天津医科大学内科学课件 Diabetes Mellitus（一）.pptVIP

Diabetes Mellitus Mei Zhu M.D Ph.D Department of Endocrinology Tianjin Medical University Hospital Profile Definition Diagnosis Classification Pathogenesis Laboratory Findings Management Complications Definition Diabetes mellitus comprises a heterogeneous group of metabolic diseases that are characterized by chronic hyperglycemia and disturbances in carbohydrate, lipid, and protein metabolism resulting from defects in insulin secretion and/or insulin action. Definition Profile Definition Diagnosis Classification Pathogenesis Laboratory Findings Management Complications Clinical manifestations Symptoms: Polyuria The consequence of osmotic diuresis secondary to sustained hyperglycemia. And this results in a loss of glucose as well as free water and electrolytes in the urine. Thirst, polydipsia The consequence of the hyperosmolar state. Polyphagia Lots of glucose was lost through urine. So patient felt hungry and ate more food to provide the energy. Clinical manifestations Weight loss Initially due to depletion of water, glycogen and triglyceride stores. Chronic weight loss due to reduced muscle mass occurs as amino acids are diverted to form glucose and ketone bodies. Dizziness Lowered plasma volume produces dizziness and weakness due to postural hypotension. Total body potassium loss and the general catabolism of muscle protein contribute to the weakness. Clinical manifestations Signs: Minimal: When insulin deficiency develops relatively slowly and sufficient water intake is maintained. Loss of subcutaneous fat and muscle wasting: slowly developing insulin deficiency. Rapid deep breathing and the fruity breath odor of acetone: diabetic ketoacidosis. Stupor or coma: when vomiting occurs in response to ketoacidosis, dehydration progresses and compensatory mechanisms become inadequate to keep plasma osmolality below 330 mosm/kg. The signs of complications. Clinical features of diabetes at diagnosis type 1 DM type 2 DM Polyuria and thirst