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The doctor talked about some instruction about the attendance and exam and so on . She said there will be a QUIZ in one of the lecture, if you present you will take 5 marks if you not you will take zero .So, please try to be present in the entire lecture. NOTE: The Dr didnt talk a lot information out of the, I will put the slide and what the Dr said in the lecture.

Diabetes characterized by hyperglycemia, that mean there is increase in glucose level Diabetes caused by affection of many factor like these 4 factor which mention in the slide above.

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*** Diabetes is associated with cardiovascular disease, its exacerbate the problem. also, we know that smoking is a risk factor of cardiovascular disease So, the smoker diabetic patient has more chance to have cardiovascular disease.
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*** If we control diabetes then we can come over all of these complications and reduce it.

EPIDEMIC: the disease affects large masses of people all over the world.
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*Type 1 diabetes can be related to autoimmune defect which related to the Iled cell of pancreas. *Type 2 diabetes is the most common one *Gestational diabetes: Diabetes in pregnancy after 2nd trimester .

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*MODY: maturity onest diabetes of the young genetic or inherited type of diabetes. *We can also, calcify diabetes as endocrine disorders like coussion syndrome which lead to increase level of cortisol then affect the level of diabetes leading to diabetes. *We have uncommon forms of immune-mediated diabetes. *Other genetic syndromes considers as a type of diabetes.

*** NORMALY (without diabetes): As you see in the picture above, we have high blood glucose level and this will be the stimulus to pancreas to secret insulin. Insulin will work in many target tissue like lipid which contain fat cells, liver, and muscle. Because the presence of insulin the glucose uptake from fat cell will increase, and decrease free fat acid release, and from the liver there will be increase in gluconeogenesis and decrease glycogenolysis (break down glycogen to increase glucose level) and increase glycogen synthesis in the muscle and liver. So, glucose work primary on the target tissue to reduce glucose level in the blood.
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*** The story of diabetic patient: The story will be sad there is arise in glucose level in the blood, because of intake of carbohydrate and meals. There is no insulin release as a response to that stimulus. The liver work as a supplying source of glucose to the tissue, then there will be decrease of glucose uptake and increase of glycogen release and increase fatty acid production. So, the glucose level in the blood will be increase.

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*There is autoimmune disease cause diabetes like hyperthyroidism and failure of the thyroid gland and other cause of anemia. * Also, viruses can trigger immune reaction then affect B-cells.
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*** In the figure you can notice that there is a genetic predisposition and there is B-cells mass and we have trigger like viral infection which cause immunological abnormalities to start and the B-cell mass start to decrease gradually with time.

*** Also, you can see pre-diabetic time. *** Pre-diabetic time: the time before diabetes form, it may be months or years before having significant destruction of B-cells which released to keep the level of B-cells.

***With time the state developed to diabetes, because there is small number or NO B-cells. Then the patient developed hyperglycemia chronically.

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*** In type 2 diabetes there is insulin but the problem that the bodys cells have less or no sensitivity of insulin, and its maybe relatively related to insulin deficiency, because with time B-cells will exhausted and secret less amount of insulin. The patients with type 2 usually have obesity.
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***There is increase in glucose level and its stimulate releasing of insulin But the problem will be in the target tissue, there will be decrease in insulin sensitivity then the glucose level increase not because decrease of insulin. Its because the insulin not work as normal on the target tissue.

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*** Multiple genes involved mean: more than one person of the family developed diabetes type 2. ***We have many theories to explain why some people has high incidence to have diabetes type 2. Like poor fetal nutrition and low birth weight and exposure to high glucose level in utero.

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*** THIS FIGURE (in the previous page) IS IMPORTANT *** *History of diabetes type 2 start with impaired glucose tolerance stage. At first there is abnormal reading of glucose but NOT diagnostic diabetes, there is increase in insulin resistance but the body produce more insulin to compensate the condition. With time the insulin resistance increase to reach maximum level and the body cant control the state and the secretion of insulin will be decreased. Also, the reading of postprandial glucose and fasting glucose (after 10 hr without eating) will be increase. This stage called known diabetes stage. *** Microvascular complication (black strip at the end of the figure) start before the patient know he has diabetes. *** Macrovascular complication: complication affects the large blood vessels. (Vessels of heart and brain) like MI & stroke . *That mean the complication start before diagnosed diabetes its start with impaired glucose tolerance.

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*Diabetes type 2 has more prevalence than type 1 because of secondary life style. (no moving, no walking aging population ... ). * More obesity epidemic means more diabetes type 2 prevalence.

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*One of the modifiable risk factor is physical inactivity for at least 30 min a day for 4-5 days a week. Also, we have dietary factor we can control it by limiting simple sugar. Eat more complex carbohydrate with high intake of fibers.

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*This table (in previous page) is very important * ***We diagnose diabetes by lab measurement, we should take more than one reading in order to establish diabetes. ***We have 3 experiment to diagnose diabetes: 1- Fasting postprandial glucose (FPG) 2- Postprandial glucose (PG) 3- Hemoglobin A1c: we use this experiment because hyperglycemia change the shape of hemoglobin. ***We need 2 criteria from 3 to diagnose diabetes. NOTE: the number in the table should memorize.

***Impaired glucose tolerance and impaired fasting glucose are modern terms, used to said this person is under risk to have diabetes. ***Its intermediate states between normal and abnormal.

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*if we dont sure that the patient is diabetic we can take these tests: _ Oral glucose tolerance test _ Tests for: Urinary ketones, antibodies, and C-peptide.
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***Plate model: its a model that tells you the healthy food which the diabetic patient should eat (DIERETIC THERAPY). *NOTE: these types of food should memorize.

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*** UKPDS: significant study which shows that diabetic patient will do better if they have long term therapy. *** look to the figure, the aim of treatment of type 1&2 is to reduce A1c less than 7.

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******This table (in the previous page) is important ***Its contain some classes of medicine, Where this class work (what is the .target organ), and what is the action .*** ALL OF THESE INFORMATION IN THE TABLE SHOULD MEMORIZE


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