Control of Blood Sugar Diabetes Mellitus

Maintaining Glucose Homeostasis Goal is to maintain blood sugar levels between ~ 70 and 110 mg/dL Two hormones play a role in maintaining glucose homeostasis: Insulin Glucagon Both are pancreatic hormones

Lowering Blood Glucose Levels Blood glucose levels rise due to eating a carbohydrate containing meal In response, the pancreas releases insulin into the blood. Beta cells of the pancreas release insulin

Lowering Blood Glucose Levels Insulin Binds to insulin receptors on cells. Cells allow glucose to enter Stimulates liver and muscle cells to store glucose as glycogen Stimulates excess glucose to be converted into fat. As a result, blood glucose levels drop.

Raising Blood Glucose Levels Blood glucose levels drop as cells use glucose. In response, the pancreas releases glucagon into the blood. Alpha cells of the pancreas release glucagon

Raising Blood Glucose Levels Glucagon: Stimulates liver cells to break down glycogen and release the glucose into the blood. As a result blood glucose levels rise.

Diabetes Mellitus Diabetes mellitus refers to a group of metabolic disorders in which the body is unable to regulate high blood glucose levels.

Diabetes Mellitus Two common forms: Type 1 diabetes Type 2 diabetes Other names: “Juvenile” diabetes Insulin dependent diabetes mellitus (IDDM) Type 2 diabetes “Adult onset” diabetes Noninsulin dependent diabetes mellitus (NIDDM)

Incidence of Diabetes Type 1 Diabetes Type 2 Diabetes 5-10 % of diabetics Onset is generally before age 20 Average age of onset ~12 Type 2 Diabetes 90-95% of diabetics Onset is generally between ages 10-19 or after age 40

Type 1 Diabetes Possible causes: Autoimmune disorder Genetic component Immune system destroys beta cells of pancreas May also be caused by a viral infection that damages the pancreas

Type 1 Diabetes Pancreas is unable to make/secrete insulin. Glucose cannot enter cells  hunger Blood glucose levels rise Glucose “spills” into the urine Water moves into blood Frequent need to urinate Thirsty

Type 1 Diabetes Cells use fats and proteins as an energy source, results in: Weight loss  hunger Ketones produced (due to “overuse” of fats for energy)  potential for diabetic acidosis

Type 1 Diabetes Diabetic acidosis (ketosis) Ketones in breath Ketones in blood and urine  can lead to diabetic coma

Type 1 Diabetes Treatment Insulin shots or pump Highly regulate intake of carbohydrates Consistent pattern of moderate carbohydrate intake to minimize fluctuations in blood glucose Closely monitor blood glucose levels

Type 2 Diabetes Associated with obesity Genetic component As gain weight, cells make fewer insulin receptors Insulin doesn’t bind as well to receptors made Genetic component More common as age

Type 2 Diabetes Fewer insulin receptors on cells Less insulin binds to cells Glucose enters cells SLOWLY Blood glucose levels remain elevated Glucose “spills” into the urine Water moves into blood Frequent need to urinate Thirsty

Type 2 Diabetes Glucose enters cells slowly… No need to use proteins or fats for energy Hungry Eat more  gain weight Exacerbates the problem

Type 2 Diabetes Pancreas continues to make insulin Often in large amounts to compensate for the insulin resistance of cells May get to point where pancreas cannot keep up with the body’s needs and insulin is required.

© 2008 Thomson - Wadsworth

Type 2 Diabetes Recommendations Lose weight Exercise Even moderate weight loss can help Exercise Increases number of insulin receptors Improves binding of insulin to the receptors Helps with weight loss

Chronic Complications of Diabetes Regular high blood glucose levels result in Cells making sugar alcohols Glucose binds to proteins on cells, damages cells Results in: Damage to blood vessels and nerves Slowed healing Unaware of wounds…… amputation Kidney damage  kidney failure Damage to cells of eyes  blindness

Chronic Complications of Diabetes Other: Increased risk of: Coronary heart disease Elevated blood lipid levels Hypertension Adults with diabetes have heart disease and stroke death rates ~ 2 to 4 times higher than adults without diabetes.

2012 US Data 9.3 % of U.S. population has diabetes Age 65 or older ~25% have diabetes 1 in 6 overweight adolescents aged 12-19 have pre-diabetes More Statistics

Diabetes by race in the U.S. Source: CDC/NCHS

Diabetes by education in the U.S. Source: CDC/NCHS