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Module 4: DIABETES MELLITUS KEY TERMS:Counter regulatory hormonesDawn phenomenon Disabesity DiabetesFasting blood glucose Gestational diabetesGlucagonGluconeogenesis Glycated hemoglobin (HbA1C)GlycogenolysisHypoglycemiaInsulinInsulin resistanceMetabolic syndromeNephropathyNeuropathyOral glucose tolerance test PolydipsiaPolyphagiaPolyuriaRandom blood glucoseSomatostatinSomogyi effectType 1 diabetesType 2 diabetesLEARNING OUTCOMESUpon conclusion of this unit the student will:1.Describe current Canadian trends in the prevalence of diabetes mellitus.2.Compare the etiology of type 1 and type 2 diabetes.3.Consider the etiology of gestational diabetes.4.Describe carbohydrate,fat and protein metabolism.5.Identify and discuss the roles of glucose-regulating hormones.6.Compare and contrast the pathophysiological events that occur in type 1 and type 2 diabetes.7.Make links between the pathogenesis of diabetes mellitus and the clinical manifestations common to this disease.8.Describe the diagnostic criteria for diabetes mellitus (DM) and pre-diabetes according to the 2013 Canadian Clinical Guidelines by the Canadian Diabetes Association.9.Discuss the scientific rationale for selection of interventions in the management of diabetes.Page 1071-110DIABETES MELLITUS PART 1Diabetes actually means excessive excretion of urine.Diabetes mellitus refers to the disorder of carbohydrate, fat and protein metabolism with absolute or relative insulin deficiency. PREVALANCE OF DIABETESIn 2008/09 the estimated prevalence of diagnosed diabetes amongst Canadian was 6.8% (2.4 million)oApproximately half of new cases diagnosed in individuals age 45-64oEstimated to rise to 3.7 million Canadian by 2019Type 2 DMaccounts for app 90% of diabetes cases>10 million Canadian live with diabetes or prediabetesoPrevalence of diabetes lower in children than adults (2008/2009)oPrevalence higher in males (7.2%) than females (6.2%) (2008/2009)Personal costs of premature death and complications Financial burdenoPersonal annual medical cost $1000 - $15 000oDiabetes estimated to cost $16.9 billion/year by 2020ETIOLOGY TYPE 1 DM
Autoimmune Type 1AAutoimmune mediated specific loss of beta cellsin the pancreatic islets Langerhans (leads to absolute insulin deficiency and is prone to ketoacidosis.) Genetic-environment interactionGenesoMHC genes on chromosome 6encode leukocyte antigens HLA-DQand HLA-DR(HLA-DR3 and HLA-DR4 is associated with an increased risk of type 1A diabetes that is 20 to 40 times higher than that of the general population.) HLA-DR2 are thought to decrease type 1 diabetes oChromosome 11 – insulin gene regulating beta cell replication and functionAutoantibodies: insulin autoantibodies, islet cells autoantibodies, antibodies directed at other islet autoantigens (glutamic acid decarboxylase-GAD & tyrosin phosphatase IA-2)Environmental factors: drugs & chemicals; nutritional intake; virusesoAlloxan, Streptozotocinand Vacoras well as certain drugs such as Pentamidinehave been associated with type 1 diabeteso