KinGdom of MediCine 💊 مملكة الطب:
#Biochemistery
#Carbohydrate_metabolism
#بوست_رقم (21)
بعتذر علي الغيبة الطويلة نسبة لظروف بس😭😭
الليلة ح نتكلم عن ال
Diabetes mellitus
🌸It is a common disease in man, predisposition to the disease is probably inherited as an autosomal.
🌸 Definition:
It is a chronic disease due to a disorder of carbohydrate metabolism, cause of which is deficiency or diminished effectiveness of insulin.
☘It is characterized by a chronic Hyperglycemia and glycosuria.
🔥 Note:
The word diabetes means increase urine volume.
🌸 Stage of diabetes mellitus:
هم 4stage وموضحين تحت في جدول في صورة مرفقة👇
🌸 Clinical types and causes:-
هم two main groups
1. Primary (Idiopathic):
ودا بِشَكِل ال major
Cause is not known, metabolic defect is insufficient insulin which may be absolute or relative.
2. Secondary:
ودا minor
It can be secondary to some disease process.
يلا نشوفهم واحد واحد بتفصيل اكتر
🌺 Primary: two clinical types:
1. Type I (Insulin dependent) IDDM
دي الاسم المستخدم حالياً
بس عندو اسم تاني كان بقولوهو ليه زمان اللي هو Juvenile"onset diabetes
ودا بحصل اكتر حاجه في ال younge .
2. Type II (Non insulin dependent) NIDDM
الاسم القديم Maturity" onset diabetes
ح انزل ليكم فروقات بين النوعين ديل في صورة تحت👇
دا شائع اكتر حاجه في ال old وال obese.
🌸 Other factors:
ودي ال factors اللي ممكن تكون سبب في Primary اللي هي
1. Hereditary:
Genetic factors more important in those who develop after 40.
In younger, type 1
في ال HLA phenotype.
2. Autoimmunity.
3. Infections: certain viral infections may precipitate type I.
4. Obesity: majority of middle aged with typeII are obese, stress like pregnancy may precipitate.
5. Over eating and under activity.
6. Insulin antagonism: type II ,the deficiency of insulin is relative and glucose induced insulin secretion may be greater and more prolonged than normal
طيب ال causes اللي بتعمل ال insulin antagonism دي شنو؟
Causes is not known but various factors have been incriminated:
1. Insulin antibodies.
2. Secretion of abnormal and less active insulin or "altered" insulin.
3. Tissue barrier to the transport of insulin to the cells
ودي من المحتمل يكون في receptors deficiency
4. Lack of cellular response to insulin.
كلامنا دا كلوو عن ال Primary
طيب يلا نشوف النوع التاني
🌺 Secondary:
زي ما قلنا هنا
Diabetes is secondary to some other diseases:
1. Pancreatic diabetes:
بكون نتيجة ل
Pancreatitis.
Haemochromatosis.
Malignancy of pancreas.
2. Abnormal concentrations of antagonistic hormones:
ودا بكون نتيجة ل
Hyperthyroidism.
Hypercorticism like Cushing's syndrome.
Hyperpituitarism like acromegaly.
Increased glucagon activity.
3. Due to therapy like corticosteroids, thiazide diuretics.
🌸 Biochemical disturbance of diabetes mellitus:
Insulin deficiency causes disturbance in CHO, lipid, protein, vitamins and minerals metabolism.
طيب نشوفهم واحد واحد👋
🍁 Carbohydrate metabolism:
لما يحصل insulin deficiency ح ينقص ال glucose uptake by tissues وبالتالي ح يحصل نقصان في ال glucose oxidation وكدا ح يزيد ال Gluconeogensis و ال glycogenolysis ودا بيؤدي ل
1. Decrease of intracellular glucose —> hunger pain —> polyphagia (excessive eating).
2. Hyperglycemia: this causes increase plasma osmolality —> dehydration.
a. Dehydration of brain cells بالتالي ح يحصل Hyperglycemia و hyperosmolal coma
b. Dehydration of body cells —> sense of thirst —> excessive drinking (polydepsia)
3. Glycosuria:
اذا ال blood glucose level اتجاوز ال renal threshold ح يظهر ال glucose في ال urine اللي هو glucosuria .
This will leads to increase osmotic diuresis that causes:
1. Excessive and frequent urination (polyurea).
2. Loss of water soluble vitamins e.g B1.
3. Loss of minerals e.g Na+ and K+.
🍁 Protein metabolism:
لما يحصل insulin deficiency دا بيؤدي لزيادة في ال protein breakdown و يحصل stimulation ل Gluconeogensis يعني يتم تحويل ال amino acids ل glucose.
This results in:
1. Phosphate release —> hyperphosphatemia.
2. Excessive breakdown of tissue proteins causing
muscle wasting.
3. Decreased antibody form
ation causing low resistance and infection.
4. Poor healing of wounds.
🍁 Lipid metabolism:
لما يحصل insulin deficiency دا ح يؤدي ل excessive lipolysis في ال adipose tissue وبالتالي ح يحصل mobilization لل free fatty acids و ال glycerol ويمشي لل blood ومن و لل liver and other tissues .
This leads to:
1. Loss of weight.
2. Hyperlipidemia —> Atherosclerosis.
3. Fatty liver.
4. Excessive ketone bodies formation —> ketonemia —> ketosis —> lead to coma (ketotic coma) and hyperkalemia.
🍁 Microangiopathy:
It is degeneration that affects small blood vessels as capillaries especially those of the kidneys and retina of the eyes.
🔥 Two of common chronic complications of diabetes mellitus are:-
1. Renal failure.
2. Blindness.
تعليقات
إرسال تعليق