DIABETES AND HYPOGLYCEMIA

What is Diabetes Mellitus? “STARVATION IN A SEA OF PLENTY”

Glucose Homeostasis NORMAL SERUM GLUCOSE mg/dl SERUM GLUCOSE SERUM GLUCOSE ISLET  -CELLS LIVER & MUSCLE METABOLIC DEMANDS INSULIN GLUCOSE UPTAKE ISLET  -CELLS LIVER & MUSCLE GLUCAGON GLYCOGENOLYSIS GLUCONEOGENESIS HYPERGLYCEMIC HORMONES MEALS X

What is Diabetes Mellitus? Hyperglycemia –Polyuria –Osmotic diuresis Polydipsia Ketosis Ketonuria Acidosis Coma Death

Types of Diabetes Mellitus Type I Type II

Type I Lack of  -cells in the pancreatic islet Little or no insulin production Usually occurs during childhood/adolescence –Once known as juvenile diabetes Autoimmune disease –Possibly triggered by infection –Genetic predisposition

Type II Insulin resistance –Followed by a decrease in  -cell numbers Usually occurs during adult life –Once known as adult onset diabetes Strong genetic predisposition Environmental factors –Obesity –Lack of exercise Resistin: Protein from fat cells & macrophages Gestational Diabetes

Effects of Uncontrolled Diabetes Mellitus on the Body

Primary effect of Insulin deficiency Hyperglycemia Polyuria Polydipsia Ketosis Ketonuria Acidosis Coma Death

Aberrant glucagon secretion Why do diabetics hypersecrete glucagon when blood sugar levels are much higher than normal?

Diabetic vascular disease Microvascular changes Macrovascular changes

Secondary effects of insulin deficiency Retinopathy Peripheral neuropathy Renal disease Cardiovascular disease Wound healing/Infection Skin disease Bone and joint complications

Monitoring and Diagnosing Diabetes Mellitus Glucosuria, glucose in the urine Blood glucose levels –Fasting: mg/dl Glucose tolerance test –3 hr. –6 hr. Glycosylated hemoglobin –Hb A1C

Treatments for Diabetes Mellitus

Type I Insulin Diet Exercise Support

Type II Diet & exercise Oral hypoglycemic drugs Insulin Reversing insulin resistance Support

Hypoglycemia What is hypoglycemia? What causes hypoglycemia? Treatment Relationship of hypoglycemia to type-II diabetes