Download Glucagon - WordPress.com

* Glucagon
The function of glucagon is increase blood glucose level .
glucagon under the regulation of insulin , that mean if we don’t
have insulin the glucagon gene will activate lead to
hyperglycemia .
*Inceratin hormone
Secret from small intestine and its function improve insulin
action and suppress the appetite .
All drugs used for treatment of DM cause body weight gain
except the Inceratin base therapy and glucophage .
Graph :- (plz refer to slide)
- insulin resistance increase with age
Once the Dr say for patient you have initial DM ''bedayt sokary''
that mean 50%of beta cell was destruction .
There is study done on people with high risk of DM development
to study the relation between BMI , amount of physical exercise
and development of DM
The patient are divided to 3 categories depend on BMI and each
category has 3 sub groups depend on amount of physical
exercise
The study show that :
-BMI increase ----> the risk of development of DM increase.
-in same group of weight if amount of physical exercise
increase the risk of development of DM decrease . ''plz refer to
slide ''
It's very important information that explain why the prevalence
rate of DM increase ,although our genetic material don’t change
actually due change in our life style .
Risk factors of diabetes type 2:
-History of gestation DM (GDM)
Female with history of GDM has high risk to have DM or has
large baby >4,3kg ,usually mom has DM and she don't know .
High glucose level on mum ---> high glucose level for baby --->
high weight of baby .
*Symptoms of hyperglycaemia in type 1 and type 2
-Polyurea , nocturea
-Increase thirst feeling , dry mouth
-Loss weight
-Blurred vision
-Numbness in finger and toe
-Fatigue
-Impotence (in some men)
Usually patient with type 2 DM come with complication as first
presentation .but type 1 DM we know what the disease start .
*Diagnosis :
We do laboratory test
1- we test blood sugar in fasting
FPG more or equal 126 mg/dl
2- two hour plasma glucose more or equal than 200 mg/dl (we
give patient 0.75 glucose dissolved in water and after 2 hour we
test the blood sugar .
3- patient with classic symptoms of hyperglycaemia and blood
glucose level more than or equal 200 mg/dl .
4 – glycoslated blood sugar (ALC)
Normally each one have percentage of glucose bind to
hemoglobin if it more than 6.5% that mean the patient is
diabetic .
Note if we have classical symptoms (Polyurea, Increase thirst
feeling, loss weight ) done one of the first three test is enough .
but if there no symptoms we should repeat test .
Can we prevent the type 2 DM?
There is study done on patient with high risk for development
type 2 DM :
1st group : they ask them to do exercise , the risk of
development DM decrease
2nd group : give him drug '' metformin''
3rd group : we don’t give him any thing .
Can we prevent type 1 DM ?
if some of children develop the DM ,other children will be follow
up and they give him imunosuppression drugs for them . actually
is not applied ''still under study'' .
*Managements of type 2 DM :
1 life style modification .
2 Oral drugs .
3 Insulin .
*Drugs therapy
1 metformin
Most drug used ,its improve insulin function by decrease the
glucose production from liver .
Side effects :
GI upset: like nausea ,diarhia and abdominal pain .
Lactic acidosis: mainly in patient with renal failure
50% fatal
Vitamin B12 diffencey
Note not cause hypoglycemia .
2- sulfonylurea cause hypoglicemia because increase insulin
secretion
3-insulin
we have different types of insulin but main problems are
hypoglycemia and weight gain .
*Complications of diabetes
Acute :
1 Hypoglycemia :as result of drug use .
2 DKA :diabetic ketoacidosis mainly in type one but can occur
in type 2.
3 hyperosmolar hyperglycemic : only in type 2 DM
Patient with DKA and hyperosmolar hyperglycemic has high
blood glucose level (400-1000 mg/dl)due insulin insuffent . the
treatment of these patients is IV fluid and IV insulin .
Chronic complication :
-Micro vascular :
Problems in eyes '' the DM first cause of blindness''
Nephropathy.
Neuropathy.
-macro vascular :
CAD
CVA
Peripheral vascular disease
Most effective way for prevention the complication is try to
control blood glucose level .
Why the immunity of diabetic patient is low ?
Toxic effect of sugar metabolize on immune cell like decrease
function of nutrophlic and macrophage .
Done by : Aseel Salh
The end