DIABETES

PETER S. AZNAR, M.D., F.P.S.P.

Types of Diabetes:
Diabetes Insipidus
Diabetes Mellitus

Diabetes Insipidus
associated with deficiency of antidiuretic
hormone (ADH)
will result to severe polyuria
associated with increase serum
osmolality and decrease urine osmolality
urine will have low specific gravity

H
2
O
URINE
ADH
H
2
O
URINE
ADH
Diabetes Mellitus
associated with defect in carbohydrate
metabolism
will also result to polyuria
associated with increase urine osmolality and
decrease serum osmolality
urine will have a high specific gravity
H
2
O
URINE
RTG
180
H
2
O
SERUM GLUCOSE
300
RTG
180
120
Diabetes Mellitus
Cardinal signs of Diabetes Mellitus:
Polyuria

Polydipsia

Polyphagia

Pruritus

Types of Diabetes Mellitus

Type I (Insulin dependent diabetes mellitus)

Type II (Non-insulin dependent diabetes mellitus)
Diabetes Mellitus Type I
Also known as Insulin Dependent Diabetes
Mellitus (IDDM) or juvenile onset
diabetes mellitus

Main defect is decrease or absence of
insulin

Associated with ketoacidosis

Treatment: Insulin



Diabetes Mellitus Type II
Also known as Non-Insulin Dependent
Diabetes Mellitus (NIDDM) or adult
onset diabetes mellitus

Main defect is absence or decrease receptors

Ketoacidosis not present

Treatment: Sulfonylureas
Diabetes Type I Type II
Other names

Insulin Dependent
Diabetes
Mellitus
(IDDM)
Juvenile
onset
Non-Insulin
Dependent
Diabetes
Mellitus
(NIDDM)
Adult onset
Defect Absence of insulin Absence or
decrease
receptors
Ketoacidosis Present Not present
Treatment Insulin Sulfonylurea


Diabetes Type I Type II
Other names

Insulin Dependent
Diabetes
Mellitus
(IDDM)
Juvenile
onset
Non-Insulin
Dependent
Diabetes
Mellitus
(NIDDM)
Adult onset
Defect Absence of insulin Absence or
decrease
receptors
Ketoacidosis Present Not present
Treatment Insulin Sulfonylurea

Diabetes Type I Type II
Other names

Insulin Dependent
Diabetes
Mellitus
(IDDM)
Juvenile
onset
Non-Insulin
Dependent
Diabetes
Mellitus
(NIDDM)
Adult onset
Defect Absence of insulin Absence or
decrease
receptors
Ketoacidosis Present Not present
Treatment Insulin Sulfonylurea

Diabetes Type I Type II
Other names

Insulin Dependent
Diabetes
Mellitus
(IDDM)
Juvenile
onset
Non-Insulin
Dependent
Diabetes
Mellitus
(NIDDM)
Adult onset
Defect Absence of insulin Absence or
decrease
receptors
Ketoacidosis Present Not present
Treatment Insulin Sulfonylurea


Diabetes Type I Type II
Other names

Insulin Dependent
Diabetes
Mellitus
(IDDM)
Juvenile
onset
Non-Insulin
Dependent
Diabetes
Mellitus
(NIDDM)
Adult onset
Defect Absence of insulin Absence or
decrease
receptors
Ketoacidosis Present Not present
Treatment Insulin Sulfonylurea

Diabetes Type I Type II
Other names

Insulin Dependent
Diabetes
Mellitus
(IDDM)
Juvenile
onset
Non-Insulin
Dependent
Diabetes
Mellitus
(NIDDM)
Adult onset
Defect Absence of insulin Absence or
decrease
receptors
Ketoacidosis Present Not present
Treatment Insulin Sulfonylurea

Diagnostic Criteria for DM:
Random plasma glucose > 200 mg/dL

Fasting plasma glucose > 126 mg/dL

2-hours plasma glucose > 200 mg/dL


Impaired Glucose Tolerance*
FBS more than 100mg/dL but less than 126mg/dL

OGTT 2 hour value more than 140mg/dL but less than
200mg/dL



*Latent or chemical diabetes

Glucose Metabolism Tests


2- hour Postprandial Test

Oral Glucose Tolerance Test (OGTT)


Patient is made to fast for 8 hours and sample is collected

Patient is given 75 grams of oral glucose

Patients blood glucose is taken after 2 hours

2 hour Postprandial Test:

Normal patients- glucose level is less than 140 mg/dL

Diabetic patients- glucose level is more than 200 mg/dL

Results
Oral Glucose Tolerance Test
75 grams of glucose is given

blood samples and urine specimens are taken at
30, 60, 120 and 180 minutes
Min 30 60 120 180
Normal
Abnormal
Neg
Neg Neg Neg
Pos
Pos
Pos/
Neg
Pos/
Neg
Min 30 60 120 180
Abnormal
Normal
200
180
160
140
120
100

Monitoring of Glucose Levels:
Daily: FBS, RBS

Weekly: Fructosamine (every 2 weeks)

Monthly: Hemoglobin A
1C
(every 3 months)
Proinsulin
Insulin
C-peptide
Increased in:
Insulinoma
Type II diabetes mellitus

Decreased in:
Exogenous insulin administration (eg., factitious
hypoglycermia)
Type I diabetes mellitus
Insulin/ C-Peptide Ratio
Use
To differentiate insulinoma from fractitious
hypoglycermia due to insulin

Interpretation
<1.0 in molarity units ( or>47.17 g/ng in con. units)
Increased endogenous insulin secretion (e.g., insulinoma,
sulfonylurea administration)
Renal failure
>1.0 in molarity units (or<47.17 ug/ ng in con. units)
Exogenous insulin administration
Cirrhosis

Diabetes Mellitus, Gestational
Hyperglycemia that develops for the first time during
pregnancy: after ~4% of pregnant women; most have return
to normal glucose tolerance after delivery. 60% become
diabetic in next 16 yrs.

Infants of Diabetic Mothers
Blood glucose less than 30mg/dL in 50% of diabetic
mothers.
Associated with hypocalcemia, occurring 24-36 hrs. after
birth.
Asymptomatic at birth but should be monitored every 6hrs.
Diabetes Mellitus, Neonatal
Blood glucose is often between 245 and 2300
mg/dL

Metabolic acidosis of some degree is usually
present

Ketonuria is variable

Laboratory findings due to dehydration
Diabetes Mellitus, Neonatal
Laboratory findings due to infection or CNS lesions,
which are present in one third of patients

Has been detected as early as fourth day. Usually
is transient

Increased association with postmaturity, low birth
weight, neonatal hypoglycemia, steroid therapy early
in neonatal period.
Tumors of Pancreas
(Hormone-Secreting), Primary
Cell Type Hormone Secreted Tumor
B cell Insulin Insulinoma
D cell Gastrin Gastrinoma
A cell Glucagon Glucagonoma
H cell VIP Vipoma
D cell Somatostatin Somatostatinoma
HPP cell Human Pancreatic HPP- Secreting Tumor
Poly- Peptide (very rare tumor)