Diabetes Mellitus (DM) 1 out of every 3 Americans has DM or pre- DM, 105,000,000 people 7th leading cause of death in USA $280,000,000,000 spent (mostly “wasted”) annually Diabetes = Mellitus = Two Flavors = Type 1 and Type 2

Control of Blood Glucose by Hormones Insulin Glucagon Cortisol

Normal range (fasting) = 70 – (100-120) mg/dl (mg/dl a.k.a. mg/100ml) Blood Glucose Values Normal range (fasting) = 70 – (100-120) mg/dl (mg/dl a.k.a. mg/100ml) > 140 mg/dl = hyperglycemia < 60 mg/dl = hypoglycemia

Why be concerned about Hyperglycemia?

Effects of Chronic Hyperglycemia

Why be concerned about Hyperglycemia? Stimulates appetite - perpetuates obesity epidemic Stimulates fat cells to store glucose as fat – “ “ “ Proteins are damaged by glycation (glucose binding) resulting in e.g. Cataracts, retinopathy = #1 cause of blindness in U.S. e.g. neuropathy – nerve damage - poor sensation … e.g. athero… & arteriosclerosis = poor circulation and slow-to-heal wounds – gangrene - amputations Ketoacidosis - Diabetic coma - Death

Diabetes Mellitus – Type 1 Less common - 10% of DM cases Formerly called “juvenile onset” and IDDM Usually appears before age 15. Pancreatic beta cells do not produce insulin. They’ve been destroyed by your immune system. Results in: 1) hyperglycemia… - When [G] > 300 mOsm - Polyuria… - Polydipsia… - Polyphagia…

Diabetes Mellitus – Type 1 (cont’d) 2) possible lipidemia & high cholesterol which  risk of … - Atherosclerosis  stroke, heart attack 3) Possible DKA… - A.k.a. diabetic coma  death Cause: Mostly genetic predisposition but… Trtmt: daily injections of insulin for life Injections coordinated with meals and activities Implantable insulin pumps Pancreatic beta cell transplants (33% success)

Diabetes Mellitus – Type 2 Most common - 90% of cases of DM Formerly called “adult onset” and NIDDM Pancreatic beta cells do produce insulin but … # of insulin receptors on muscle and fat (and liver?) is reduced OR… Receptors have become “insulin resistant” Either way… rate of glucose uptake into cells is slowed resulting in… - hyperglycemia Causes: Sugary diet Lack of exercise Carrying too much body fat Fat cells produce hormone-like compounds that make target cell receptors resistant to insulin 90% of all cases occur in overweight adults and overweight children Genetics

Diabetes Mellitus – Type 2 Results : hyperglycemia… polyuria… polydipsia… polyphagia… Probable lipidemia & high cholesterol which  risk of … - Atherosclerosis  stroke, heart attack, Possible DKA…

Diabetes Mellitus – Type 2 (cont’d) The DM Type 2 epidemic In 2010 11% of adults in North America By 2050 28% “ “ “ “ More & more cases ( incidence) More & more cases in young children…. …no longer “adult onset.” Trtmt: Most cases prevented/controlled by smart food choices and exercise Smaller more frequent meals  sugars intake  fats intake  Complex carbs – low glycemic index  Proteins intake  Physical activity  response of insulin receptors https://www.youtube.com/watch?v=rbN_AEHzpqQ Meds such as Glucophage, Amaryl, Metformin Monitor blood sugar with Hb A1c (Glycosylated Hemoglobin) Possible insulin injections (but still not considered “Type 1”) -- so IDDM no longer distinguishes Type 1 from Type 2

Why is diabetes (and hyperglycemia) so common?

Gestational Diabetes Mellitus, GDM DM associated with pregnancy Cause: Elevated levels of estrogen and progesterone make target cells temporarily insulin resistant Placenta releases insulinase thus accelerating rate of… Results in temporary, DM Type 2 (usually NIDDM) Infants often large… (11-13 lbs) and delivered by C-section Why? Normal source of insulinase is liver.