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Hypertension
0/3
Mechanisms of Blood Pressure Regulation
07:36
Pathogenesis of Primary and Secondary Hypertension
41:56
End of Topic Quiz
00:20:00
Ischaemic Heart Disease
0/5
Atherosclerosis
14:37
Plaque Formation
06:06
Pathophysiology of Angina
09:44
Pathophysiology of Myocardial Infarction
11:49
End of Topic Quiz
00:20:00
Heart Failure Mechanisms
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Types of Heart Failure (Systolic vs. Diastolic)
09:06
Pathophysiological Changes in Heart Failure
07:56
Clinical Manifestations and Stages of Heart Failure
02:59
End of Topic Quiz
00:20:00
Alzheimer’s Disease
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Pathogenesis of Alzheimer’s Disease
08:53
Genetic and Environmental Risk Factors
07:24
Clinical Stages and Symptoms
04:27
End of Topic Quiz
00:20:00
Parkinson’s Disease
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Pathogenesis of Parkinson’s Disease
13:53
Motor and Non-Motor Symptoms
31:18
Risk Factors and Progression
03:43
End of Topic Quiz
00:20:00
Pain Pathways and Analgesia
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Types of Pain
11:47
Pathways of Nociception
08:14
Mechanisms of Pain Modulation
24:13
Pharmacological and Non-Pharmacological Pain Management
24:16
End of Topic Quiz
00:20:00
Diabetes Mellitus
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Types of Diabetes
05:58
Pathophysiology of Hyperglycaemia
06:15
Acute and Chronic Complications
17:05
Management Strategies
05:54
End of Topic Quiz
00:20:00
Thyroid Disorders
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Hypothyroidism
05:39
Hyperthyroidism
12:07
Pathophysiology of Thyroid Hormone Synthesis and Regulation
07:53
End of Topic Quiz
00:20:00
Cushing’s vs Addison’s Disease
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Cushing’s Disease
13:41
Addison’s Disease
11:58
Key Differences Between Cushing’s and Addison’s Disease
15:40
End of Topic Quiz
00:20:00
Cardiovascular & Endocrine Pathophysiology

Introduction

  • Diabetes is a chronic metabolic disorder characterised by hyperglycaemia (high blood sugar levels) due to defects in insulin secretion, insulin action, or both.
  • Insulin, a hormone produced by the pancreas, is crucial for regulating blood sugar levels by allowing glucose to enter cells for energy.
  • Unmanaged diabetes can lead to severe long-term complications affecting various organs.

Major Types of Diabetes

Type 1 Diabetes

  • Autoimmune disease where the immune system destroys insulin-producing cells in the pancreas, resulting in little or no insulin production.
  • Usually diagnosed in children and young adults, but it can occur at any age.
  • Requires lifelong insulin therapy to manage blood sugar levels.
  • Symptoms develop rapidly, and individuals often present with diabetic ketoacidosis (DKA), a life-threatening condition.
  • Key Features:
    • Cause: Autoimmune destruction of pancreatic beta cells.
    • Insulin Production: Little to none.
    • Treatment: Lifelong insulin therapy.
    • Typical Onset: Childhood and young adulthood.

Type 2 Diabetes

  • The most common type of diabetes, accounting for 90-95% of cases.
  • Characterised by insulin resistance (body cells don’t respond properly to insulin) and/or insufficient insulin production by the pancreas.
  • Develops gradually, often without noticeable symptoms in the initial stages.
  • Risk factors include obesity, physical inactivity, family history, and certain ethnicities.
  • Management involves lifestyle modifications (diet, exercise), oral medications, and sometimes insulin therapy.
  • Key Features:
    • Cause: Insulin resistance and/or insufficient insulin production.
    • Insulin Production: Reduced or insufficient.
    • Treatment: Lifestyle changes, oral medications, and potentially insulin.
    • Typical Onset: Adulthood, but increasingly seen in younger populations.

Gestational Diabetes

  • Develops during pregnancy in women without pre-existing diabetes.
  • Caused by hormonal changes during pregnancy leading to insulin resistance.
  • Usually resolves after delivery, but increases the risk of developing type 2 diabetes later in life.
  • Management focuses on blood sugar control through diet, exercise, and sometimes medication.
  • Key Features:
    • Cause: Hormonal changes during pregnancy leading to insulin resistance.
    • Onset: During pregnancy.
    • Resolution: Typically resolves after delivery.
    • Future Risk: Increased risk of developing type 2 diabetes.

Other Types of Diabetes

  • Prediabetes: A condition where blood sugar levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes. It increases the risk of developing type 2 diabetes and cardiovascular disease.
  • Monogenic Diabetes (MODY & Neonatal Diabetes): Caused by genetic mutations affecting insulin production or action. MODY is inherited and often diagnosed before age 25, while neonatal diabetes presents within the first six months of life.
  • Type 3c Diabetes: Results from damage to the pancreas due to conditions like pancreatitis, pancreatic cancer, or surgery.
  • Latent Autoimmune Diabetes in Adults (LADA): A slower-progressing form of autoimmune diabetes, often initially misdiagnosed as type 2.
  • Diabetes Induced by Medications or Conditions: Some medications (e.g., steroids, antipsychotics) and conditions (e.g., Cushing syndrome) can cause diabetes.

Complications of Diabetes

  • Chronic hyperglycaemia can damage blood vessels and nerves, leading to various complications.
  • Acute Complications:
    • Diabetic Ketoacidosis (DKA)
    • Hyperosmolar Hyperglycaemic State (HHS)
    • Severe Hypoglycaemia
  • Long-term Complications:
    • Cardiovascular disease (heart attack, stroke, atherosclerosis)
    • Nerve damage (neuropathy)
    • Kidney disease (nephropathy)
    • Eye damage (retinopathy)
    • Foot problems
    • Skin infections
    • Amputations
    • Sexual dysfunction
    • Gastroparesis
    • Hearing loss
    • Oral health issues
    • Mental health issues (depression)

Management of Diabetes

  • Blood Sugar Monitoring: Regular monitoring is essential to assess the effectiveness of treatment plans and guide adjustments.
  • Medications:
    • Oral Antidiabetic Drugs: Used for type 2 diabetes and sometimes prediabetes to improve insulin sensitivity or production.
    • Insulin: Required for type 1 diabetes and may be needed for some individuals with type 2 or gestational diabetes.
  • Lifestyle Modifications:
    • Diet: Healthy eating habits with a focus on balanced meals and carbohydrate control are crucial for managing blood sugar levels.
    • Exercise: Regular physical activity improves insulin sensitivity and helps manage weight.
  • Managing Other Risk Factors: Controlling blood pressure, cholesterol levels, and maintaining a healthy weight are essential to reduce cardiovascular risks.

Prevention

  • While some types of diabetes (type 1, monogenic) are not preventable, lifestyle modifications can help reduce the risk of developing type 2 and gestational diabetes.
  • Preventive measures include:
    • Maintaining a healthy weight
    • Regular physical activity
    • Healthy diet
    • Stress management
    • Limiting alcohol intake
    • Adequate sleep
    • Smoking cessation

Prognosis

  • The outlook for individuals with diabetes depends on various factors, including diabetes type, management effectiveness, age of diagnosis, and the presence of complications.
  • Early diagnosis, effective management, and lifestyle modifications can significantly improve the quality of life and reduce the risk of complications.
  • Consistent blood sugar control is crucial for a better prognosis.

Conclusion

  • Diabetes is a complex metabolic disorder with various types and potential complications.
  • Understanding the different types, their causes, and management strategies is crucial for healthcare professionals, especially pharmacists, who play a vital role in patient education and medication management.
  • Effective management and lifestyle modifications can significantly improve the quality of life and long-term health outcomes for individuals with diabetes.

References

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