Diabetes
Mellitus
FARSANA P.S. ,41
2nd sem Bpharm,NCP
OVERVIEW
Introduction
Classification of diabetes mellitus
Metabolic changes in diabetes
Management of diabetes
INTRODUCTION
Diabetes mellitus is a clinical condition characterized by increased
blood glucose level (hyperglycemia) due to insufficient or inefficient
(incompetent) insulin. In other words, insulin is either not produced in
sufficient quantity or inefficient in its action on the target tissues. As a
consequence, the blood glucose level is elevated which spills over
into urine (glycosuria) in diabetes mellitus.
Cellular Starvation Despite High Glucose:
• Despite abundant glucose in the bloodstream, body cells are starved due
to impaired glucose uptake.
• This paradoxical situation—scarcity in plenty—defines the essence of
diabetes mellitus.
Hormonal Players:
• Insulin and glucagon play pivotal roles in blood glucose regulation.
Classification of diabetes mellitus
Diabetes mellitus is broadly divided into 2 groups, namely insulin-dependent diabetes
mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). This
classification is mainly based on the requirement of insulin for treatment.
Non-insulin dependent diabetes
Insulin-dependent mellitus (NIDDM)
diabetes mellitus (IDDM) Diabetes
Mellitus
1.Insulin-Dependent Diabetes Mellitus (IDDM):
⚬ Also known as type I diabetes or juvenile-onset diabetes.
⚬ Occurs mainly in childhood (typically between ages 12 and
15).
⚬ Accounts for about 10 to 20% of known diabetics.
⚬ Characterized by almost total deficiency of insulin due to
destruction of pancreatic beta cells (Beta-cells).
⚬ Causes of beta-cell destruction include drugs, viruses, or
autoimmunity.
⚬ Symptoms appear when 80-90% of E-cells are destroyed.
⚬ Patients with IDDM require insulin therapy.
2. Non-Insulin-Dependent Diabetes Mellitus (NIDDM):
⚬ Also called type II diabetes or adult-onset diabetes.
⚬ Most common form, accounting for 80 to 90% of diabetics.
⚬ Occurs in adults (usually above 35 years) and is less severe than IDDM.
⚬ Causative factors include genetic and environmental influences.
⚬ Often associated with obesity.
⚬ Obesity leads to decreased insulin receptors on the insulin responsive
target cells.
⚬ Some NIDDM patients have normal or increased insulin levels.
⚬ Weight reduction through diet control can often correct NIDDM.
Recent Insights on NIDDM:
Research suggests that increased levels of tumor necrosis factor-D (TNF-D) and
resistin, along with reduced secretion of adiponectin by adipocytes in obese
individuals, contribute to insulin resistance by impairing insulin receptor function.
Metabolic changes in diabetes
Diabetes mellitus is associated with several metabolic alterations. Most important
among them are hyperglycemia, ketoacidosis and hyper-triglyceridemia.
1.Hyperglycemia:
⚬ Elevated blood glucose concentration is a hallmark of uncontrolled diabetes.
⚬ Causes:
￭ Reduced glucose uptake by tissues.
￭ Increased glucose production via gluconeogenesis and glycogenolysis.
⚬ When blood glucose exceeds the renal threshold, glucose spills into urine (glycosuria).
⚬ Glucose Toxicity:
￭ High glucose levels can harm the body:
• Osmotic effects/hypertonic effects: Water drawn from cells into extracellular
fluid and excreted into urine, leading to dehydration.
• Beta-cell damage due to free radicals (enhanced oxidative phosphorylation,
oxidative stress, and increased free radicals).
• Glycation of proteins associated with complications (neuropathy, nephropathy,
retinopathy).
2. Ketoacidosis:
⚬ Increased fatty acid mobilization results in overproduction of ketone bodies.
⚬ Ketoacidosis can occur, leading to acid-base imbalances.
3. Hypertriglyceridemia:
⚬ Conversion of fatty acids to triacylglycerols and the secretion of VLDL and chylomicrons is
comparatively higher in diabetics
⚬ Low activity of lipoprotein lipase.
⚬ Elevated plasma levels of VLDL, chylomicrons, and triacylglycerols.
⚬ Hypercholesterolemia is also common in diabetics.
Management of diabetes
Diet, exercise, drug and, finally, insulin are the management options in diabetics.
Approximately, 50% of the new cases of diabetes can be adequately controlled by diet
alone, 20- 30% need oral hypoglycemic drugs while the remaining 20-30% require
insulin.
1.Dietary Management:
⚬ A crucial aspect of diabetes control.
⚬ Recommendations:
￭ Caloric Intake: Diabetic patients are advised to consume low-calorie diets (low in carbohydrates
and fats).
￭ Protein and Fiber: Emphasize high-protein and fiber-rich foods.
￭ Carbohydrates: Opt for complex carbohydrates (starches) rather than refined sugars (sucrose,
glucose).
￭ Fat Intake: Reduce fat intake, focusing on unsaturated fatty acids.
￭ Exercise: Regular physical activity complements diet control, especially for obese non-insulin-
dependent diabetes mellitus (NIDDM) patients.
2. Hypoglycemic Drugs:
• Two main categories:
⚬ Sulfonylureas: Commonly used (e.g., acetohexamide, tolbutamide,
glibenclamide).
￭ Action: Promote endogenous insulin secretion, reducing blood glucose levels.
⚬ Biguanides: Less commonly used due to side effects.
3. Management with insulin :
• Two types of insulin preparations:
• Short-Acting Insulins: Unmodified; action lasts about 6 hours.
• Long-Acting Insulins: Modified (e.g., protamine-bound); duration varies based on
the specific preparation.
REFERENCE
Biochemistry by D. Satyanarayana and U.Chakrapani
page no. : 669,679-683
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