)IABETES
MELLITTJIS
Irfiroduction
Diabetes mellifus is a chronic endocrine
disorder, charactenzedby
hyperglycaemia
resurting fnrm
absolute or relative insulin defir:iency.
There are a number of different causes of diabetes
but by far the
majority of cases are crassifiedr
as eifher fype 1 0r type 2 diafutes. The pathophysiologSr
of type t
diabefes derives from the autoilnmune
destnrction
of insulin-secreti
ng pancreaticp-cells,
resulting in
insulin deficiency
and subsequent
hyperglycaemia.
Tlpe 1 diabetes accounts for about ro-rs%
of all
diabetics Type 2 diabetes
is cfuwactefized,
by abnormalinsulin
secretion
due to peripheral
resistance
and accounts for 85-90% of all persons
with diabetes.
while type
t diabetes
usually manifests itself in
childhood
or adolescence and type
2 diabetes
at a latet stage, clinical manifestation and progrnession
vary considerably
and some p{rtients
might nor be creaay classified
as having either type 1 0r 2
inifially Tlpe 1 diabetes may occur at any ageand with late onset usuauy shows slower pnrgression,
and fype 2 manifests itself more and more often earlier in life, even in childhood
and adolescence,
somefimes
allowing for accurale diagnosis only over time. In the uncontrorled
state,
both types of
diabetes are charucteizd
by increased hepatic glucose output and decreased glucose
uptake in the
muscles and adipy- tissue Patients with type I diabetes are at risk of severe lipolysis Ieading to
diahenc ketoacidosis
The remaining insulin activity in
ww 2 diaberes usually inhibits ripolysis and
ketone production
such that these patients
are less likely to develop ketoacidosis
but are more likely to
develop a hyperosmolar,
non_kelotic state . (l)