1. Disturbances of carbohydrate metabolism. Diabetes mellitus. The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health of the Russian Federation Lecture presentation Professor Pirozhkov S.V. Department of Pathophysiology 2014-2015 education year

2. TYPICAL FORMS OF DISORDER OF CARBOHYDRATE NETABOLISM ● ● Hypoglycemia (< 3.3 mmol/L of blood) ● ● Hyperglycemia (> 5.6 mmol/L of blood) ● ● Glycogenoses ● ● Aglycogenoses ● ● Pentosemia, hexosemia

3. CAUSES OF HYPOGLYCEMIA ● Neurogenic ● Endocrinogenic ● Hepatic ● Renal ● Inadequate substrate supply ● Use of drugs

4. SYMPTOMS OF HYPOGLYCEMIA I.Associated with activation II. Associated with glucose of the sympathetic system deprivation of the brain (autonomic response) (neuroglycopenia) ● sweating ● dizziness ● tremor ● headache ● tachycardia ● blurred vision ● anxiety ● poor reasoning ● sharp sensation of hunger ● ataxia ● confusion ● seizures ● loss of consciousness

5. CAUSES OF HYPERGLYCEMIA ● Neurogenic ● Endocrinogenic ● Alimentary ● Hepatogenic

6. Diabetes mellitus is a disease or syndrome characterized by systemic derangements of carbohydrate, lipid and protein metabolism, acid-base and water-mineral balance, resulting from absolute or relative deficiency of pancreatic insulin

7. Epidemiology of diabetes mellitus (DM): Epidemiology of diabetes mellitus (DM): ► Worldwide, more than 140 million people suffer from DM. ► Approximately 80% to 90% of patients have type 2 DM. ► DM increases with ageing. In 2000 the prevalence of DM was: 0.19% in people < 20 years old; 8.6% in people > 20 years old; 20.1% in individuals > 65 years old

8. Insulin deficiency KETOACIDOSIS POLYPHAGIAHYPERGLYCEMIA GLUCAGON EXCESS Muscle Kidney Adipose tissue Increased lipolysis (free fatty acids) Increased protein catabolism (amino acids) Liver Gluconeogenesis Ketogenesis Metabolic derangements typical for diabetes mellitus type I POLYURIA

9. MAIN MANIFESTATIONS OF METABOLIC DISORDERS IN DIABETES MELLITUS CARBOHYDRATES PROTEINS LIPIDS WATER Hyperazot- emia, increased blood urea nitrogen Hyper- glycemia Glucose- uria Hyperlactacidemia Azoturia ACIDOSIS Hyper- lipidemia Ketonemia Ketoneuria Polyuria Poly- dypsia

10. Genetic aspects of diabetes mellitus type 2: ► Among identical twins, the concordance rate is 70% to 90% ► In first-degree relatives with type 2 diabetes (and in non-identical twins), the risk of developing disease is 5 to 10 times higher than in age- and weight- matched subjects without a family history ► Unlike type I diabetes, the disease is not linked to any HLA genes

11. Phases of the clinical course of diabetes mellitus type 2 Resistance Blood insulin Blood glucose to insulin concentration level I phase moderately increased normal increased II phase greatly increased hyperglycemia increased after meal III phase greatly insufficiently hyperglycemia increased increased for in the fasting a particular state glucose level

12. CHRONIC COMPLICATIONS OF DIABETES MELLITUS ► Microvascular ● Eye disease - retinopathy (nonproliferative/proliferative) - macular edema ● Neuropathy - sensory and motor (mono- and polyneuropathy) - autonomic ● Nephropathy

13. CHRONIC COMPLICATIONS OF DIABETES MELLITUS ► Macrovascular ● Coronary artery disease ● Peripheral vascular disease ● Cerebrovascular disease ► Other ● Gastrointestinal (gastroparesis, diarrhea) ● Genitourinary (uropathy/sexual disfunction) ● Dermatologic (pigmented pretibial papules) ● Infectious ● Eye diseases (cataract, glaucoma)