Download 3-1 Diabetes Mellitus

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
Control of Blood Glucose by Hormones
Insulin
Glucagon
Cortisol
Blood Glucose Values
Normal range (fasting) =
70 – (100-120) mg/dl
(mg/dl a.k.a. mg/100ml)
> 140 mg/dl = hyperglycemia
< 60 mg/dl = hypoglycemia
Why be concerned about Hyperglycemia?
Effects of Chronic Hyperglycemia
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 slowto-heal wounds – gangrene - amputations
Ketoacidosis - Diabetic coma - Death
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…
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)
•
•
•
•
Diabetes Mellitus – Type 2
Most common - 90% of cases of DM
Formerly called “adult onset” and NIDDM
Pancreatic beta cells do produce insulin but …
1) # of insulin receptors on muscle and fat (and liver?) is
reduced OR…
2) Receptors have become “insulin resistant”
Either way… rate of glucose uptake into cells is slowed resulting
in…
- hyperglycemia
Causes:
1. Sugary diet
2. Lack of exercise
3. Carrying too much body fat
o Fat cells produce hormone-like compounds that make
target cell receptors resistant to insulin
o 90% of all cases occur in overweight adults and
overweight children
3. Genetics
Diabetes Mellitus – Type 2
• Results :
1. hyperglycemia… polyuria… polydipsia… polyphagia…
2. Probable lipidemia & high cholesterol which  risk of …
- Atherosclerosis  stroke, heart attack,
3. Possible DKA…
•
•
•
•
•
•
Diabetes Mellitus – Type 2 (cont’d)
The DM Type 2 epidemic
In 2010 11% of adults in North America
By 2050 28%
“
“
“
“
More & more cases ( incidence)
More & more cases in young children…. …no longer “adult onset.”
Trtmt:
1)
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
2) https://www.youtube.com/watch?v=rbN_AEHzpqQ
3)
4)
5)
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
Why is diabetes (and hyperglycemia) so common?
Gestational Diabetes Mellitus, GDM
•
•
•
•
DM associated with pregnancy
Cause:
1. Elevated levels of estrogen and progesterone make target
cells temporarily insulin resistant
2. 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.