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The State Education Institution of Higher Professional Training
The First Sechenov Moscow State Medical University
under Ministry of Health of the Russian Federation
Department of Pathophysiology
Disturbances of
carbohydrate metabolism.
Diabetes mellitus.
Lecture presentation
Professor Pirozhkov S.V.
2014-2015 education year
TYPICAL FORMS OF DISORDER OF
CARBOHYDRATE NETABOLISM
● Hypoglycemia (< 3.3 mmol/L of blood)
● Hyperglycemia (> 5.6 mmol/L of blood)
● Glycogenoses
● Aglycogenoses
● Pentosemia, hexosemia
CAUSES OF HYPOGLYCEMIA
● Neurogenic
● Endocrinogenic
● Hepatic
● Renal
● Inadequate substrate supply
● Use of drugs
SYMPTOMS OF HYPOGLYCEMIA
I. Associated with activation
of the sympathetic system
(autonomic response)
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sweating
tremor
tachycardia
anxiety
sharp sensation of hunger
II. Associated with glucose
deprivation of the brain
(neuroglycopenia)
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dizziness
headache
blurred vision
poor reasoning
ataxia
confusion
seizures
loss of
consciousness
CAUSES OF HYPERGLYCEMIA
● Neurogenic
● Endocrinogenic
● Alimentary
● Hepatogenic
Diabetes mellitus is a disease or
syndrome characterized by systemic
derangements of carbohydrate, lipid
and protein metabolism, acid-base
and water-mineral balance, resulting
from absolute or relative deficiency of
pancreatic insulin
Epidemiology of diabetes mellitus
(DM):
► Worldwide, more than 140 million people
suffer from DM.
► Approximately 80% to 90% of patients have
type 2 DM.
► DM increases with ageing. In 2000 the
prevalence of DM was:
0.19% in people < 20 years old;
8.6% in people > 20 years old;
20.1% in individuals > 65 years old
Insulin deficiency
GLUCAGON
EXCESS
Adipose tissue
Muscle
Increased lipolysis
(free fatty acids)
Increased protein
catabolism (amino
acids)
Gluconeogenesis
Ketogenesis
Liver
POLYPHAGIA
KETOACIDOSIS
HYPERGLYCEMIA
Kidney
POLYURIA
Metabolic derangements typical for diabetes mellitus type I
MAIN MANIFESTATIONS OF METABOLIC DISORDERS IN
DIABETES MELLITUS
CARBOHYDRATES
Hyperglycemia
Glucoseuria
PROTEINS
Hyperazotemia,
increased
blood urea
nitrogen
LIPIDS
WATER
Hyperlipidemia
Polyuria
Polydypsia
Ketonemia
Hyperlactacidemia
Azoturia
ACIDOSIS
Ketoneuria
Genetic aspects of diabetes mellitus type 2:
► Among identical twins, the concordance
rate is 70% to 90%
► In first-degree relatives with type 2
diabetes (and in non-identical twins), the
risk of developing disease is 5 to 10
times higher than in age- and weightmatched subjects without a family
history
► Unlike type I diabetes, the disease is not
linked to any HLA genes
Phases of the clinical course of diabetes mellitus type 2
Resistance
to insulin
Blood insulin
concentration
Blood glucose
level
I phase
moderately
increased
increased
normal
II phase
greatly
increased
increased
hyperglycemia
after meal
III phase
greatly
increased
insufficiently
increased for
a particular
glucose level
hyperglycemia
in the fasting
state
CHRONIC COMPLICATIONS OF DIABETES MELLITUS
► Microvascular
● Eye disease
- retinopathy (nonproliferative/proliferative)
- macular edema
● Neuropathy
- sensory and motor (mono- and polyneuropathy)
- autonomic
● Nephropathy
CHRONIC COMPLICATIONS OF DIABETES MELLITUS
► Macrovascular
● Coronary artery disease
● Peripheral vascular disease
● Cerebrovascular disease
► Other
● Gastrointestinal (gastroparesis, diarrhea)
● Genitourinary (uropathy/sexual disfunction)
● Dermatologic (pigmented pretibial papules)
● Infectious
● Eye diseases (cataract, glaucoma)