Diabetes Mellitus

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Unit 10

• Diabetes Mellitus

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Text A

• Prospects for Research in Diabetes Mellitus

Teaching Set-up 1. Group Discussion 2. Background
Knowledge 3. Understanding the Text 4. Assignment
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Word Formation

1. retin/o (retina) e.g. retinopathy
2. nephr/o (kidney) e.g. nephropathy
3. neur/o (nerve) e.g. neuropathy
4. heter/o ( different) e.g. heterogeneous
5. glyc/o (sugar)
6. pharmac/o (pharmacy)
7. xeno- (different) e.g. xenograft
8. pro- (before) e.g. progenitor

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Group Discussion

• 1. What do you know about diabetes ?
• 2. Why is diabetes viewed as a modern epidemic ?
• 3. How to prevent diabetes as early as possible ?

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Introduction

• Diabetes mellitus is often referred to simply
  as
• diabetes (Greek to pass through). And
  Mellitus
• ( Latin, meaning honey , is a reference to
  the sweet
• taste of the urine.)
• Diabetes mellitus is a syndrome of disordered
  
• metabolism, usually due to a combination of
  hereditary
• and environmental causes, resulting in
  abnormally high
• blood sugar levels (hyperglycemia).

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• Blood glucose levels are controlled by a complex
• interaction of multiple chemicals and hormones in
  the
• body, including the hormone insulin made in the
  beta
• cells of the pancreas. Diabetes mellitus refers
  to the
• group of diseases that lead to high blood glucose
  levels
• due to defects in either insulin secretion or
  insulin action
• in the body.

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• Diabetes develops due to a diminished
  production of
• insulin (in type 1) or resistance to its
  effects (in type 2
• and gestational). Both lead to hyperglycemia,
  which
• largely causes the acute signs of diabetes
  excessive urine
• production, resulting compensatory thirst and
  increased
• fluid intake, blurred vision, unexplained
  weight loss,
• lethargy, and changes in energy metabolism.

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• All forms of diabetes have been treatable since
  insulin
• became medically available in 1921, but there is
  no cure.
• The injections by a syringe, insulin pump, or
  insulin pen
• deliver insulin, which is a basic treatment of
  type 1
• diabetes. Type 2 is managed with a combination of
  
• dietary treatment, exercise, medications and
  insulin
• supplementation.

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Signs and symptoms

• The classical triad of diabetes symptoms is
  polyuria,
• polydipsia and polyphagia, which are,
  respectively,
• frequent urination, increased thirst and
  consequent
• increased fluid intake, and increased appetite.
• 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.

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• Type 1 diabetes may also cause a rapid yet
  significant
• weight loss (despite normal or even increased
  eating)
• and irreducible mental fatigue. All of these
  symptoms
• except weight loss can also manifest in type 2
  diabetes
• in patients whose diabetes is poorly controlled.

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Overview of the most significant symptoms of
diabetes.
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• Both type 1 and type 2 diabetes share similar
  symptoms
• caused by chronically high blood glucose levels.
• Symptoms of both type 1 and type 2 diabetes
  include
• excessive thirst
• frequent urination
• weight loss
• increased appetite
• unexplained fatigue
• slow healing cuts, bruises, and wounds

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• frequent or lingering infections (e.g., urinary
  tract
• infection)
• mood swings and irritability
• blurred vision
• headache
• high blood pressure
• dry and itchy skin
• tingling, numbness, or burning in hands or feet

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• Many Patients are asymptomatic
• Symptoms when present are
• Polydipsia
• Polyphagia
• Polyuria
• weight loss
• Tiredness
• Recurrent skin
• infections

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• Complications
• Diabetes and its treatments can cause many
  complications.
• Acute complications ( hypoglycemia,
  ketoacidosis, ) may
• occur if the disease is not adequately
  controlled. Serious
• long-term complications include cardiovascular
  disease ,
• chronic renal failure, retinal damage (which can
  lead to
• blindness), nerve damage (of several kinds), and
  
• microvascular damage, which may cause erectile
• dysfunction and poor wound healing. Poor healing
  of
• wounds, particularly of the feet, can lead to
  gangrene,
• and possibly to amputation.

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Diabetes Complications

• Having diabetes increases your risk for many
  serious complications.

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Heart Disease (cardiovascular disease)
Diabetes heart
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Blindness(retinopathy)
Neovascularization Fiber proliferation Retinal
detachment
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Nerve Damage(neuropathy)
Diabetic neuropathy
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Kidney Damage(nephropathy)
Diabetic kidney
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Infection
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• MACROANGIOPATHY

• MICROCIRCULATORY DISTURBANCE

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• NEUROPATHY

• CATARACT

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Acromelic gangrene
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Foot ulcers are a common complication of the
"diabetic foot". They allow a portal for
infection to occur.
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So ,what can we do?
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• Adequate treatment of diabetes, as well as
  increased
• emphasis on blood pressure control and
  lifestyle factors
• (such as not smoking and maintaining a healthy
  body
• weight), may improve the risk profile of most
  of the
• chronic complications. In the developed world,
  diabetes
• is the most significant cause of adult
  blindness in the
• non-elderly and the leading cause of
  non-traumatic
• amputation in adults, and diabetic nephropathy
  is the
• main illness requiring renal dialysis in the
  United States.

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Epidemiology

• In 2000, according to the World Health
  Organization,
• at least 171 million people worldwide suffer
  from diabetes,
• or 2.8 of the population. Its incidence is
  increasing
• rapidly, and it is estimated that by the year
  2030, this
• number will almost double. Diabetes mellitus
  occurs
• throughout the world, but is more common
  (especially
• type 2) in the more developed countries. The
  greatest
• increase in prevalence is, however, expected to
  occur in
• Asia and Africa, where most patients will
  likely be found
• by 2030.

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• The increase in incidence of diabetes in
  developing
• countries follows the trend of urbanization and
  lifestyle
• changes, perhaps most importantly a
  "Western-style"
• diet. This has suggested an environmental (i.e.,
  dietary)
• effect, but there is little understanding of the
  mechanism
• at present, though there is much speculation,
  some of it
• most compellingly presented.

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• For at least 20 years, diabetes rates in North
  America
• have been increasing substantially. In 2008
  there were
• about 24 million people with diabetes in the
  United
• States alone, from those 5.7 million people
  remain
• undiagnosed. Other 57 million people are
  estimated to
• have pre-diabetes.

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• Pre-diabetes is a serious medical condition that
• can be treated.  The good news is that people
• with pre-diabetes can prevent the development
• of type 2 diabetes by making changes in their
• diet and increasing their level of physical
  activity.
• They may even be able to return their blood
• glucose levels to the normal range.

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Prevention
First
Three levels
1) To the healthy bodies, reduce the risk of
getting diabetes.
2) To the diabetics, be sure that early to find,
early to treat, avoid complications as
possible as they can.
3) To the ones with complications, engage to
reduce the mortality.
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Prevention
Second
Three more and one less
Intake less food and avoid the food with high
lipid. No smoking. No drink.
Learn more
Read books, watch TV, and listen to broadcast
about diabetes.
Eat less
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Prevention
Relax more
Exercise more
Increase the time and amount of exercise to avoid
fat.
Keep optimistic, and combine exertion with rest.
Third
Examine the blood sugar regularly
People especially elders should examine the blood
sugar regularly whether they have relevant
symptoms or not.
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Understanding the Text

• Para. 1
• cardinal characteristic feature----????
• Question
• 1. What is the main characteristic of diabetes
  mentioned
• in paragraph one ?

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• Para. 2
• documentation----??
• (?????????????????????
• ????,??????????????)
• DCCT----???????????
• UKPDS----??????????
• retard----delay ??
• increment----increase
• elucidate---- explain

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• insight----view
• coincide (with)---1)???? 2) ??????
• to be exactly the
  same or very similar
• insulin pumps----????
• oral antidiabetic agents----????????
• Question
• 2. What are the long-term complications of
  diabetes
• mentioned in this paragraph ?

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• Para. 3
• insulin-dependent diabetes mellitus
• ?????????
• juvenile-onset diabetes
• ?????????
• pancreatic / pancreas ----
• smolder----to burn slowly without a flame
• ????? (???)???? ??
• markers----???
• preclinical phase----
• prediabetic state----

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• allow for----
• devastating----destructive extremely severe
• practical----workable feasible
• Question
• 3. What are the basic mechanisms that cause type
  1
• diabetes ?

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• Para. 4
• administered---- applied
• forms of insulin----?????
• couple----vt. (usu. passive) to join or link to
  ??, ??
• e.g. The fog, coupled with the amount of traffic
  on the
• roads, made driving very difficult.
• islet cell transplantation----??????
• regeneration----??
• immortalized----ever lasting
• cell line----???
• predispose to---- be susceptible to

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• Question
• 4. In the authors opinion, what research areas
  are
• necessary for the prevention of type 1
  diabetes ?

• Genes that predispose to type 1 diabetes
• Environmental factors that trigger the disease
• Cellular and molecular causes of the autoimmune
  
• destruction

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• Para. 5
• responsible genes----
• Question
• 5. Are there any connections between lifestyle
  and increasing incidence of type 2 diabetes ?
  Give examples.

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• Para. 6
• prior to----
• compensatory----???
• destined to----??
• decompensated----???????
• Question
• 6. What does this paragraph mainly talk about ?

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• Para. 7
• insulin action cascade----
• pathway----?? ??
• genetic determinants----??????
• susceptibility----???
• genetic variation----????
• gene expression profile----??????
• Question
• 7. What research areas are closely related to the
  new
• targets for pharmacologic intervention ?

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• Para. 8-13
• allele----????
• mechanistic----?????
• cornerstone----??
• enhancement----??
• genetic predispositions----?????
• adverse effects----???
• dissect----???????
• specific/defined----???
• pharmaceutical agents----??

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Question 8. Can you identify some diabetes
research areas mentioned in Current
Issues of the text ?

• Identification of genetic components of types
  1 and 2
• diabetes
• For type 1 diabetes, the basic mechanisms,
• environmental triggers and their interaction with
  genetic
• predispositions
• For type 2 diabetes, molecular components
  involved in
• insulin signaling, secretion, and ß cell growth
  and
• development, genetic and behavioral contributions
  to
• obesity.

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• Para. 14
• aggressive efforts----????
• (???????????????????,
• ??????????????????,
• ???????????)

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• Para. 15
• cadaveric islet cell transplants----??????
• ß????????????????,??????
• ??,?????????????????????
• ?????ß??????????????????
• ???ß???????????ß??????
• Question
• 9. Are there any limitations to future cadaveric
  islet cell
• transplants ? How to solve the problem ?

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• Para. 16
• coupled with----
• ?????????ß??????????
• ????????????????????
• ?????,I?????????????

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• Para. 17
• in parallel with----
• (????????,??II????????
• ????????????????????
• ????????????????????
• ?????????????????)
• a sound basis for----

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• Question
• 10. What do these two paragraphs mainly talk
  about ?

The significance of identification of genes
responsible for type 1 and 2 diabetes
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• Para. 18
• preferably----
• (????????????????????????
• ??????????,?????????????
• ?)
• morbidity/mortality
• Question
• 11. What is essential in dealing with diabetic
• complications according to this paragraph
  ?

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• Para. 19
• scourge----affliction
• Question (para. 14-19)
• 12. What do you think of the authors forecasts
  about
• diabetes prevention, treatment and cure ?
  Take one
• example from the text to illustrate your
  point.
• 13. Do you have predictions of your own about the
  
• prevention and treatment of diabetes ?
  Discuss with
• your partners.

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Phrases in the Text

• 1. cardinal characteristic feature
• 2. diabetic retinopathy
• 3. insulin preparations/delivery
• 4. oral antidiabetic agents
• 5. insulin-dependent diabetes mellitus
• 6. juvenile-onset diabetes
• 7. islet cell transplantation
• 8. cell line

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• 9. metabolic defect
• 10. hyperglycemic diabetic state
• 11. insulin action cascade
• 12. genetic determinants
• 13. gene expression profiling
• 14. environment triggers
• 15. genetic predispositions
• 16. highly specific immunosuppressive agents

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• 17. adverse effects
• 18. pharmaceutical agents/ treatments
• 19. specific targeted treatment
• 20. predisposing diabetes genes
• 21. diabetes susceptibility
• 22. susceptible individuals
• 23. health care delivery system
• 24. therapeutic modalities

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Assignment

• 1. Translate phrases in the text into Chinese
• 2. Finish reading Text B, C and D after class
• 3. Preview unit 11