Diabetes mellitus is characterized by hyperglycemia due to insufficient insulin production or ineffective insulin. There are two main types - type 1 diabetes results from autoimmune destruction of insulin-producing pancreatic beta cells, while type 2 diabetes involves insulin resistance along with relative insulin deficiency. Insulin regulates carbohydrate, fat, and protein metabolism, maintaining blood glucose levels. Glucagon has opposing effects, promoting gluconeogenesis and glycolysis to increase glucose levels. Tight regulation of insulin and glucagon secretion is needed to keep glucose within its narrow physiological range.
Glycogenolysis, process by which glycogen, the primary carbohydrate stored in the liver and muscle cells of animals, is broken down into glucose to provide immediate energy and to maintain blood glucose levels during fasting. These slides will provide you detail explanation of Glycogenolysis.
Glucose tolerance test- Indications, contraindications, preparation of a patient, precautions, types of GTT, normal curve, diabetic curve, renal glycosuria, lag curve, Criteria for diagnosis of DM
They are water soluble substances.
2. They are synthesized at a relatively low rate in well nourished individuals.
3. Plasma level of ketone bodies < 1mg/dl.
4. Urinary level of ketone bodies <3 mg/24 hour urine.
Glycogenolysis, process by which glycogen, the primary carbohydrate stored in the liver and muscle cells of animals, is broken down into glucose to provide immediate energy and to maintain blood glucose levels during fasting. These slides will provide you detail explanation of Glycogenolysis.
Glucose tolerance test- Indications, contraindications, preparation of a patient, precautions, types of GTT, normal curve, diabetic curve, renal glycosuria, lag curve, Criteria for diagnosis of DM
They are water soluble substances.
2. They are synthesized at a relatively low rate in well nourished individuals.
3. Plasma level of ketone bodies < 1mg/dl.
4. Urinary level of ketone bodies <3 mg/24 hour urine.
blood glucose homeostasis and the role of tissues and hormones, roles of Insulin and glucagon in regulating blood glucose, regulation of glucose metabolism during exercise, insulin receptor and its mechanism
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#NUTRITIONIST #INTERNATIONAL DIETICIANS
This content is made for all student of medical ,nutrition ,doctors ,zoology ,chemistry ,medical who are still preparing for examination .feel free to give suggestion.
Pancreatic hormone - Endocrinology for biochemistryASHA SIVAJI
Pancreatic hormone - In this you will know about synthesis, metabolism, mode of action, biological actions, regulation and disorders related with insulin,Glucagon, Pancreatic somatostatin and pancreatic polypeptide.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. Diabetes mellitus is the 3rd leading cause of
death in many developed countries.
Diabetes is a major cause of blindness, renal
failure, amputation, heart attacks and stroke.
Diabetes mellitus is a characterized by
increased blood glucose level
(hyperglycemia) due to insufficient or
inefficient (incompetent) insulin.
3. Insulin is a polypeptide hormone produced
by the β-cells of islets of Langerhans of
pancreas.
It influences the metabolism of
carbohydrate, fat & protein.
It is an anabolic hormone, promotes the
synthesis of glycogen, triacylglycerols &
proteins.
4. Human insulin (mol. wt. 5,7341) contains 51
amino acids, arranged in 2 polypeptide chains.
A chain – 21 amino acids & B chain – 30 amino
acids.
Both are held together by 2 interchain disulfide
bridges, connecting A7 to B7 & A20 to B19.
There is an intrachain disulfide link in chain A
between the amino acids 6 & 11.
5. The gene for insulin synthesis is located on
chromosome 11.
The synthesis of insulin involves two
precursors, namely preproinsulin with 108
amino acids (mol. wt. 11,500) & proinsulin with
86 amino acids (mol. wt. 9,000).
6. They are sequentially degraded to form the
active hormone insulin & a connecting
peptide (C-peptide).
Insulin & C-peptide are produced in
equimolar concentration.
C-peptide is biologically inactive.
Its estimation is useful index for the
endogenous production of insulin.
7. In the β-cells, insulin (also proinsulin)
combines with zinc to form complexes.
In this complex form, insulin is stored in the
granules of the cytosol which is released in
response to various stimuli by exocytosis.
8.
9. Factors stimulating insulin secretion:
Glucose & amino acids
Gastrointestinal hormones – secretin, gastrin,
pancreozymin increase the secretion.
Factors inhibiting insulin secretion:
Epinephrine from adrenal medulla is most
potent inhibitor of insulin secretion.
10. Insulin has a half-life of 4-5 minutes.
About 40-50 units of insulin is secreted daily
human pancreas.
The normal range of insulin: 20-30 μU/ml.
A protease enzyme – insulinase degrades
insulin.
Insulinase is mainly present in liver & kidney.
11. Effects on carbohydrate metabolism:
Insulin lowers blood glucose level by
promoting its utilization & storage & by
inhibiting its production.
Effect on glucose uptake by tissues:
Insulin is required for uptake of glucose by
muscle (skeletal, cardiac & smooth), adipose
tissue, leukocytes & mammary glands.
12. About 80% of glucose uptake in the body is
not dependent on insulin.
Effect on glucose utilization:
Insulin increases glycolysis in muscle & liver.
Insulin activates key enzymes of glycolysis –
glucokinase, PFK & pyruvate kinase.
Glycogen production is increased, due to
increased activity of glycogen synthase by
insulin.
13. Effect on glucose production:
Insulin decreases gluconeogenesis by
suppressing the enzymes pyruvate
carboxylase, phosphoenol pyruvate
carboxykinase & glucose 6- phosphatase.
Insulin also inhibits glycogenolysis by
inactivating the enzyme glycogen
phosphorylase.
14. Effects on lipid metabolism:
The net effect of insulin on lipid metabolism
is to reduce the release of fatty acids from
the stored fat & decrease the production of
ketone bodies.
Adipose tissue is the most sensitive to the
action of insulin.
15. Effect on lipogenesis:
Insulin favours the synthesis of
triacylglycerols from glucose by providing
more glycerol 3-phosphate & NADPH.
Insulin increases the activity of acetyl CoA
carboxylase, a key enzyme in fatty acid
synthesis.
16. Effect on lipolysis:
Insulin decreases the activity of hormone-
sensitive lipase & reduces the release of fatty
acids from stored fat.
The mobilization of fatty acids from liver is
also decreased by insulin.
Effect on ketogenesis:
Insulin reduces ketogenesis by decreasing
the activity of HMG CoA synthetase.
17. Effects on protein metabolism:
It stimulates the entry of amino acids into the
cells, increases protein synthesis & reduces
protein degradation.
Insulin promotes cell growth & replication.
This is mediated through certain factors such
as epidermal growth factor (EGF), platelet
derived growth factor & prostaglandins.
18. Insulin receptor mediated signal transduction:
Insulin receptor:
It is a tetramer consisting of 4 subunits – α2β2.
The subunits are in the glycosylated form.
They are held together by disulfide linkages.
α – subunit (mol. wt. 135,000) is extracellular &
it contains insulin binding site.
19. β – subunit (mw. 95,000) is a transmembrane
protein which is activated by insulin.
The cytoplasmic domain of β – subunit has
tyrosine kinase activity.
The insulin receptor is synthesized as a single
polypeptide & cleaved to α & β subunits which
are then assembled.
Insulin receptor has a half-life of 6-12 hours.
About 20,000 receptors/cell in mammals.
20. Signal transduction:
Insulin binds to the receptor, a conformational
change is induced in the α-subunits of insulin
receptor.
This results in the generation of signals which
are transduced to β-subunits.
The net effect is that insulin binding activates
tyrosine kinase activity of intracellular β-
subunit of insulin receptor.
21. This causes the autophosphorylation of
tyrosine residues on β-subunit.
Receptor tyrosine kinase also phosphorylates
insulin receptor substrate (IRS).
The phosphorylated IRS, in turn, promotes
activation of other protein kinases &
phosphatases, finally leading to biological
action.
22.
23. Insulin-mediated glucose transport:
The binding of insulin to insulin receptor signals the
translocation of vesicles containing glucose
transporters from intracellular pool to the plasma
membrane.
The vesicles fuse with the membrane recruiting the
glucose transporters.
The glucose transporters are responsible for the
insulin-mediated uptake of glucose by the cells.
24.
25. As the insulin level falls, the glucose
transporters move away from the membrane
to the intracellular pool for storage & recycle.
Insulin mediated enzyme synthesis:
Insulin promotes the synthesis of enzymes
such as glucokinase, PFK & pyruvate kinase.
This is brought about by increased
transcription & translation.
26. Glucagon, secreted by α-cells of the pancreas.
It is a polypeptide hormone composed of 29
amino acids (mol. wt. 3,500) in a single chain.
It is synthesized as proglucagon, on sequential
degradation releases active glucagon.
Its amino acid sequence is the same in all
mammalian species & half-life. i.e. about 5
minutes.
27. The secretion of glucagon is stimulated by
low blood glucose concentration, amino
acids derived from dietary protein & low
levels of epinephrine.
Increased blood glucose level markedly
inhibits glucagon secretion.
28. Glucagon enhances the blood glucose level
(hyperglycemic).
Primarily, glucagon acts on liver to cause
increased synthesis of glucose & enhanced
degradation of glycogen.
29. Effects on lipid metabolism:
Glucagon promotes fatty acid oxidation
resulting in energy production & ketone
body synthesis.
Effects on protein metabolism:
Glucagon increases the amino acid uptake
by liver & promotes gluconeogenesis.
30. The maintenance of glucose level in blood
within narrow limits is a very finely &
efficiently regulated system.
It is essential to have continuous supply of
glucose to the brain.
31. Following a meal, glucose is absorbed from
the intestine and enters the blood.
The rise in blood glucose level stimulates the
secretion of insulin.
The uptake of glucose by most extrahepatic
tissues, except brain is dependent on insulin.
Insulin helps in the storage of glucose as
glycogen or its conversion to fat.
32. Normally, 2 to 2½ hours after a meal, blood
glucose level falls to near fasting levels.
It may go down further; but this is prevented
by processes that contribute glucose to the
blood.
For another 3 hours, hepatic glycogenolysis
will take care of the blood glucose level.
33. Thereafter gluconeogenesis will take charge
of the situation.
Liver is the major organ that supplies the
glucose for maintaining blood glucose level.
Glucagon, epinephrine, glucocorticoids,
growth hormone, ACTH & thyroxine will keep
the blood glucose level from falling.
They are referred to as antiinsulin hormones
or hyperglycemic hormones.
34. Random blood sugar
Fasting blood sugar
Post-prandial blood sugar
Hyperglycemia
Hypogycemia
Glucose is estimated by GOD/POD or
hexokinase method.
35. Insulin:
It is produced in response to hyperglycemia.
Some amino acids, free fatty acids, ketone
bodies, drugs such as tolbutamide also cause
the secretion of insulin.
It is hypoglycemic hormone that lowers in
blood glucose level.
36. Glucagon:
Hypoglycemia stimulates its production.
It increases blood glucose concentration.
It enhances gluconeogenesis & glycogenolysis.
Epinephrine:
It is secreted by adrenal medulla.
It acts on muscle & liver to bring about
glycogenolysis by increasing phosphorylase
activity.
37. Thyroxine:
It is a hormone of thyroid gland.
It elevates blood glucose level by stimulating
hepatic glycogenolysis & gluconeogenesis.
Glucocorticoids:
Glucocorticoids increases gluconeogenesis.
The glucose utilization by extrahepatic tissues is
inhibited by glucocorticoids.
The overall effect of glucocorticoids is to elevate
blood glucose concentration.
GH & ACTH also increases blood glucose.
38. A fall in plasma glucose less than 50 mg/dl is
called as hypoglycemia.
Hypoglycemia is life-threatening.
The manifestations include headache,
anxiety, confusion, sweating, slurred speech,
seizures & coma, and, if not corrected, death.
39. Post-prandial hypoglycemia:
This is also called reactive hypoglycemia & is
observed in subjects with an elevated insulin
secretion following a meal.
This causes transient hypoglycemia & is
associated with mild symptoms.
The patient is advised to eat frequently rather
than the 3 usual meals.
40. Fasting hypoglycemia:
Fasting hypoglycemia is not very common.
It is observed in patients with pancreatic β-
cell tumor & hepatocellular damage.
Hypoglycemia due to alcohol intake:
Alcohol consumption causes hypoglycemia
This is due to the accumulation of NADH,
which diverts pyruvate & oxaloacetate to
form lactate & malate.
41. Finally gluconeogenesis is reduced due to
alcohol consumption.
Hypoglycemia due to insulin overdose:
The most common complication of insulin
therapy in diabetic patients is hypoglycemia.
This is particularly observed in patients who
are on intensive treatment.
42. Diabetes mellitus (DM) is a metabolic disease
due to absolute or relative insulin deficiency.
DM is a common clinical condition.
It is a major cause for morbidity & mortality.
Mainly two types.
Type 1 diabetes mellitus (T1DM).
Type 2 diabetes mellitus (T2DM).
43. Also known as IDDM or (less frequently)
juvenile onset diabetes, mainly occurs in
childhood (between 12 -15 years age).
IDDM accounts for about 10 to 20% of the
known diabetics.
Characterized by almost total deficiency of
insulin due to destruction of β-cells.
44. The β-cell destruction may be caused by drugs,
viruses or autoimmunity.
Due to certain genetic variation, the β-cells are
destroyed by immune mediated injury.
Symptoms of diabetes appear when 80-90% of
the - β cells have been destroyed.
The pancreas ultimately fails to secrete insulin
The patients of IDDM require insulin therapy.
45. Also called as non-insulin dependent diabetes
mellitus (NIDDM).
Accounting for 80 to 90% of diabetic population.
NIDDM occurs in adults (above 35 years) & is
less severe than IDDM.
The causative factors of NIDDM include genetic
& environmental.
NIDDM commonly occurs in obese individuals.
46. Gestational diabetes mellitus (GDM):
This term is used when carbohydrate intolerance is
noticed, for the first time, during a pregnancy.
A known diabetic patient, who becomes pregnant, is
not included in this category.
Glucose challenge test (GCT) is done between 22 & 24
weeks of pregnancy by giving an oral glucose load
of 50 g of glucose regardless of the time.
If the 2-hour post-glucose value is >140 mg/dl, the test
is positive.
47. Impaired glucose tolerance (IGT):
Also called as Impaired Glucose Regulation (IGR).
Plasma glucose values are above the normal level, but
below the diabetic levels.
In IGT, the FBS value is 110 & 126 mg/dl & PPBS value is
between 140 & 200 mg/dl.
Requires careful follow-up because IGT progresses to
frank diabetes at the rate of 2% patients per year.
48. Impaired fasting glycemia (IFG):
In this condition, fasting plasma glucose is
above normal (between 110 & 126 mg/dl); but
the 2 hour post-glucose value is within
normal limits (less than 140 mg/dl).
These persons need no immediate treatment;
but are to be kept under constant check up.
49. Secondary to other known causes:
Endocrinopathies (Cushing's disease,
thyrotoxicosis, acromegaly)
Drug induced (steroids, beta blockers, etc.)
Pancreatic diseases (chronic pancreatitis,
fibrocalculus pancreatitis, hemochromatosis,
cystic fibrosis).
50. The diagnosis of diabetes can be made on
the basis of individual's response to the oral
glucose load, commonly referred to as oral
glucose tolerance test (OGTT).
Preparation of the subject:
Carbohydrate-rich diet for at least 3 days
prior to the test.
51. All drugs known to influence carbohydrate
metabolism should be discontinued (2 days).
The subject should avoid strenuous exercise
on the previous day of the test.
Person should be in an overnight fasting
state.
During the course of GTT, the person should
be comfortably seated & should refrain from
smoking & exercise.
52. Glucose tolerance test should be conducted
preferably in the morning (ideal 9 to 11 AM).
A fasting blood sample is drawn and urine
collected.
The subject is given 75 g glucose orally,
dissolved in about 300 ml of water, to be
drunk in about 5 minutes.
53. Blood & urine samples are collected at 30
minute intervals for at least 2 hours.
All blood samples are subjected to glucose
estimation while urine samples are
qualitatively tested for glucose.
54. The fasting plasma glucose level is 75-110 mg/dl
in normal persons.
On oral glucose load, concentration increases
& peak value (140 mg/dl) is reached in less
than an hour which returns to normal by 2
hours.
Glucose is not detected in any of the urine
samples
55. In individuals with impaired glucose
tolerance, the fasting (110-126 mg/dl) as well as
2 hour (140-200 mg/dl) plasma glucose levels
are elevated.
These subjects slowly develop frank diabetes.
Dietary restriction & exercise are advocated
for the treatment of impaired glucose
tolerance.
56.
57. Condition Plasma glucose concentration as mmol/l (mg/dl)
Normal IGT Diabetes
Fasting
<6.1
(<110)
<7.0
(<126)
>7.0
(>126)
2 hours
after
glucose
<7.8
(<140)
<11.1
(<200)
>11.1
(>200)
58. For conducting GTT in children, oral glucose is
given on the basis of weight (1.5 to 1.75 g/kg).
In case of pregnant women, 100 g oral
glucose is recommended.
Mini GTT carried out in some laboratories,
fasting and 2 hrs. sample (instead of 1/2 hr.
intervals) of blood & urine are collected.
59. To evaluate the glucose handling of the body
under physiological conditions, fasting blood
sample is drawn, the subject is allowed to
take heavy breakfast, blood samples are
collected at 1 hour & 2 hrs (post-prandial-
meaning after food).
Urine samples are also collected.
This type of test is commonly employed in
established diabetic patients for monitoring
the control.
60. For individuals with suspected malabsorption,
intravenous GTT is carried out.
Corticosteroid stressed GTT is employed to detect
latent diabetes.
Glycosuria:
The commonest cause of glucose excretion in urine
(glycosuria) is diabetes mellitus.
Glycosuria is the first line screening test for diabetes.
Normally, glucose does not appear in urine until the
plasma glucose concentration exceeds renal
threshold (180 mg/dl).
61. Renal glycosuria:
Renal glycosuria is a benign condition due to
a reduced renal threshold for glucose.
It is unrelated to diabetes & should not be
mistaken as diabetes.
Further, it is not accompanied by the classical
symptoms of diabetes.
62. Alimentary glycosuria:
In certain individuals, blood glucose level rises
rapidly after meals resulting in its spill over
into urine.
This condition is referred to as alimentary
glycosuria.
It is observed in some normal people & in
patients of hepatic diseases, hyperthyroidism
& peptic ulcer.
63. Hyperglycemia:
Elevation of blood glucose concentration is the
hallmark of uncontrolled diabetes.
Hyperglycemia is primarily due to reduced
glucose uptake by tissues & its increased
production via gluconeogenesis &
glycogenolys.
Glucose is excreted into urine (glycosuria).
64. Ketoacidosis:
Increased mobilization of fatty acids results
in overproduction of ketone bodies which
often leads to ketoacidosis.
Hypertriglyceridemia:
Conversion of fatty acids to TAGs & secretion
of VLDL & chylomicrons is higher in diabetics.
Plasma levels of VLDL, chylomicrans, TAGs &
cholesterol are increased.
65. Glycosuria – glucose excretion in urine.
Due to osmotic effect, more water
accompanies the glucose (polyuria).
To compensate for this loss of water, thirst
center is activated & more water is taken
(polydypsia).
To compensate the loss of glucose & protein,
patient will take more food (polyphagia).
66. Diabetic keto acidosis (DKA):
DKA more common in T1DM.
Normally the blood level of ketone bodies is
<1 mg/dl & only traces are excreted in urine.
Increased synthesis causes the accumulation
of ketone bodies in blood.
It causes ketonemia, ketonuria & smell of
acetone in breath.
Together constitute ketosis.
67. Detected by Rothera's test.
Supportive evidence may be derived from
estimation of serum electrolytes, acid–base
parameters & glucose estimation.
68. The urine of a patient with diabetic keto
acidosis will give positive Benedict's test as
well as Rothera's test.
But in starvation ketosis, Benedict's test is
negative, but Rothera's test will be positive.
69. Diabetes Mellitus:
The combination of hyperglycemia,
glucosuria, ketonuria & ketonemia is called
diabetic ketoacidosis (DKA).
Untreated diabetes mellitus is the most
common cause for ketosis.
Deficiency of insulin causes accelerated
lipolysis & more fatty acids are released into
circulation.
70. Oxidation of these fatty acids increases the
acetyl CoA pool.
Enhanced gluconeogenesis restricts the
oxidation of acetyl CoA by TCA cycle, since
availability of oxaloacetate is less.
71. In starvation, dietary supply of glucose is
decreased.
Available oxaloacetate is channelled to
gluconeogenesis.
The increased rate of lipolysis provides
excess acetyl CoA which is channeled to
ketone bodies.
The high glucagon favors ketogenesis.
72. Hyperemesis (vomiting) in early pregnancy may
also lead to starvation-like condition & may lead to
ketosis.
In both diabetes mellitus & starvation, the
oxaloacetate is channelled to gluconeogenesis.
Acetyl CoA cannot be fully oxidized in TCA cycle.
This excess acetyl CoA is channelled into ketogenic
pathway.
73. Metabolic acidosis:
Acetoacetate & β-hydroxy butyrate are
accumulated, causes metabolic acidosis.
There will be increased anion gap.
Reduced buffers:
The plasma bicarbonate is used up for
buffering of these acids.
74. Kussmaul's respiration:
Patients will have typical acidotic breathing due to
compensatory hyperventilation.
Smell of acetone in patient's breath.
Osmotic diuresis induced by ketonuria may lead to
dehydration.
Sodium loss:
The ketone bodies are excreted in urine as their
sodium salt, leading to loss of cations from the body.
75. High potassium:
Due to lowered uptake of potassium by cells
in the absence of insulin.
Dehydration:
Sodium loss further aggravates dehydration.
Coma:
Hypokalemia, dehydration & acidosis
contribute to the lethal effect of ketosis.
76. Parenteral administration of insulin & glucose.
Intravenous bicarbonate to correct acidosis.
Correction of water imbalance by normal
saline.
Correction of electrolyte imbalance.
77. Hyperglycemia is directly or indirectly
associated with several complications.
These include
Atherosclerosis
Retinopathy
Nephropathy
Neuropathy.
78. Dietary management:
A diabetic patient is advised to consume low
calories (i.e. low carbohydrate & fat), high
protein & fiber rich diet.
Diet control & exercise will help to a large
extent obese NIDDM patients.
79. Hypoglycemic drugs:
The oral hypoglycemic drugs are broadly of
two categories-sulfonylureas & biguanides.
Sulfonylurea such as acetohexamide,
tolbutamide & gibenclamide are frequently
used.
They promote the secretion of endogenous
insulin & help in reducing blood glucose level.
80. Management with insulin:
Two types of insulin preparations are
commercially available – short acting & long
acting.
The short acting insulins are unmodified &
their action lasts for about 6 hours.
The long acting insulins are modified ones &
act for several hours, which depends on the
type of preparation.
81. Glycated hemoglobin:
Refers to the glucose derived products of normal adult
hemoglobin (HbA).
Glycation is a post-translational, non-enzymatic
addition of sugar residue to amino acids of proteins.
Among the glycated hemoglobins, the most abundant
form is HbA1c.
HbA1c is produced by the condensation of glucose
with N-terminal valine of each β-chain of HbA.
82. The rate of synthesis of HbA1c is directly related to
the exposure of RBC to glucose.
The concentration of HbA1c serves as an indication of
the blood glucose concentration over a period.
HbA1c concentration is about 3-5%.
In diabetic patients, HbA1c is elevated (15%).
HbA1c reflects the mean blood glucose level over 2
months period prior to its measurement.
83. Other proteins in the blood are glycated.
Glycated serum proteins (fructosamine) can
also be measured in diabetics.
Albumin is the most abundant plasma
protein, glycated albumin largely contributes
to plasma fructosamine measurements.
Albumin has shorter half-life than Hb.
Glycated albumin represents glucose status
over 3 weeks prior to its determination.
84. Microalbuminuria is defined as the excretion of 30-
300 mg of albumin in urine per day.
Microalbuminuria represents an intermediary stage
between normal albumin excretion (2.5-30 mg/d) &
macroalbuminuria (>300 mg/d).
The small increase in albumin excretion predicts
impairment in renal function in diabetic patients.
It indicates reversible renal damage.
85. Textbook of Biochemistry – U Satyanarayana
Textbook of Biochemistry – DM Vasudevan