Fatima was brought confused

Fatima was brought confused

1. Due to

   • Diabetes
     • Affect the Pancreas
       • Normal structure
         • Elongated, tapered organ
         • Behind the stomach
         • Parts
           • Head "Right side"
             • Widest part
             • lies in the curve of the duodenum
           • Body "Tapered left side"
           • Tail "Near spleen"
         • 2 types of glands
           • Exocrine
             • Secretes digestive enzymes
           • Endocrine
             • Islets of Langerhans
               • Secretes hormones into the bloodstream
               • Type of islets
                 • Beta cells
                   • Insulin and Amylin
                     • Regulation of glucose
                       • Role of other hormones
                     • Carbohydrate, protein & fat metabolism in well fed state
                       • Normal range of calories intake
                     • Gluconeogenesis and Glycogenolysis
                 • Alpha cells
                   • Glucagon
                 • Delta cells
                   • Somatostatin
                 • PP cells
                   • Pancreatic polypeptide
                 • Epsilon cells
                   • Ghrelin
         • Blood supply
           • Head
             • Superior and inferior pancreaticoduodenal arteries
               • Branches of the gastroduodenal
           • Pancreatic branches of the splenic artery
         • Venous drainage
           • Head of the pancreas
             • Into the superior mesenteric branches of the hepatic portal vein
           • The rest
             • Pancreatic veins via the splenic vein
     • Types "Classification"
       • Type 1
         • Immune mediated
           • Insulin dependent diabetes mellitus
           • Juvenile onset diabetes
           • 5–10% of diabetes
           • Cellular-mediated autoimmune destruction of beta cells
           • Strong association with HLA
           • Etiology
             • Genetic susceptibility
             • Autoimmunity
               • Evidence
                 • Lymphocytic infiltration (Insulitis)
                 • Other autoimmune diseases
             • Environmental factors
               • Virus infection
                 • Islet cell injury
                 • Molecular mimicry
               • Chemicals/Drugs
           • Pathogenesis
           • Autoantibodies
             • Glutamic Acid Decarboxylase
             • Insulin
             • Tyrosine phosphatases IA-2
             • Zink transporter 8
         • Idiopathic
           • Strongly inherited
           • Not associated with HLA
         • LADA (1.5)
           • Age (30-50)
           • Glutamic acid decarboxylase antibodies
       • Gestational
         • 5-10% of pregnant women
         • Third trimester
         • Disappears after delivery
         • Greater risk of
       • Monogenic
         • MODY
           • 15 forms
           • Age of 35
           • Autosomal dominant inheritance
         • Permanent Neonatal diabetes
           • Age of 6 months
           • Transient
             • Overexpression of genes
           • Permanent
             • Autosomal dominant mutations
         • Mitochondrial diabetes
           • Mutations in the mitochondrial DNA
           • Commonest mutation is m.3243A>G
           • Maternally inherited diabetes and deafness syndrome
       • Secondary
         • Pancreatic disease
         • Endocrinopathies
         • Drug induced
         • Insulin action
         • Genetics syndromes
         • Infections
         • Post transplantation
       • Type 2
         • Non-insulin dependent diabetes mellitus
         • Types
           • Insulin resistance
           • Secretory defect
           • Both
         • Adult onset diabetes
         • 90-95% of diabetes
         • No autoimmune destruction of beta cells
         • Etiology
           • Genetic factors
             • Greater importance in type 2 in type 1
             • Genetic defects may affect
               • Beta Islet cells function
               • Peripheral resistance
           • Abnormal insulin secretion
             • Progressive age-related loss of beta Islet cells function
             • Amylin accumulation
           • Insulin resistance
             • Reduced number of receptors
             • Abnormally functioning receptors
             • Post-receptor defects
           • Environmental factors
             • Obesity
             • Physical inactivity
             • Psychosocial stress
         • Pathogenesis
     • Epidemiology
       • Diabetes people: 108 million in 1980 to 422 million in 2014
       • Half of all deaths > High blood glucose > Before 70
       • UAE
         • IDF: in 2017, 17.3% of UAE population (Age 20-79) > Type 2 diabetes
         • Over 1 million people living with diabetes in the UAE
           • Prevalence: 15th worldwide
     • Clinical manifestations
       • Hyperglycemia
       • Polyuria
         • Diabetes insipidus
         • Diuretics Caffeine Ethanol
       • Glucosuria
       • Polyphagia
       • Weight loss and muscle weakness
       • Diabetic ketoacidosis (Types 1)
         • Oxidation of the free FA
       • Polydipsia
     • Investigations
       • Blood test
         • Fasting plasma glucose test
         • Random plasma glucose test
         • Glucose challenge test
         • Oral glucose tolerance test
       • Special tests
         • C-peptide
         • GADA
         • IA-2alpha and IA-2beta
         • ICA
       • Other tests
         • Urine test
         • FBC
         • Urea and electrolytes
         • Liver function tests
         • Fasting lipid profile
         • ECG
         • Thyroid tests
         • Serum B12 and red cell folate
         • Coeliac auto-antibody screen
       • Glucometer
     • Management
       • Lifestyle modification
         • Diet
         • Physical activity
       • Oral hypoglycemics
         • Biguanides
           • Metformin
             • Decrease hepatic glucose production
         • Thiazolidinediones
           • Rosiglitazone / Pioglitazone
             • Improve peripheral insulin sensitivity
         • Alpha-glucosidase
           • Acarbose / Miglitol
             • Delay carbohydrate absorption
         • Sulfonylureas
           • Glimepiride / Glipizide / Glyburide / Gliclazide
             • Stimulate insulin secretion from pancreatic beta cells
         • Short-acting insulinotropic agents
           • Repaglinide / Nateglinide
             • Stimulate insulin secretion from pancreatic beta cells
         • Glucagon-like peptide receptor agonists
           • Exenatide / Liraglutide
             • Incretin mimetics
         • DPP-4 Inhibitors
           • Sitagliptin / Saxagliptin / Linagliptin
             • Inhibit the enzyme DPP-4
         • Pramlintide
           • Delays gastric emptying / Suppresses glucagon secretion / Decreases appetite
         • Sodium-glucose transporter 2 inhibitors
           • Canagliflozin / Dapagliflozin / Empagliflozin
             • Causes glycosuria and lowers glucose levels
       • Insulin therapy
         • Mechanism
           • Bind insulin receptor
           • Liver "Increase glycogen storage"
           • Muscle "Increase protein synthesis"
           • Fat "TG storage"
           • Cell membrane "Increase K uptake"
         • Adverse effects
           • Hypoglycemia
           • Lipodystrophy
           • Rare HSR
           • Weight gain
       • Pancreatic transplant
       • Managing the hypertension in diabtetes
         • ACEi
         • ARB
         • CCB
         • Diuretic
     • Complications
       • Microvascular
         • Retinopathy
         • Neuropathy
           • Diabetic foot disorders
         • Nephropathy
       • Macrovascular
         • CVD
       • Diabetic coma
         • Hyper/hypoglycemia
     • Psychosocial aspect
       • Adjustment disorder
       • Lowered self-esteem
       • Depression
       • Diet non-adherence
       • Psychological burden "Obesity"

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