1. Diabetes Mellitus Zhang Zongji Department of Pathology
Kunming Medical College

2. OVERVIEW Characteristic feature is hyperglycemia and glycosuria.
Deficiency in Insulin
Disorder of metabolism in glucose, protein and fat
Genetic predisposition
Environmental insult
Target-tissue resistance
Chronic Disorder
Destruction of pancreatic islet
Characteristic feature is hyperglycemia and glycosuria.
Injury of many organs occur in long-standing diabetes.

3. World health problem

4. Insulin
Beta cell of the pancreatic islet

6. CLACIFICATION Primary diabetes mellitus Secondary diabetes mellitus
Arise from any diseases causing extensive destruction of pancreatic islet
Non-Insulin-dependent diabetes mellitus, NIDDM
Insulin-dependent diabetes mellitus, IDDM
Special types of diabetes mellitus
Gestational diabetes mellitus

7. Insulin-dependent diabetes mellitus IDDM
TYPEⅠor Juvenile-onset diabetes
TypeⅠA and TypeⅠB
HLA genes
Beta cell
IDDM
insulin
virus
autoimmunity
Genetic Susceptibility：6p21— MHC- Ⅱ（ HLA-DP，DQ，DR）

8. Non-Insulin-dependent diabetes mellitus NIDDM
TYPEⅡor adult-onset diabetes
90%～95%
两个基本因素
两个基本环节
遗传易感性
多基因变异
PPARγ
ARNT
PTPN1
B细胞缺陷
胰岛素分泌紊乱
Hyperglycemia
中国人相关基因
胰岛素受体基因
载脂蛋白AI及B基因
葡萄糖激酶(GCK)基因
对胰岛素抵抗性
葡萄糖不适当利用
NIDDM
环境因素
Obesity

10. MORPHOLOGY

11. 1. Pancreatic islet Not specific Ⅰ>Ⅱ Leukocytic infiltration(ⅠA)
Reduction in the number and size of islet（Ⅰ)
Beta-cell degranulation（ⅠA)
Hyaline（Ⅰ) and Amyloid （Ⅱ) replacement of islet

12. Myocadial infarction Vascular system Atherosclerosis
Vessels of all sizes are affected
Atherosclerosis
Myocadial infarction

13. Gangrene of the lower extremities
World Diabetes Day 2005 focused on diabetes and foot care.

14. Hyaline arteriolosclerosis：Hypertension

15. Diabetes microangiopathy:
Diffuse thickening of basement membranes

16. Diabetic nephropathy
Glomerular lesions
Renal vascular leisions
Pyelonephritis
Renal failure

17. Blindness Diabetic ocular complication Retinopathy nonproliferative
Cararact
Glaucoma
Blindness

18. Diabetic neuropathy and other lesions
Chronic ulcer of leg

19. CLINICAL FEATURES Hyperglycemia and glycosuria “三多一少”： Polyuria
Polyphagia
Polydipsia
Loss of weight
Ketoacidosis
Late complication

20. COMPLICATION: Long-Standing Diabetes

21. Atherosclerosis
Susceptibility to infections
Myocardial infarction
Stroke (cerebrovascular accidents)
Gangrene of the leg
Renal failure
Atherosclerotic heart disease
CAUSE OF DEATH:

22. November 14 ：“World Diabetes Day ”

23. THANKS