Diabetes Mellitus : Definition, Classification, Pathogenesis, Treatment And MCQs for NEET, GPAT, CSIR NET JRF

” Diabetes mellitus represents a group of metabolic disorders in which there is impaired glucose utilization, including hyperglycemia.”

1.] In diabetes mellitus fat, protein and carbohydrate metabolism is commonly affected.

2.] People with diabetes are very much prone to infection.

3.] In this metabolic syndrome some of the major features are – central obesity, hypertriglyceridaemia, low LDL cholesterol, hyperglycemia and the hypertension.

4.] Diabetes mellitus is a leading cause of morbidity ( refers to having a disease or a symptoms of disease, or to the amount of disease in population, it also refers to medical problems caused by treatment) and mortality all over the world.

5.] The rise in prevalence is more for – Type 2 diabetes than for Type 1.

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CLASSIFICATION :-

There are basically two types of diabetes :

A.] Type 1 Diabetes Mellitus : It is also called insulin dependent diabetes mellitus. In this type 1 diabetes about 10% cases of diabetes mellitus were constituted. Previously, it is termed as juvenile – onset diabetes (JOD) due to its occurrence in younger age and was called insulin dependent for insulin replacement as treatment.

Based on underlying etiology, type 1 diabetes mellitus is further divided into 2 types :-

• Subtype 1A (immune – mediated) DM : characterized by auto – immune destruction of beta cells which usually leads to insulin deficiency.
• Subtype 1B (idiopathic) DM : characterized by insulin deficiency with tendency to develop ketosis but these patients are negative for autoimmune markers.

B.] Type 2 Diabetes Mellitus : This type comprises about 80% cases of DM. Previously, this type 2 diabetes is termed as non – insulin dependent diabetes mellitus (NIDDM) or maturity – onset diabetes. Type 2 DM mainly affect older individuals. Many Type 2 DM patients require insulin therapy to control hyperglycemia or to prevent ketosis.

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PATHOGENESIS :-

Depending upon the etiology discussed above of DM; hyperglycemia may result from the following :

• Reduced insulin secretion
• Decreased glucose use by the body
• Increased glucose production

A.] Pathogenesis of Type 1 DM : Basically, in type 1 diabetes mellitus there is a destruction of beta – cells mass, which leads to absolute deficiency of insulin.

Pathogenesis of type 1 ADM are as follows :

• At birth, individuals with genetic susceptibility to this disorder have normal beta – cell mass.
• Also beta – cells act as an auto antigens and activate CD4+ T lymphocytes, bringing about immune destruction of pancreatic beta – cells by autoimmune phenomena and take months to years.
• Trigger of autoimmune process appears to be some infectious or environmental factor which specifically targets beta – cells.

B.] Pathogenesis of Type 2 DM : In type 2 DM either a delayed insulin secretion relative to glucose load (impaired insulin secretion), or the peripheral tissue are unable to respond to insulin (insulin resistance).

Pathogenesis of Type 2 DM are as follows :

• Type 2 DM is a more complex multi factorial disease.
• There is a greater role of genetic defect and heredity.
• Two main mechanism for hyperglycemia in type 2 DM – insulin resistance and impaired insulin secretion, are interlinked.
• Obesity also plays a very important role.
• Increased hepatic synthesis of glucose also contribute to hyperglycemia.

TREATMENT :-

Medication given to the TYPE-I Diabetic patients are as follows :-

Short-acting insulin

• regular insulin (Humulin and Novolin)

Rapid-acting insulins

• insulin aspart
• insulin glulisine
• insulin lispro

Intermediate-acting insulin

• insulin isophane

Long-acting insulins

• insulin degludec
• insulin detemir
• insulin glargine
• insulin glargine

Combination insulins

• insulin aspart protamine-insulin aspart
• insulin lispro protamine-insulin lispro
• insulin lispro protamine-insulin lispro
• human insulin NPH-human insulin regular
• human insulin NPH-human insulin regular
• insulin degludec-insulin aspart

Amylinomimetic drug

• Pramlintide is an amylinomimetic drug. It’s an injectable drug given before meals.

Medications for type 2 diabetes

Sulfonylureas

• glimepiride
• gliclazide
• glipizide
• glyburide
• chlorpropamide
• tolazamide
• tolbutamide

Biguanides

• The most common biguanide is metformin
• Metformin can also be combined with other drugs for type 2 diabetes.

Thiazolidinediones

• Rosiglitazone
• Pioglitazone (Banned now)

Alpha-glucosidase inhibitors

• Acarbose
• Miglitol

Dipeptidyl peptidase-4 (DPP-4) inhibitors

DPP-4 inhibitors help the body continue to make insulin.

These drugs can also help the pancreas make more insulin. These drugs include:

• Alogliptin
• Linagliptin
• Saxagliptin
• Sitagliptin

Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists)

These drugs are similar to the natural hormone called incretin.

• Albiglutide
• Dulaglutide
• Exenatide
• Liraglutide
• Semaglutide

Meglitinides

• Nateglinide
• Repaglinide

Sodium-glucose transporter (SGLT) 2 inhibitors

• Dapagliflozin
• Canagliflozin
• Empagliflozin
• Ertugliflozin

Dopamine agonist

• Bromocriptine is a dopamine agonist.

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MULTIPLE CHOICE QUESTIONS :-

1.] Diabetes is beat defined as ?

a. A metabolic disease characterized by low blood sugar

b. A metabolic disease characterized by high blood sugar

c. A family of blood infection

d. None of the above

2.] diabetes can be cured with diet, exercise and medication ?

a. True

b. False

3.] Which is not an symptom of diabetes ?

a. Itchy skin

b. Thirst

c. Frequent urination

d. Muscle Pain

4.] Insulin is a natural hormone secreted by which organ or gland ?

a. The kidney

b. The liver

c. The pancreas

d. The spleen

5.] Type – 2 diabetes can cause long term damage in the ?

a. Kidneys

b. Eyes

c. Nerves

d. All of the above

6.] Gestational diabetes occurs ?

a. During pregnancy

b. After a bout with shingles

c. At birth

d. After menopause

7.] People with diabetes are prone to ?

a. Acne (pimples)

b. Shingles

c. Infection

d. Migraine

8.] When the body does not respond to the insulin it makes this is called ?

a. Type 1 diabetes

b. Type 2 diabetes

c. Both

d. None of the above

9.] With Type 1 diabetes, the body does not produce insulin ?

a. True

b. False

10.] Prediabetes is considered as a reversible condition ?

a. True

b. False

SOLUTIONS :-

1.] (b) A metabolic disease characterized by high blood sugar

2.] (b)

3.] (d) Muscle pain

4.] (c) The pancreas

5.] (d)

6.] (a) During pregnancy

7.] (c) Infection

8.] (b) Type 2 diabetes

9.] (a)

10.] (a)

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 808 – 818.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 909 – 922.