Diabetes Mellitus
Autor: Olá | Publicado: 2013-05-24T06:52:00-07:00

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O diabetes mellitus (DM) não é uma única doença, mas um grupo
heterogêneo de distúrbios metabólicos que apresentam em comum a hiperglicemia.
Essa hiperglicemia é o resultado de incorreções na ação da insulina, alterações
na secreção de insulina ou ambos.



A insulina é um hormônio proteico cujas principais funções são:

&nbsp;impedir
     que a taxa de açúcar no sangue venha a ultrapassar, após a alimentação, os
     valores de 160-180 mg/dl;&nbsp;
armazenar
     glicose no fígado e nos músculos na forma de glicogênio;&nbsp;
participar
     do crescimento ósseo, muscular e de vários órgãos. 


A produção de insulina é regulada de acordo com os tipos e a quantidade
de alimentos ingeridos. A insulina exerce a sua função de manter os níveis de
açúcar na corrente sanguínea, em valores normais, pelo mecanismo de feedback,
ou seja, conforme os níveis de açúcar no sangue caem, a insulina através da
utilização de receptores na superfície celular permite a passagem da glicose
para o interior da célula.

A classificação atual do DM inclui quatro classes clínicas: DM tipo 1,
DM tipo 2, outros tipos específicos de DM e diabetes mellitus gestacional.
Ainda existem duas categorias, referidas como pré-diabetes, que são a glicemia
de jejum alterada e a tolerância à glicose diminuída.



O DM tipo 1 (DM1), corresponde a 5%-10% dos casos, é o resultado de uma
destruição das células beta pancreáticas com conseqüente deficiência de
insulina. Na maioria dos casos essa destruição das células beta pancreáticas
tem causa auto-imune.

Além do componente auto-imune, o DM1 apresenta forte associação com
determinados genes que podem ser predisponentes ou protetores para o
desenvolvimento da doença.

A taxa de destruição das células beta pancreáticas é variável, sendo em
geral mais rápida entre as crianças. A forma lentamente progressiva ocorre
geralmente em adultos e é referida como LADA.



O diabetes mellitus tipo 2 (DM2) é a forma presente em 90%-95% dos casos
e caracteriza-se por defeitos na ação e na secreção da insulina. Em geral ambos
os defeitos estão presentes quando a hiperglicemia se manifesta, porém pode
haver predomínio de um deles. A maioria dos pacientes com essa forma de
DM&nbsp; apresenta sobrepeso ou obesidade. O DM2 pode ocorrer em qualquer
idade, mas é geralmente diagnosticado após os 40 anos. Os pacientes não são
dependentes de insulina exógena para sobrevivência, porém podem necessitar de
tratamento com insulina para a obtenção de um controle metabólico adequado.

Diferentemente do DM1 auto-imune não há indicadores específicos para o
DM2. Existem provavelmente diferentes mecanismos que resultam na forma de DM2 e
com a identificação futura de processos patogênicos específicos ou defeitos
genéticos, o número de pessoas com essa forma de DM irá diminuir às custas de
uma mudança para uma classificação específica.



Todos aqueles com glicemia de jejum entre 100 e 125 mg/dl são
considerados pré diabéticos.

Há a possibilidade de se prevenir o desenvolvimento de um dos
componentes da pré diabetes através de mudanças de hábitos de vida. Estudo
publicado pelo Diabetes Prevention Program (DPP), onde a adoção de dietas
hipocalórica e hipolipídica, associadas a um programa de caminhadas de pelo
menos 150min/semana, durante um período de três anos, determinou uma redução de
58% no risco de progressão de intolerância à glicose para o DM. O efeito da
mudança de hábitos de vida foi observado em ambos os sexos, em todos os grupos
étnicos e faixas etárias. 



fonte: Diretrizes da SBD-2006 






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  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
   UnhideWhenUsed="false" Name="Dark List Accent 1"/>
  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
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  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
   UnhideWhenUsed="false" Name="Light List Accent 2"/>
  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
   UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
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   UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 3"/>
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   UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
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  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
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   UnhideWhenUsed="false" Name="Light List Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
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   UnhideWhenUsed="false" Name="Light List Accent 5"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 5"/>
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   UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
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   UnhideWhenUsed="false" Name="Light List Accent 6"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
   UnhideWhenUsed="false" Name="Dark List Accent 6"/>
  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
  <w:LsdException Locked="false" Priority="19" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
  <w:LsdException Locked="false" Priority="21" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
  <w:LsdException Locked="false" Priority="31" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
  <w:LsdException Locked="false" Priority="32" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
  <w:LsdException Locked="false" Priority="33" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
  
  
 
<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
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 mso-style-parent:"";
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<![endif]-->