Monday, April 26, 2010

DIABETES MELLITUS -Partt 1 اعداد د.اسلام عبد العظيم

Diabetes Mellitus

FACT
Insulin convert glucose to glycogen for internal storage in liver and muscle cells.

Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose by the hormone glucagon.

Higher insulin levels increase some anabolic ("building up") processes such as cell growth and duplication, protein synthesis, and fat storage. 

Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa

If the amount of insulin available is insufficient glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.
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Types:
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1. Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin.
2. Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
3. Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM..

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Signs and symptoms
• polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).[11] Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children.
• However, in type 2 diabetes symptoms usually develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid weight loss and mental fatigue. 
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Medications
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1-Sulfonylureas
First-generation agents
o tolbutamide (Orinase)
o acetohexamide (Dymelor)
o tolazamide (Tolinase)
o chlorpropamide (Diabinese)
Second-generation agents
o glipizide (Glucotrol)
o glyburide (Diabeta, Micronase, Glynase)
o glimepiride (Amaryl)
o gliclazide (Diamicron)
They are insulin secretagogues, The "second-generation" drugs are now more commonly used.

They are more effective than first-generation drugs and have fewer side effects. All may cause weight gain.

Sulfonylureas are only useful in Type II diabetes, as they work by stimulating endogenous release of insulin. They work best with patients over 40 years old, who have had diabetes mellitus for under ten years.

They can not be used with type I diabetes, or diabetes of pregnancy. They can be safely used with metformin or -glitazones. The primary side effect is hypoglycemia.