1. Diabetes Mellitus
Passant Mohammed
Faculty of science
Biochemistry

3. Goals growth of diabetes. Diabetes Mellitus Definition
Pathophysiology of Diabetes
Symptoms
Classification Type 1 ,2
Mechanism
Management of Diabetes
Nutritional Management

4. Egypt will face explosive growth of diabetes
Source: Diabetes Atlas, 2nd edition, IDF

5. Diabetes Mellitus
Disease in which the body doesn’t produce or properly use insulin, leading to hyperglycemia.

6. What Are the Symptoms?

7. Glucosurea
Frequent urination
High blood glucose
Increased thirst
Increased hunger (especially after eating)
Dry mouth

8. Pathophysiology of Diabetes
When you eat, your body
breaks food down into
glucose. Glucose is a type of sugar that is your body’s
main source
of energy.

9. Pathophysiology of Diabetes
As blood glucose
rises, the body
sends a signal to
the pancreas, which
releases insulin.

10. Pathophysiology of Diabetes
Acting as a key, insulin
binds to insulin
receptor), unlocking
the cell so glucose can
pass into it. There,
most of the glucose is
used for energy right
away.

11. Non-insulin dependent (NIDDM or type II)
Classification:
Insulin dependent
(IDDM or type I)
Non-insulin dependent (NIDDM or type II)

12. Type I Diabetes Low or absent endogenous insulin
Dependent on exogenous insulin for life
Onset generally < 30 years
5-10% of cases of diabetes
Onset sudden
The total lack of insulin leads to two metabolic crises; a marked increase in the rate of lipolysis in adipose tissue and activation of hepatic gluconeogenesis in spite of high plasma glucose levels.  The dramatically  increased rate of lipolysis in adipose tissue follows the lack of insulin inhibition of hormone-sensitive lipase.  The increase in fatty acids that results leads to a massive synthesis of ketone bodies in the liver.  These then exceed the buffer capacity of the blood, leading to ketoacidosis.  Excess acid is a potent poison for the brain.  Coma and death follow ketoacidosis.
Blood glucose levels

13. Type I Diabetes Cell

14. Type II Diabetes Insulin levels may be normal, elevated or depressed
Characterized by insulin resistance,
diminished tissue sensitivity to insulin.
Often occurs >40 years
Blood sugar levels are dependent upon glucose uptake after meals and hepatic release of glucose between meals.   The sugar released from the liver comes either from stored glycogen or production of glucose from lactate and amino acids.  This production of glucose is largely responsible for stabilization of postprandial blood sugar levels.  The hyperglycemia noted in type 2 diabetes partially results from lack of control over hepatic glucose formation due to resistance to insulin.  It has recently become clear that part of this insulin effect occurs indirectly through insulin-sensitive receptors in the brain (more precisely, in the hypothalamus).    

15. Type II Diabetes

16. Risk factors for type 2 diabetes
Are overweight.
Are 45 or older.
Are physically inactive.
Have a parent with type 2 diabetes.
Have abnormal cholesterol levels.
Have had gestational diabetes, or
given birth to a baby greater than 9
lbs.

17. Management of Diabetes Mellitus
Nutrition
Blood glucose
Medications
Physical activity/exercise
Behavior modification
Nutrition management
Blood glucose monitoring
Medications – insulin or oral hypoglycemic agents
Physical activity/exercise
Behavior modification

18. Nutritional Management for Type I Diabetes
Consistency and timing of meals
Timing of insulin
Monitor blood glucose regularly
Consistency and timing of meals
Timing of meals and administration of insulin
Insulin plans should be designed to match the person’s eating pattern
Monitor blood glucose regularly

19. Nutritional Management for Type II Diabetes
Weight loss
Smaller meals and snacks
Physical activity
Monitor blood glucose and medications
Weight loss: 10-20# is sufficient
Smaller meals and snacks
Physical activity
Monitor blood glucose and medications

21. References :
1) Dr .Nihal Elguindy : Ph.D : Biochemistry, Faculty of Science, Alexandria University. 2) Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin by Gary Scheiner  3) The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed by Gretchen Becker  وزاره الصحة والسكان 4) Adel Sukkar عادل سكر5)