LM World

Normal Insul i n Metabo l ism and the Glucose Homeosta s is The nor m al glucose ho m eostasis is tightly r e gulated by three inter related process. Hepatic glucose production Glucose intake and utilization by Insulin secretion.             Insulin secretion is m odulated such that glucose product i on and utilization rise or fall to m aintain nor m al blood glucose levels, the hu m an insulin MRna is transcribed. Translocation of m essage occurs in the rough endoplas m i c reticulum yielding a pre-pro insulin, there follows a proteol y tic cleava g e of pre-peptide sequences to yield a pro insulin, and in the gol g i appar a tus cl eavage of t h e C-peptides to y ield in s ulin s equen c e, both insulin and c-peptides are st or ed in secretory granules and secreted together after a physiological sti m ulus. The release of insulin from the beta cells is biphasic in m a nne

Diagnostic Criteria f o r Gestational Dia be tes (GDM)             Gestational diabetes m ellitus is de f i n ed as any d e gree of glu c ose i n tol e r a nce with onset or fir s t recogniti o n during pregnancy. T h e definition applies regardless of whether insulin or only diet m odification is used for treat m ent or of whether the condition persists after the pregnancy. It does not exclude the possibility that unrecognized glucose intolerance m ay have antedated or b e gun conco m itantly with the pregnancy.             Six weeks or m ore after the pregnancy ends, she should be r eclassified, based on the criteria f or diabetes as 1) diabetes 2) IFG 3) IGT or 4) normoglyce m i a .             Previous recom m endations were that screening for GDM be perfor m ed in all the pregnancies. However, there are certain fac t ors that place a wo m an at a lower risk of develop m ent of

The Dia g nostic Criter i a f or Diabetes M ellitus The new criteria             The diagn o stic crite r ia f or diabetes m ellitus have been m odi f i ed form those previously recom m end e d by the NDDG or WHO.             Three ways to diagnose to diagnose diabe t es are possible and m u st be confir m ed, on a subsequent day by any one of the three m ethods m entioned.             For exa m ple, one instance of sympto m s with casual plas m a glucose value of >200 m g/dl, confir m ed on a subsequent day by 1) F P G (fasting p l as m a glucose) >126 m g/dl. An 2) OGTT (oral glucose tolerance test) with the 2-hour post load value of >200 MG/DL, or 3) sympto m s with a casual plas m a glucose >200mg/dl, warrants the diagnosis of diabetes.             For epide m iological p u rpose, e s ti m ates of diabetes p re v alence and incide n ce should be based on an FPG (fa

Definit i on and Classif i cation of Diab e t e s Melli t u s:             DM refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.   Several distinct type of DM are caused by a complex interaction of genetics and environmental factors. Depending on the etiology of DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.           The National Diabetes Data Group ( NDDG) in the USA published a provisional consensus   classification   and   diagnosis   of   d i abetes   m ellitus   and   o t h er   categ o ries   of glucose tolerance, which beca m e the basis for that recommended by t h e W orld Health Organization (WHO) Expert com m ittee on diabetes in 1980.                   The    WHO classification represented a landmark by providing standardized diagnostic criteria for diabetes and a un i form ter m inology sui