文档介绍：Diabetes Mellitus
Renming Hu ,PhD
Department of Endocrinology
Huashan Hospital
Institute of Endocrinology and Diabetes at Fudan University
Classification of diabetes(ADA-1997)
Type 1
(beta-cell destruction, usually leading to absolute insulin deficiency)
Autoimmune
Idiopathic
Type 2
(may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance)
Other specific types
Gestational diabetes**
Other specific types
ic defects of beta-cell function
ic defects in insulin action
Diseases of the exocrine pancreas
Endocrinopathies
Drug- or chemical-induced
Infections
mon forms of immune-mediated diabetes
Other ic syndromes sometimes associated with diabetes
Pathogenesis
Pathology
Type 1 DM:inflammation of pancreas
Type 2 DM:amyloidosis of pancreas
Large vessel :atherosclerosis
Kidney :diffuse or nodular glomerular sclerosis
Retina:arteriolar sclerosis、microaneurysm、exudates、new vessel formation
Nerve:axon degeneration 、myelinolysis
Pathophysiology
Abnormalities in metabolism
Carbohydrate :anabolism,catabolism、 utilization
Lipid : anabolism,catabolism,ketoplasia
protein: anabolism,catabolism,glyconeogenesis
Insulin secretion curve :normal and diabetics
Clinical Presentation
Natural history of type 2 DM
After the diagnosis of type 2 diabetes:
IR constantly exists
Insulin secretion ability gradually declines:
When FPG reachs the diagnostic criteria,insulin secretion ability has already declined by 50%
When FPG≥,-cell insulin secretion ability
When FPG≥10,-C insulin secretion ability has already neared absolute deficiency