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Diabetes Mellitus.docx

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McMaster University
Peter Helli

Diabetes Mellitus Part 1Diabetes excessive excretion of urineDiabetes Mellitus disorder of carbs fat and protein metabolism with absolute or relative insulin deficiencyPrevalence of DiabetesIn 0607 increased by 4 from previous year and 21 from 0203 to 0607Type 2 DM account for app 90 of diabetes cases2 million 1 in 16 Canadians dx with diabetes 9 mill Canadians live with diabetes or pre diabetesPrevalence 62 59 in female 63 in malesLower in children then adultsChildren 0335 year old 24Peaking at 7570 at 234Cost of Diabetesreduce quality of life heart disease stroke blind amputation and erectile dysfunction85 of people with diabetes die by heart attack or strokeType 1 Diabetic life might be shortened by 15 yearsType 2 Diabetic life might be shortened by 510 yearFinancial Burden Personal annual medical cost 100015000Diabetes estimated cost the Canadian Health Care system to cost 169 Billion by 2020Etiology Type 1 Diabetes MellitusAutoimmune Type 1AAutoimmune mediated specific loss of beta cells in the pancreatic islets Langerhands9095 of Type 1 DiabetesPrimarily result of beta cell destructionProne to ketoacidosisGeneticenvironment interactionGenes MHC genes on chromosome 6 encode leukocyte antigens HLADQ and HLADR increase risk of diabetesChromosome 11insulin gene regulating beta cell replicationfunctionMore then one genetic polymorphismBetween 1013 with newly diagnosed type 1 have a firstdegree relative with type 1Autoantibodies insulin autoantibodies islet cell autoantibodies antibodies directed at other islet auto antigen glutamic acid decarboxylaseGAD and tyrosine phosphatase IA2Environmental factors drugchemicals nutritional intake boivin milk viruses more in fall and winter in northern hemisphere40 of people with congenital rubella infection develop type 1 diabetes10 classified as having type 2 diabetes who fall into category in type 1A diabetes LADADiagnosed in childhood peaks in 12 yearIdiopathic Type 1BNo evidence of autoimmunityEtiology is unknownLess than 10 of people with type 1 diabetesStrong genetic component of type 1B diabetesMost affected African and Asian descentVarying degrees of insulin deficiency episodic ketoacidosisEtiology Type 2 DMCharacterized by hyperglycemia insulin resistance and relative insulin deficiencyRange from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistanceEnvironment genetic interaction1520 people with firstdegree relatives have diabetesGenes genetic defect of beta cells function genetic defects in insulin synthesis secretion and actionsRisk factors age obesity hypertension physical inactivity and family historyMetabolic syndrome high risk for developing type 2 diabetes and associated cardiovascular complicationsMostly in adults however increasing prevalence in children has child hood obesity rates climbEtiology GDM Gestational Diabetes MellitusAny degree of glucose intolerance with onset or first recognition during pregnancyExact etiology of glucose intolerance unknown combination of insulin resistance and impaired insulin secretionRisk factors older age family history history of glucose intolerance obesity poor obstetrics outcome infant more than 9 poundsDiagnosis based on lab values different then non pregnantUntreated can increase maternal and perinatal morbidityControlled same as other pregnancyOthersSpecifics genetically defines form of diabetes Maturity Onset of Diabetes of the Young present at young age mild disease with some insulin production Inherent autosomal dominant transmission
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