Diabetes mellitus Renming Hu m. d, phD Department of Endocrinology Huashan Hospital Institute of Endocrinology and Diabetes at Fudan University
Diabetes Mellitus Renming Hu M.D,PhD Department of Endocrinology Huashan Hospital Institute of Endocrinology and Diabetes at Fudan University
Classification of diabetes (ADA-1997) pe (beta-cell destruction, usually leading to absolute insulin deficiency Autoimmune Idiopathic ●Type2 (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without nsulin resistance ● Other specific types e Gestational diabetes*x
Classification of diabetes(ADA-1997) Type 1 ⚫ (beta-cell destruction, usually leading to absolute insulin deficiency) • Autoimmune • Idiopathic ⚫ Type 2 – (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance) ⚫ Other specific types ⚫ Gestational diabetes**
Other specific types o Genetic defects of beta-cell function o Genetic defects in insulin action Diseases of the exocrine pancreas ● Endocrinopathies o Drug-or chemical-induced ● Infections o Uncommon forms of immune-mediated diabetes o Other genetic syndromes sometimes associated with diabetes
Other specific types ⚫ Genetic defects of beta-cell function ⚫ Genetic defects in insulin action ⚫ Diseases of the exocrine pancreas ⚫ Endocrinopathies ⚫ Drug- or chemical-induced ⚫ Infections ⚫ Uncommon forms of immune-mediated diabetes ⚫ Other genetic syndromes sometimes associated with diabetes
Pathogenesis
Pathogenesis
Pathology e Type I DM: inflammation of pancreas e Type 2 DM: amyloidosis of pancreas e Large vessel: atherosclerosis Kidney diffuse or nodular glomerular 60 clerosis 目east 口 north Retina arteriolar sclerosis microaneurysm、 exudates、 new vessel seasonseason season S ormation Nerve: axon degeneration myelinolysis
Pathology ⚫ Type 1 DM：inflammation of pancreas ⚫ Type 2 DM：amyloidosis of pancreas ⚫ Large vessel ：atherosclerosis ⚫ Kidney ：diffuse or nodular glomerular sclerosis ⚫ Retina：arteriolar sclerosis、 microaneurysm、exudates、new vessel formation ⚫ Nerve：axon degeneration 、 myelinolysis 0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 season 1 season 2 season 3 season 4 east west north
Pathophysiology
Pathophysiology
Abnormalities in metabolism ● Carbohydrate: anabolism, catabolism个 utilization Lipid anabolism, catabolism ketoplasia ● protein: anabolism↓, catabolism↑, yconeogenesis
Abnormalities in metabolism ⚫ Carbohydrate ：anabolism ，catabolism、 utilization ⚫ Lipid ： anabolism ，catabolism ， ketoplasia ⚫ protein： anabolism ，catabolism ， glyconeogenesis
Insulin secretion curve normal and diabetics 1600 1400 Hhtype2 1200 占1000 -normal 800 obese 600 400 200 0 30 60 90 120 clock time(hours)
Insulin secretion curve :normal and diabetics 0 200 400 600 800 1000 1200 1400 1600 0 3 0 6 0 9 0 120 clock time(hours) insulin(μU/ml） type2 normal obese type 1
Clinical presentation
Clinical Presentation
Natural history of type 2 DM After the diagnosis of type 2 diabetes IR constantly exists Insulin secretion ability gradually declines: When FPG reachs the diagnostic criteria, insulin secretion ability has already declined by 50% When FPG≌7.0 mmoL,阝- insulin secretion ability When fPg≥10~11.0mmol/L,β- Insulin secretion ability has already neared absolute deficiency
Natural history of type 2 DM After the diagnosis of type 2 diabetes: IR constantly exists Insulin secretion ability gradually declines: When FPG reachs the diagnostic criteria，insulin secretion ability has already declined by 50% When FPG≥7.0mmol/L，-cell insulin secretion ability When FPG≥1011.0mmol/L，-C insulin secretion ability has already neared absolute deficiency