1、Diabetes MellitusRenming Hu M.D,PhDDepartment of EndocrinologyHuashan HospitalInstitute of Endocrinology and Diabetes at Fudan UniversityClassification of diabetes(ADA-1997)Type 1 l (beta-cell destruction, usually leading to absolute insulin deficiency) Autoimmune Idiopathic l Type 2 (may range from
2、 predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance) l Other specific types l Gestational diabetes*Other specific typeslGenetic defects of beta-cell function lGenetic defects in insulin action lDiseases of the exoc
3、rine pancreas lEndocrinopathies lDrug- or chemical-induced lInfections lUncommon forms of immune-mediated diabetes lOther genetic syndromes sometimes associated with diabetesPathogenesisPathology l Type 1 DM： inflammation of pancreasl Type 2 DM： amyloidosis of pancreasl Large vessel ： atherosclerosi
4、sl Kidney ： diffuse or nodular glomerular sclerosis l Retina： arteriolar sclerosis、microaneurysm、 exudates、 new vessel formationl Nerve： axon degeneration 、myelinolysisPathophysiology Abnormalities in metabolism lCarbohydrate ： anabolism ， catabolism、 utilization lLipid ： anabolism ， catabolism ，ket
5、oplasialprotein： anabolism ， catabolism ，glyconeogenesisInsulin secretion curve :normal and diabetics Clinical PresentationNatural history of type 2 DMAfter the diagnosis of type 2 diabetes:IR constantly existsInsulin secretion ability gradually declines:When FPG reachs the diagnostic criteria， insulin secretion ability has already declined by 50%When FPG 7.0mmol/L， -cell insulin secretion ability When FPG 1011.0mmol/L， -C insulin secretion ability has already neared absolute deficiency
