Maturity onset

There are multiple causes of diabetes. Whereas the molecular bases of some forms of diabetes are well understood, in many cases etiologies are unknown. It is customary to divide diabetes into two main forms insulin-dependent diabetes mellitus (IDDM), also referred to as Type I or juvenile-onset diabetes, and noninsulin-dependent diabetes mellitus (NIDDM), also called Type II or maturity-onset diabetes (3). 

Type 2—Noninsulin-dependent diabetes mellitus (NIDDM). Fonner names of this type of diabetes mellitus include maturity-onset diabetes, adult-onset diabetes, and stable diabetes. 

Mutations in GK (Hx IV) causes maturity-onset diabetes of the young (MOD Y), a form of non-insulin-dependent diabetes mellitus (NIDDM) characterized by onset before 25 years of age and an autosomal dominant inheritance (PI 2). This suggests that the mutations in other forms of Hx may also contribute to the development of NIDDM. Among them, Hx II is a particularly attractive candidate, although this isozyme is not expressed in red blood cells. Hx II has been analyzed extensively in the muscle of prediabetic insulin-resistant individuals. But studies have shown that Hx II mutation alone is unlikely to have a significant role in the development of peripheral insulin resistance and NIDDM (L6). 

This is cliitically important because a failure to control the blood glucose level adequately can lead to diabetes melUtus. Therefore, it can be argued that glucokinase is essential to prevent the development of diabetes in normal humans. Indeed, a deficiency of glucokinase in the P-cell gives rise to one type of diabetes, known as maturity onset diabetes in the young (MODY). 

FFA free fatty acid MODY maturity onset diabetes in the young... 

Treatment of Maturity-Onset (Type II) Diabetes Mellitus... 

In the case of NIDDM (maturity onset or type II diabetes mellitus), insulin is present in the blood at normal (or even elevated) levels, but fails to promote any of its characteristic effects. A number of factors can contribute to such insulin resistance, including ... 

Acetohexamide has a duration of action of 10-16 hours. It is metabolized in the liver to an active metabolite. Acetohexamide is not used often anymore and it is considered only to be indicated in a minority of patients with maturity-onset diabetes. 

Non-insulin dependent or type II diabetes (NIDDM). Formerly called non ketotic or maturity onset diabetes. It arises due to insulin resistance in peripheral tissues. 

It is indicated in the treatment of maturity onset non ketotic diabetes mellitus unresponsive to diet and neurogenic diabetes insipidus. 

Adverse effects include, nausea, vomiting, skin rash and epigastric distress. It is mainly used in maturity onset diabetes mellitus. 

They are indicated in maturity onset noninsulin dependent diabetes mellitus and diabetes mellitus not responding adequately with dietary restrictions or with sulfonylureas. 

Jankelson OM, Beaser SB, Howard FM, Mayer J. Effect of coffee on glucose tolerance and circulating insulin in men with maturity-onset diabetes. Lancet 1967 l(7489) 527-9. 

Figure 4. TOP The amount of keto amine-linked glycosylation of insoluble collagen plotted as a function of subject s age. BOTTOM The amount of insoluble collagen plotted as a function of subject s age. Key O. normal +, juvenile-onset diabetic and , maturity-onset diabetic.

The drug with the higher affinity constant will successfully displace the drug with the lower. The result is an increase in the free drug concentration of the latter. For example, tolbutamide (an oral hypoglycemic agent used in maturity-onset diabetes mellitus) is approximately 95 percent bound and 5 percent free (see Table 4.1). In the presence of the anti-inflammatory drug phenylbutazone (which is nearly 100 percent... 

Diabetes mellitus has been diagnosed in approximately 14 million people in the United States. Of these, 10-20 percent are classified as having insulin-dependent, juvenile-onset (type 1) while the remainder have non-insulin-dependent, maturity-onset (type 2). However, the situation can be somewhat more complex than these straightforward definitions in that type 1 can occur at any age and type 2 can require the use of insulin. At the present time, there is a serious increase in type 2 diabetics, particularly among the young. 

Insulin is the only currently effective treatment for the millions of diabetics who suffer from Type I diabetes (also known as insulin-dependent and juvenile onset diabetes). There are also a significant number of people with Type II diabetes (also known as maturity-onset diabetes) who need insulin. Insulin is a peptide, and if given orally it is broken down by enzymes in the gut (see Section 1.6.1). Thus it has always... 

Mogensen C (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. New England journal of Medicine 310 356-360. 

Type 1 diabetes, formerly known as childhood , juvenile or insulin-dependent diabetes, is not exclusively a childhood problem. Adults who contract type 1 diabetes may be misdiagnosed with type 2 diabetes. A subtype of type 1 (identifiable by the presence of antibodies against /3-cells) typically develops slowly and is often confused with type 2. In addition, a small proportion of type 1 cases have the hereditary condition maturity onset diabetes of the young (MODY), which can also be confused with type 2. 

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