MEDICINAL CHEMISTRY

(iii) Other types:
(a) Insulin receptor abnormalities
(b) Hormonal etioloy e.g., acromegaly
(c) Pancreatic disease
(d) Genetically related abnormalities
(e) Drug-induced conditions.
Another term 'diabetes insipidius' is sometimes used in which the urine of the patient
remains tasteless. Now-a-days, the term 'diabetes insipidius' is reserved for the conditions
produced by the disorders of the pituitary gland and the term, diabetes mellitus is used to
describe the actual diabetes.
(i) Insulin dependent diabetes mellitus (IDDM): This condition results when there is
under production of insulin in childhood or adolescence. The principal derangement is
the failure of cells to produce insulin in full capacity. The insignificant amounts of insulin
fail to properly utilise ancd metabolise carbohydrate as the available source of energy. To
overcome the shortage in energy production, body attempts to find out other alternative
pathways. To meet the demand of energy, fat and protein metabolism gets
accelerated. These metabolic alterations are symptomized by the presence of increased
amounts of ketone bodies and nitrogenous waste material both in the blood and in the
urine. In severe ketosis, coma follows. In less severe cases, poor wound healing,
infection, nausea, vomiting, restlessness and drowsiness constitute as main
symptoms. Evidences are gathering to suggest that juvenile diabetes may have a viral
origin. Scattered reports support this proposal. The communicable nature of this type of
diabetes adds to the evidence. The persons having genetic susceptibility to get affected by
virus easily get diabetes. Recently ‘encephalomyocarditis' virus was reported to produce
diabetes when injected into mice. It is proposed that a viral attack may trigger an auto
immune reaction which destroys some of the pancreatic β - cells and thus cuts off
partially the source of insulin. Though there is marked reduction in the number of β -
cells, the number of α, D and PP cells appears to be unaffected. The decreased number of
β cells may get decreased due to the patients exposure to certain chemicals. These
chemicals selectively destroy pancreatic β-cells and reduce the secretion of insulin. Such
agents include, alloxan, uric acid, dehydroascorbic acid, quinolones and streptozocin.
Table 4: Insulin dependent versus non-insulin dependent forms of diabetes mellitus
IDDM NIDDM
1. Lacks the ability to synthesize and release 1. Can synthesize and release insulin but not enough
insulin due to destruction of some β- cells. to meet the requirement.
2. Obesity is not the common factor. 2. Obesity is generally a contributing factor.
3. Occurs at an early age 3. Occurs in the people usually over the age of
forty.
4. May be of viral origin. 4. May be of hereditary origin.
5. Equally affects male and female. 5. Females are more attacked than males.
6. The mass of α, D and PP cells
remain unchanged.
6. The mass of β, D and PP cells remain unchanged.
7. Characterized by decreased secretion
7. Characterized by increased secretion of
of insulin.
glucagons
8. Insulin therapy is the only answer. 8. Oral hypoglycemic agents can serve the purpose.