1. 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

2. Control of Blood Glucose by Hormones
Insulin
Glucagon
Cortisol

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

4. Why be concerned about Hyperglycemia?

5. Effects of Chronic Hyperglycemia

6. 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

7. 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…

8. 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)

9. 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

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

11. Diabetes Mellitus – Type 2 (cont’d)
The DM Type 2 epidemic
In % of adults in North America
By % “ “ “ “
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
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

12. Why is diabetes (and hyperglycemia) so common?

13. 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.