1. Homeostasis and Diabetes L2

2. What is Homeostasis? Glucose concentration
Body cells work best if they have the correct
Temperature
Water levels
Glucose concentration
Your body has mechanisms to keep the cells in a constant environment.

3. What is Homeostasis?
The maintenance of a constant environment in the body is called Homeostasis

4. Controlling Glucose levels
Your cells (muscles, brain, etc) need an exact level of glucose in the blood. (normal serum level 65 – 105 mg)
Excess glucose gets turned into glycogen in the liver
Blood glucose levels are regulated by 2 hormones (chemical messengers) from the pancreas called:
Insulin
Glucagon

5. Normal Maintenance of Blood Glucose Levels
Eat a meal:
Pancreas detects increased glucose levels in blood and secretes INSULIN
This results in uptake of GLUCOSE by:
Cells that need it for energy (including brain)
Liver and muscle cells to be stored as glycogen
Pancreas stops release of Insulin
Glucose levels return to normal (80-120)

6. Glucose levels rise after a meal.
Insulin is produced and glucose levels fall to normal again.
Glucose
Concentration
Normal
Time
Meal eaten

7. Glycogen
If there is too much glucose in the blood, Insulin tells the liver to convert some of it to glycogen
Insulin
Glucose in the blood

8. When blood glucose becomes high
INSULIN allows glucose to enter cells
Liver
Produce & store glycogen
Inhibits glycogen breakdown
Muscles
Promotes protein and glycogen synthesis
Fat cells
Promotes storage of triglycerides

9. Hyperglycemia= high blood glucose levels
Drowsy
Flushed
Thirsty

10. Normal Maintenance of Blood Glucose Levels, cont.
Blood glucose drops due to NOT eating
Pancreas detects and releases glucagon
stimulates the release of glycogen (broken down to glucose)
Glucose is released into the blood and levels return to normal.

11. Meal eaten Glucose levels rise after a meal. Diabetic
Concentration
Diabetic
Insulin is not produced so glucose levels stay high
Time
Meal eaten

12. Glycogen
If there is not enough glucose in the blood, Glucagon tells the liver to convert glycogen into glucose.
Glucagon
Glucose in the blood

13. Hypoglycemia= LOW blood sugar
Glucagon: causes release of glucose from liver
breakdown of glycogen to glucose

14. Hypoglycemia
Weak, sweaty
Confused/irritable/ disoriented

15. Diabetes Some people do not produce enough insulin.
When they eat food, the glucose levels in their blood cannot be reduced.
This condition is known as DIABETES.
Diabetics sometimes have to inject insulin into their blood. They have to be careful of their diet.

16. Insulin The glucose in the blood increases,
Glycogen
but there is no insulin to tell the liver to convert it into glycogen.
Insulin
Glucose concentration rises to dangerous levels.
Glucose in the blood

17. Diabetes Mellitus (problem with glucose metabolism)
Major health problem US/worldwide
Complications [lousy blood vessels]
Blindness
Renal failure
Amputations
[heart attacks and strokes]
[OB/neonatal complications]

18. Diabetes Mellitus The good news:
Blood glucose control reduces complications of Diabetes!

19. Diabetes Mellitus Absence (or ineffectiveness of ) insulin
Cellular resistance
Cells can’t use glucose for energy
Starvation mode
Compensatory breakdown of body fat/protein

20. Diabetes Mellitus HYPERGLYCEMIA: fluid/electrolyte imbalance.
Sodium, chloride, potassium excreted (frequent urination)
Dehydration (thirsty all the time)
cells are starving, so person feels hungry despite eating huge amounts of food. Starvation state remains until insulin is available. (eats too much)

21. Diabetes Mellitus Complications of chronic hyperglycemia
Macrovascular complications
Cardiovascular disease (heart attack)
Cerebrovascular disease (strokes)
Microvascular
Blindness (retinal proliferation, macular degeneration)
Amputations
Diabetic neuropathy (diffuse, generalized, or focal)
Erectile dysfunction

22. Classifying Diabetes Mellitus
Type I Diabetes: autoimmune
Beta cell destruction in genetically susceptible person
Some viral infections

23. Classifying Diabetes Mellitus
Type II Diabetes
Reduction in ability of most cells to respond to insulin
Poor control of liver glucose output
Decreased beta-cell function (eventual failure)

24. Diabetes Mellitus Major risk factors Family history Obesity
Origin (Afro-American, Hispanic, Native American, Asian-American)
Age (older than 45)
History of gestational diabetes
High cholesterol
Hypertension

25. Diabetes Mellitus Prevention of effects: combination approach
Increased exercise
Decreases need for insulin
Reduce calorie intake
Improves insulin sensitivity
Weight reduction
Improves insulin action

26. Triad of Treatment Diet Medication Exercise Oral hypoglycemics
Insulins
Exercise

27. Diabetes treatment Exercise Under physician supervision
Check glucose prior

28. Diabetes treatment Diet Lower calorie
Fewer foods of “high glycemic index”
Spread meals evenly

29. Diabetes treatment Anti-Diabetic medications Oral hypoglycemic agents
Insulins

30. Stimulate pancreas to secrete insulin Adverse reactions
Glyburide
Adverse reactions
Hypoglycemia
Water retention/edema
Photosensitivity
May need to add insulin in times of stress

31. Insulin Made in beta cells of the pancreas
Moves glucose into cells (thus acts like growth hormone in a way)
Moves potassium into cells (can buy time in emergencies)

32. Insulin preparations Rapid acting Short acting (regular)
Intermediate acting (NPH)
Long acting

33. Some things to know Insulin moves potassium into cells
Good for emergency situations
Dangerous if potassium level already low

34. Some things to know… Dawn Phenomenon vs Somogi’s effect
Blood sugar rises in early morning
Somogi’s (rebound) effect
Blood sugar rise in morning as reaction to hypoglycemic time during the night

35. Some things to know… Diabetic foot care
Dry, cracked skin + poor circulation could = loss of a limb
For the most part nurses don’t trim nails of diabetic clients. Refer to Podiatrist.

36. Typical diabetic foot ulcer

37. Quick Quiz:
1. Give name of the very important anabolic hormone that builds up glucose and stores it as glycogen.
2. What is the usable form of sugar in the blood called?
3. What are the cells associated with insulin production called?
4. What is the main problem (physiologically) that exists in people that are diabetic?

38. .5. Low blood sugar will stimulate what to be released?
6. Describe how someone would look/act if they were hyperglycemic
7.Describe someone who is hypoglycemic
8. List 3 treatments/preventions for diabetes and label if they are for Type 1, 2 or both
9. What is the good news for diabetes?