Surah: 18- Al-Kahf

Aya: 46

Diabetes Mellitus II

Type II DM or NIDDM
More common than IDDM 90 % of all diabetics Usually occurs after 30 years of age Maturity onset DM or adult onset DM Obesity is very common cause sensitivity of tissues to insulin Hyperinsulinemia Insulin resistance

NIDDM
Insulin receptors decrease in obese people Fat deposition some how reduces the number of insulin receptors Metabolic syndrome
Obesity Insulin resistance Fasting hyperglycemia blood cholesterol and triglycerides ( LDL) HDL Hypertension

NIDDM
Common in many types of obesities
PCOS- polycystic ovary syndrome
ovarian androgens Insulin resistance Hyperinsulinemia

Cushing syndrome - Insulin resistance Acromegaly - Insulin resistance Genetic causes of obesity and insulin resistance

Causes of insulin resistance

Overweight- obesity glucocorticoids GH Pregnancy PCOS Genetic lipodystrophy Autoimmunity against insulin receptors Hemochromatosis

NIDDM
Early stages
Moderate hyperglycemia after meals More secretion of insulin not very effective to reduce blood sugar level

Later
Burning of the beta cells Actual insulin deficiency

Genetic makeup determines weather the pancreas can sustain hyperglycemia or not. NIDDM treated
reduction in weight exercise caloric restriction Oral hypoglycemic are effective in early stages

Comparison of type I and Type II DM

Type I Less than 20 yrs age Not obese Insulin deficient Hyperglycemia Normal insulin sensitivity Ketoacidosis common Treated with insulin

Type II More than 30 yrs age Usually obese Insulin normal or more Hyperglycemia Reduced insulin sensitivity Ketoacidosis not common Treated with exercise, Weight reduction, oral hypoglycemic drugs

Diagnosis
Urinary glucose
Normally no glucose present Glucosurea in diabetes mellitus Amount of glucose in urine proportional to blood glucose level

Fasting blood glucose level

Normal 80- 90 mg/dl (110 mg/dl upper limit) Hyperglycemia more than 110 mg/dl 300 -1200 mg/dl

Diagnosis
Blood insulin level
IDDM
Very low (even absent) fasting No increase even after ingestion of glucose

NIDDM
Normal or even very high fasting level Further increase after ingestion of glucose

Diagnosis: Glucose tolerance test

Diagnosis
Glucose tolerance test
Fasting blood glucose measured Ingestion of glucose (1 gram/kg body weight) Blood glucose measured after regular intervals of 1530 minutes for a few hours Normal
Fasting level less than 90 mg/dl Rises to 120-130 mg/dl Returns to fasting or even lower level within 2 hours

Diabetic
Fasting level more than 110 mg/dl Rises to very high levels 200 or more Remains high for longer time Does not return to fasting level even after 4-6 hours

Diagnosis
Acetone breath
Ketosis Acetone is a volatile substance Vaporized in expired air Sweat smell of acetone can be detected very easily Ketoacids level in urine is also measure of the severity of disease

Treatment
Normal diet with sufficient insulin IDDM requires insulin treatment
Regular insulin ( duration of action 3-8 hours) Long acting insulin (precipitated with zinc and/or proteins) duration of action 10-48 hours

NIDDM
Exercise Diet control Weight reduction Oral hypoglycemic drugs Insulin

Treatment
Lipid lowering drugs
Most of the grave complications like. IHD, CVA, Retinopathy, nephropathy, cataract, Hypertension, atherosclerosis, gangrene all are due to impaired fat metabolism, hyperchosterolemia Statins reduce blood lipid and many of these grave complications