated with the metabolic
syndrome, complicated by other diseases.
3. Gestational (diabetes in pregnancy)—Due to growth hormone, progesterone,
cortisol and prolactin excess.
4. Maturity onset diabetes in the young (MODY)—Genetic ? cell malfunction.
5. Lipotropic—Genetic defect in insulin action.
6. Diseases of exocrine pancreas.
7. Endocrine diseases—Pheochromocytoma, Cushing syndrome, acromegaly,
hyperthyroidism.
8. Drug-induced—Steroids, thiazides, phenytoin, niacin.
9. Congenital diseases—Down’s, Klinefelter’s, Turner syndrome, Friedreich s
ataxia.

Type I diabetes mellitus:
Type I diabetes has a rapid, discernible onset, usually before 30 years of age. It
is usually autoimmune in origin, insulin dependent, and develops ketoacidosis if
untreated.
Agent:
1. Infections—Mumps, coxsackie, CMV, rubella
2. Nutrition—Early introduction of cow s milk
3. Autoimmunity—Against islet cells, glutamic acid decarboxylase
4. Genetic—Associated with HLA DR3 and DR4.

Type II diabetes mellitus:
Agent:
Insulin resistance seems to be the primary pathology. Up to a certain age, this
resistance is countered by increasing secretion, until ? cell dysfunction sets in
and insulin production drops. Insulin resistance is brought on in the first place by
rapid rise of blood glucose after regular meals of refined sugars (burgers, colas,
candies) along with obesity.
Host:
1. Age—Type II diabetes usually comes to light only after 30, and many people
in the world live with it without being aware of it.
2. Sex—Type II diabetes is male dominant.
3. Genetic—Family history of Type II diabetes is a risk factor.