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DIABETES
   is a group of metabolic diseases characterized by elevated of glucose in theblood (hyperglycemia) resulting from defects in insulin and insulin action.  Major sources of this glucose are absorption of ingested food ingastrointestinal tract and formation of glucose by the liver from food substance.Insulin  a hormone produced by the pancreas, controls the level of glucose in theblood by regulating the production and storage of glucose In diabetic state, the cells may stop responding to insulin or the pancreasmay stop producing insulin intirely.Leads to hyperglycemia, which may result in acute metabolic complicationsush as:a. diabetic ketoacidosis (DKA)b. hyperglycemic hyperosmolar nonketotic syndrome (HHNS) Long-term effects of hyperglycemic contribute to:1.macro vascular complication (coronary artery disease, cerebrovascular disease and peripheral vascular disease)2.chronic macrivascular complication (kidney and eye disease)3.neuropathic complication (disease of the nerve)Primary Goal of treatment for patients with diabetes
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controlling blood glucose level
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preventing acute
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long term complication
CLASSIFICATION OF DIABETES
 Several different types of DMa.causeb.clinical coursec.treatmentMajor classifications of diabetes are: 
 
a. type 1 diabetes (previously referred to as insulin-independentdiabetes mellitus) IDDMb. type 2 diabetes (previously referred to as non-insulin-independentdiabetes mellitus) NIDDMc. gestational diabetes mellitusd. DM with others conditions or syndrome 
OVERVIEW
   terms “insulin-dependent diabetes” and “non-insulin-dependent diabetes” areno longer used because they have resulted in classification of patients on thebasis of the treatment of their diabetes rather than the underlying etiology.  Approximately 5% to 10% of people with diabetes have type 1 diabetes,which the insulin- producing pancreatic beta cells are destroyed by anautoimmune process.
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type 1 diabetes is characterized by an acute onset, usually beforeage 30   approximately 90% to 95% of people with diabetes have type 2 diabetes,which result from decreased sensitivity to insulin (called insulin resistance) andimpaired beta cell functioning resulting in decreased insulin production. 
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type 2 diabetes is first treated with diet and exersice
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type 2 diabetes occurs more among people who are older than 3o years and obese.   borderline diabetes is classified as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) and refers to a condition in which blood glucoselevel fall between normal levels and levels considered diagnostic for diabetes. 
Risk Factors for Diabetes Mellitus
 1.Family history of diabetes2.Obesity3.Race/Ethnicity4.Age
 
5.Previously independent impaired fasting glucose or impaired glucosetolerance6.Hypertension7.HDL cholesterol level or triglyceride level8.History of gestational diabetes or delivery of babies over 9 lbs. 
PHYSIOLOGY AND PATHOPHYSIOLOGY OF DIABETES
   insulin is secreted by beta cells, which are one of four types of cells in theislets of Langerhans in the pancreas.  Insulin is an anabolic, or storage, hormone.  Insulin secretion increases and moves glucose from the blood into muscle,liver, and fat cells, when the person eats a meal.  In those cells, insulin:1.transports and metabolize glucose for energy2.stimulates storage of glucose in the liver and muscle3.signals the liver to stop the release of glucose
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enhances storage of dietary fat in adipose tissue5.accelerates transport of animo acids into cells  insulin also inhibits the breakdown of stored glucose, protein, and fat. 
Classification of Diabetes Mellitus and Related Glucose Intolerances
Current ClassificationPrevious ClassificationCharacteristics andImplicationType 1 Juvenile diabetesJuvenile-onset diabetesKetosis-prone diabetesBrittle diabetesInsulin-dependent diabetesmellitus(IDDM) Onset any age, but usuallyyoung (<30yrs).Usually thin at diagnostic;with recent weight loss.Etiology includes genetics,immunologic, or environmental factors.Often have islet cellantibiotics.Little or no endogenousinsulin.Need insulin to reserve lifeKetosis-prone when insulinabsent.Acute complication of hyperglycemia:diabetics
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