Diabetes Mellitus Overview and Treatments

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Diabetes Mellitus Overview and Treatments
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Estimated lifetime risk of developing diabetes
for individuals born in the United States in 2000
Narayan et al, JAMA, 2003
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Diabetes Mellitus a group of diseases
characterized by high levels of blood glucose
resulting from defects in insulin production,
insulin action, or both

• 20.8 million in US ( 7 of population)
• estimated 14.6 million diagnosed (only 2/3)
• Consists of 3 types
• 1) Type 1 diabetes
• 2) Type 2 diabetes
• 3) Gestational diabetes

• Complications
• - Stroke
• - Heart attack
• - Kidney disease
• - Eye Disease
• - Nerve Damage

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Diabetes Mellitus

• Type 1 Diabetes
• - cells that produce insulin are destroyed
• - results in insulin dependence
• - commonly detected before 30

• Type 2 Diabetes
• - blood glucose levels rise due to
• 1) Lack of insulin production
• 2) Insufficient insulin action (resistant
  cells)
• - commonly detected after 40
• - effects gt 90
• - eventually leads to ß-cell failure
• (resulting in insulin dependence)

Gestational Diabetes 3-5 of pregnant women in
the US develop gestational diabetes
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Testing
Fasting Plasma Glucose Test (FPG) - (cheap,
fast) fasting B.G.L. 100-125 mg/dl signals
pre-diabetes gt126 mg/dl signals diabetes
Oral Glucose Tolerance Test (OGTT) tested for
2 hrs after glucose- rich drink 140-199 mg/dl
signals pre- diabetes gt200 mg/dl signals
diabetes
A.K.A. Glycated Hemoglobin tests
A1C

• 80 to 90 mg per 100 ml, is the normal fasting
  blood glucose concentration in humans and most
  mammals which is associated with very low levels
  of insulin secretion.

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In the case of type 1 diabetes, insulin levels
are grossly deficient. Thus type 1 diabetes is
invariably treated with insulin

• Type 2 diabetes is frequently associated with
  obesity. Serum insulin levels are normal or
  elevated, so this is a disease of insulin
  resistance. A number of treatment options may be
  employed.

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• Animation showing overview of diabetes
• http//www.healthscout.com/animation/1/34/main.htm
  l

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• Pancreatic Hormones
• Insulin
• Amylin
• Glucagon
• Somatostatin
• Pancreatic Polypeptide

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Who need insulin medicine

• Type I (insulin dependent) diabetes patients
  whose body produces no insulin.
• Type 2 diabetes patients that do not always
  produce enough insulin.

Treatment

• subcutaneous injection

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Insulin drug evolution
Stage 1 Insulin was extracted from the glands
of cows and pigs. (1920s) Stage 2
Convert pig insulin into human insulin by
removing the one amino acid that distinguishes
them and replacing it with the human version.
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• Stage 3 Insert the human insulin gene into E.
  coli and culture the recombinant E.coli to
  produce insulin (trade name Humulin). Yeast is
  also used to produce insulin (trade name
• Novolin) (1987).

Recombinant DNA technology has also made it
possible to manufacture slightly-modified forms
of human insulin that work faster (Humalog and
NovoLog) or slower (Lantus) than regular human
insulin.
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In Conclusion

• 2 major types of diabetes
• (3 with Gestational)
• Type 1 gt insulin dependant (5-10)
• Type 2 gt insulin resistance disease often
  succumbs to insulin dependence (gt90)