Classification And Diagnosis Of Diabetes

1. Classification and Diagnosis of
Diabetes
Exeter Diabetes Care Team

2. Introduction
Prevelance
Definition
Diagnosis
Different types of diabetes
Action of insulin
Treatment
Brief overview of complications

3. UK Prevalence of Diabetes
1.4 million with diagnosed diabetes
1 million with undiagnosed diabetes
3 million predicted by 2010 in the
UK
221 million predicted worldwide by
2010

4. Definition
Diabetes – The term diabetes
mellitus describes a metabolic
disorder of multiple aetiology which
is characterized by hyperglycaemia
with disturbances of carbohydrate,
fat and protein metabolism resulting
from defects in insulin secretion,
insulin action or both.

5. Diagnosis
Glucose Tolerant Population:
FPG <6mmol/l
OGTT 2hour value <7.8mmol/l
oNon Glucose Tolerant Population
Impaired fasting glucose
FPG 6-7mmol/l
Impaired glucose tolerance
OGTT 2-hour value 7.8-11.1mmol/l
oType 2 Diabetes
FPG >7mmol/l
Random plasma glucose >11.1mmol/l

6. What Is a Normal Blood Sugar
Level?
Normal range 4 – 7 mmol/l
Aim for normoglycaemia
Prevent diabetes complications
Encourage self management

7. Classification of Diabetes
Type 1
Type 2
Gestational
Other specific types (genetic)

8. P e rip h e r

a l

g lu c o s e
u p ta k e

G lu c o s e
a b s o rp tio n

G lu c o s e
p ro d u c ti
o n
B lo o

d
g luc o
s e
Liver Mu s c l
e
In te s tin e
Ad ip o s e
Blood glucose levels

9. Insulin structure
51 amino acids arranged as a two chained
molecule connected by two disulphide bridges:
A chain 21 amino acids
B chain 30 amino acids

10. Effects of insulin
Glucose metabolism
Suppresses hepatic gluconeogenesis
Suppresses hepatic glycogenolysis
Stimulates uptake of glucose into
skeletal muscle & fat
Suppresses breakdown of protein & fat

11. D e c re a s e d h e p a tic

g lu c o s e p ro d u c tio n

In c re a s e d p e rip h e ra l

g lu c o s e u p ta k e
Primary effects of insulin
on blood glucose
Muscle
Liv e r
P a n c re a s

12. Effects of insulin
Protein metabolism
May increase protein synthesis –
especially in muscular tissue
Inhibits protein breakdown
(proteolysis)

13. Effects of insulin
Lipid metabolism
Increases triglyceride synthesis
(lipogenesis)
Inhibits breakdown of triglycerides in
adipose tissue (lipolysis)

14. Glucose uptake
Glucose transporters required for glucose to cross
cell membrane
Transporters accelerate transport along glucose
concentration gradient – does not require energy
Transporters in brain, liver, kidneys are insulin
independent or very slightly insulin dependent
GLUT4-transporter:
highly insulin sensitive
located on fat, muscle, heart cells

15. Without insulin:
Hepatic glucose production
permitted
Uptake of glucose into muscle and
fat cells is restricted
Lipids and protein are broken down
Hyperglycaemia aggravated by food
intake

16. Type 1 Diabetes
Onset typically <40 years
Usually normal weight or slim
No endogenous insulin production
Onset “dramatic”
Family history less common
Insulin required to sustain life

17. Type 1 diabetes
• :
Us e d to be kno w n a s
IDDM
type I
juvenile-onset diabetes

18. Symptoms of Type 1
Frequent urination
Thirst
Weight loss
Fatigue
Ketones (acetone on breath)

19. Type 1 diabetes
•Onset typically childhood & adolescence
•Usually normal weight or slim
•Pancreatic β cells destroyed
•Onset often “dramatic”
•Family history less common – first degree
relatives
•Autoimmune disease
•Insulin required to sustain life

20. Type 1 Diabetes - Symptoms
Frequent urination
(polyuria/nocturia)
Thirst
Fatigue
Ketones(acetone on breath)
Weight loss-can be dramatic
Other minor symptoms-skin
infections, muscle cramps,blurred
vision, puritis

21. Management of Type 1
Diet and exercise
Insulin
Aim is to normalise blood glucose
level

22. Type 2 Diabetes
Onset typically>40 years
Genetic predisposition
Associated with obesity
Slow onset of symptoms
Insulin not required to sustain life
but often used to maintain health
Wrongly perceived as “mild
diabetes”

23. Features of Type 2 Diabetes
Reduced insulin secretion from the
pancreas
The body is also resistant to the
insulin that it is producing

24. Symptoms of Type 2
Excessive thirst
Frequent urination
Fatigue
Blurred vision
Recurrent infections
Sometimes weight loss
Sometimes ketones
Some, all or none of the above!!

25. Review
Type 1 diabetes – no insulin
production
Type 2 diabetes –
Insufficient insulin
Resistance to insulin

26. Diagnosis
More prone to diabetes if:
Obese
Asian or afro-Caribbean
Over 65 years
Family history of diabetes
History of gestational diabetes
Other auto-immune disease

27. Diagnostic Criteria
Fasting Blood Glucose >7.0
Random Blood Glucose >11.1

28. Treatment of Type 2
Diet alone – low fat, low sugar, high
fibre = healthy
Diet and tablets
Diet, tablets and insulin
Diet and insulin

29. Monitoring Diabetes
Urine testing –
All results should be negative
Only shows positive when blood
sugar level is above 10 mmolls

30. Monitoring Diabetes
Home blood glucose monitoring
Using a meter
Gives accurate level of sugar at
time of testing
Quick and easy to do

31. Monitoring Diabetes
Blood test for Glycated haemoglobin
Aim to achieve HbA1c 7% or below
HbA1c – reviews an average over
the last 3 months

32. Possible Complications
Small vessel complications:
Retinopathy = affect on the small
blood vessels on the back of the eye
Nephropathy = affect on the
kidneys
Neuropathy = affect on the nerves
and circulation

33. Possible Complications
Large vessel complications:
Heart disease
Poor circulation leading to foot
problems
Stroke

34. How to Prevent
Aspirin is commonly prescribed
Aim for HbA1c of 7% or less
Aim for blood pressure no greater than
140/80
Aim for cholesterol level of less than
4.0mmol/l

35. Advice to Patients
Maintain healthy weight
Regular exercise
Reduce salt intake
Healthy intake of fruit and vegetables
Limit alcohol consumption
Stop smoking
Reduce intake of saturated fat
Increase intake of oily fish

36. Symptoms of Hypoglycaemia
A ‘hypo’ is any blood sugar level
below normal i.e.. 4 mmol/l
Sweating
Shaking
Change in mood i.e.. Confusion,
aggression
Extreme hunger
Numbness/tingling around lips

37. Management of Hypoglycaemia
Should be treated immediately with:
5-6 dextrose sweets or half glass
lucozade or sugar in water, etc
Followed by carbohydrate snack
Blood sugar level should then be
checked again in 10 minutes to
check response

38. Summary
Discussed definition and diagnosis
of diabetes.
Its prevalence
Types
Treatment
Brief review of complications