1. DIABETES AND HYPOGLYCEMIA

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

3. Glucose Homeostasis NORMAL SERUM GLUCOSE 80-120 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

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

5. Types of Diabetes Mellitus Type I Type II

6. 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

7. 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

8. Effects of Uncontrolled Diabetes Mellitus on the Body

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

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

11. Diabetic vascular disease Microvascular changes Macrovascular changes

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

13. Monitoring and Diagnosing Diabetes Mellitus Glucosuria, glucose in the urine Blood glucose levels –Fasting: 80-120 mg/dl Glucose tolerance test –3 hr. –6 hr. Glycosylated hemoglobin –Hb A1C

14. Treatments for Diabetes Mellitus

15. Type I Insulin Diet Exercise Support

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

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