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diabetes

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diabetes

diabetes

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  • Celerion is actively recruiting adults living with diabetes (Type 1 or Type 2). Upon qualifying, these individuals would have the opportunity to earn up to $250 per day while contributing to ongoing diabetes research.

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    diabetes diabetes Presentation Transcript

    • Diabetes Mellitus Pathophysiology
    • Diabetes Mellitus
      • Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
      • The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
      • The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
    • Insulin secretion
    •  
    • Action of insulin
    • Action of insulin on CHO, Fat and Protein Metabolism
      • Carbohydrate
      • Facilitates the transport of glucose into muscle and adipose cells
      • Facilitates the conversion of glucose to glycogen for storage in the liver and muscle.
      • Decreases the breakdown and release of glucose from glycogen by the liver
      • Protein
      • Stimulates protein synthesis
      • Inhibits protein breakdown; diminishes gluconeogenesis
      • Fat
      • Stimulates lipogenesis- the transport of triglycerides to adipose tissue
      • Inhibits lipolysis – prevents excessive production of ketones or ketoacidosis
    • Major Reason for Insulin Secretion
      •  secretion
        • Elevated blood glucose levels
        • Increased fatty acids
        • GI hormones
        • Glucagon, growth hormone, cortisol
        • Insulin resistance
      •  secretion
        • Decreased blood glucose levels
        • Decreased food intake (fasting)
    • Hyperglycemia
      • an excessive amount of glucose circulates in the blood plasma
      • chronic levels exceeding 125 mg/dl can produce organ damage
    • Glucose Homeostasis
    • What goes wrong in Diabetes ?
      • Multitude of mechanisms
        • Insulin
          • Regulation
          • Secretion
          • Uptake or breakdown
        • Beta cells
          • damage
    • Type 1 Diabetes
      • Low or absent endogenous insulin
      • Dependent on exogenous insulin for life
      • Onset generally < 30 years
      • 5-10% of cases of diabetes
      • Onset sudden
        • Symptoms: 3 P’s: polyuria, polydypsia, polyphagia
    • Type 1 Diabetes cell
    •  
    • Metabolic defects in Type 1 Diabetes
      • Hyperglycemia and ketoacidosis
      • Hypertriacylglycerolemia
    • Type 2 Diabetes
      • Insulin levels may be normal, elevated or depressed
        • Characterized by insulin resistance,
        • diminished tissue sensitivity to insulin,
        • and impaired beta cell function (delayed or inadequate insulin release)
      • Often occurs >40 years
    • Type 2 Diabetic cell
    • Insulin Receptors
      • REMEMBER: the main action of the insulin receptor is to signal the cell to absorb glucose .
      • A decrease in insulin receptor signaling leads to type 2 diabetes mellitus.
        • Thus, the cells are not able to take up glucose, leading to hyperglycemia (an increase in glucose circulating in the blood), and all the resulting sequelae.
    • Type 2 Diabetes
      • Risk factors: family history, sedentary lifestyle, obesity and aging
      • Controlled by weight loss, oral hypoglycemic agents and or insulin
    • Metabolic defects in Type 2 Diabetes
      • Hyperglycemia
      • Hypertriacylglycerolemia ----- low levels of insulin ---- decreased activity of lipoprotein lipase ------ raised plasma level of VLDL
    • Long term effects of Diabetes Mellitus
      • Microvascular complications :-
      • - retinopathy
      • - nephropathy
      • - neuropathy
      • Macrovascular complications :-
      • - stroke
      • - cardiovascular disease
    • Screening/Diagnosis of Diabetes
    •  
    • Diabetic Process
      • Decreased insulin production or action
        • -> Increased glucose accumulates in blood
        • -> hyperglycemia
        • -> need to dilute glucose in circulating blood
        • -> fluids drawn from intracellular spaces to vascular bed
        • -> Thirst (polydipsia)
    • Diabetic Process
      • Thirst (polydipsia)
        • -> increased fluid intake
        • -> increased fluid volume
        • -> kidneys need to excrete excess volume
        • -> Polyuria (frequent urination)
          • Glycosuria (excretion of glucose into urine)
    • Diabetic Process:
      • Lack of glucose for energy/metabolism
        • -> cells starve
        • -> increased hunger ( Polyphagia )
        • -> increased food intake (weight gain)
      • No glucose to metabolize
        • -> protein metabolism (nitrogen imbalance)
        • -> fat metabolism: (ketone bodies (ketosis))
    • Diabetic Process:
      • Polydipsia, polyuria and polyphagia can lead to a fluctuations in blood glucose levels (hyperglycemia and hypoglycemia)
        • -> damage to small blood vessels throughout the body
        • -> serious impairment, especially kidneys, eyes, and heart
      • In pregnancy: decreased glucose to uterus and increased glucose to fetus
        • -> hypoglycemia at birth
    • Importance of glucose regulation
      • The brain: normally dependent on glucose for oxidative metabolism and function
      • Hypoglycemia
        • brain fuel deprivation
          • functional brain failure
            • corrected by raising plasma glucose concentrations
      • Hyperglycemia
        • Osmotic water loss (cellular and systemic)
          • Damages blood vessels
    • Hyperglycemia Symptoms
      • Classic Hyperglycemic Triad (the 3 P’s of diabetes):
        • Polydipsia
          • frequent thirst
          • excessive thirst
        • Polyuria
          • frequent urination
          • excessive urination
        • Polyphagia
          • frequent hunger
          • pronounced hunger
    • Additional Symptoms of Hyperglycemia
      • Blurred vision
      • Fatigue
      • Weight loss
      • Poor wound healing
      • Dry mouth
      • Dry or itchy skin
      • Impotence (male)
      • Recurrent infections
      • Kussmaul hyperventilation: deep, rapid breathing
      • Fruity/acetone smell on the breath
      • Cardiac arrhythmia
      • Stupor
      • Coma
      • Death
    • Glycemic Control
      • Glucose cycle: glucose in the bloodstream is made available to cells in the body
        • dependent upon
          • glucose entering the bloodstream
          • insulin allowing appropriate uptake into the cells of the body.
        • Both require management.
    • Glycemic Control
      • Management
        • highly intrusive
        • compliance is an issue
          • relies on user lifestyle change
          • often on regular sampling and measuring of blood glucose levels
      • Highly individual
    • Glycemic Control
      • Many of the long-term complications of diabetes, especially microvascular complications, result from many years of elevated blood glucose levels.
      • Good glycemic control, (70-130 mg/dl, or 3.9-7.2 mmol/L) is the important goal of diabetes care.
    • Glycemic control
      • The hemoglobin A1c (glycosylated hemoglobin) reveals “average” glucoses over the preceding 2-3 months.
      • In normal glucose metabolism, the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method).
    • Glycemic Control
      • &quot;Perfect glycemic control&quot;
        • glucose levels were always within the normal range (70-130 mg/dl, or 3.9-7.2 mmol/L)
      • “ Perfect” glycemic control very difficult, and even &quot;good glycemic control&quot; usually describes blood glucose levels that average somewhat higher than the normal range.
      • “ Poor glycemic control”
        • Persistently elevated blood glucose and glycosylated hemoglobin levels
        • May persist over months and years before severe complications develop.
    • Summary
      • Diabetes occurs when either there is inadequate insulin production in the pancreas or there is inadequate absorption of insulin into the cells.
      • Insulin is needed for metabolism of glucose for energy at the cellular level
      • Lack of glucose for metabolism  metabolism of fat and protein for energy, polyuria, polydipsia, and polyphagia (classic symptoms of diabetes) and others listed earlier
      • Chronic condition that can lead to multiple serious complications
      • Goal: glycemic control
    •  
    • Hypoglycemia symptoms
      • Shakiness
      • Nervousness
      • Sweating
      • Dizziness or light-headedness
      • Sleepiness
      • Confusion
      • Another clue to nocturnal hypoglycemia is postprandial hyperglycemia after breakfast
      • Difficulty speaking
      • Anxiety
      • Weakness
      • Hypoglycemia can also happen during sleep
        • crying out or having nightmares
        • finding pajamas or sheets damp from perspiration
        • feeling tired, irritable, or confused after waking up
    • Hypoglycemia
      • Hypoglycemia, also called low blood glucose or low blood sugar,
        • occurs when blood glucose drops below normal levels.
      http://hubpages.com/hub/Hypoglycemia_Symptoms_and_Treatments