Diabetes Alpha cells Beta cells Delta cells Type I IDDM Pancreas is responsible for insulin levels Produce glucagon Stimulates breakdown of glycogen in liver glycogenolysis Stimulated formation of carbohydrates in liver Stimulates breakdown of lipids Secretion is regulated by blood sugar levels Low sugar levels alpha release glucagon Secrete insulin helps glucose to move across the cell membrane blood glucose levels Secretion is regulated by blood glucose level High gluc beta release insulin Produces somatostatin inhibits the production of glucagon and insulin Balances Alpha and Beta cell function Affects 10 of people with DM Autoimmune disease beta cell destruction Often leads to absolute insulin dependency Develops most often in children and young adults Obesity is a factor but less so than with type 2 Strongly inherited Environmental factors can be the trigger chemical toxin found in smoked meat Viruses that trigger autoimmune response Islet antibodies presence can diagnose pre clinical DM Symptoms appear after 80 of beta cells destroyed Type II NIDDM Most common affects 90 of people with DM Usually diagnosed after age 40 but seeing in younger younger people Associated with older age obesity family history of DM previous gestational DM physical inactivity certain ethnic populations Hereditary traits mostly with identical twins Obesity is a major risk factor 88 are obese 20 over ideal weight NO beta cell destruction chronic high glucose make beta cells less efficient Impaired liver muscle tissue sensitivity to insulin Impaired insulin secretion Gestational DM DM Glucose intolerance first diagnosed during pregnancy Affects about 5 of DM population Symptoms generally disappear after termination of pregnancy Insulin is needed in a prescribed amount for glucose to get into cells unlocks the door 1 2 Nerve intestine kidney don t need insulin to use glucose 3 Low glucose levels stimulate the release of stored glucose 4 High glucose levels stimulate pancreas to release more insulin 5 Decreased glucose utilization Ingested glucose can t be transported into cells so plasma levels rise Liver can t store glucose as glycogen without adequate insulin a Nerve intestine and kidney cells don t need insulin to transport glucose into their cells b Skeletal and fat cells do c d e So blood glucose levels continue to rise f Glucose appears in urine g Glucose is osmotic diuretic h Dehydration appears osmotic diuresis 6 Increased fat mobilization a Muscle are crying for glucose so fat stores are broken down b Ketones are formed as a byproduct of fat metabolism and produce hydrogen ions c Measured in urine smelled on breath d Acid base balance disturbed metabolic acidosis e f Lipid breakdown increases lipid levels Leads to arteriosclerosis 7 Increased protein utilization a Amino acids building blocks of protein are converted to glucose in the liver further elevating glucose levels leads to protein breakdown Insulin is needed to build protein b c Type 1 diabetics often appear emaciated due to constant protein breakdown Symptoms Cardinal signs Polyuria Polydipsia from dehydration Polyphagia protein breakdown Weight loss Water loss less muscle mass protein breakdown Blurred vision blood vessels clogging not feeding retina Pruritis vaginitis bacterial and fungal infections great food available Weakness fatigue dizziness K loss postural B P from fluid loss Asymptomatic type 2 Body adapts to slow changes for a while Slow healing wounds dark patches acanthosis nigricans Ranges Sulfonylureas Fasting blood sugar 100 norm 100 125 pre 126 DIABETES Glucose tolerance 140 norm 140 199 pre 200 DIABETES GTT should return to normal in 2 hours Diabeta Glucotrol Amaryl Micronase Stimulate beta cells to secrete insulin Mild diuretic Used for Type 2 Take 1 2 times per day before meals Biguanides Metformin Glucophage Makes muscle cells more sensitive to insulin Decreases glucose produced by liver Decreases LDL s and triglycerides Decreases amount of insulin needed in type 2 Take 1 3 times per day Alpha Gluc Inhibitor Acarbose Precose Glycet Delays digestion of complex carbohydrates so glucose levels peak later after meals Used in type 2 DM Take with every meal Meglitinides Prandin Starlix Stimulates beta to secrete insulin Take 30 before each meal Used for type 2 Thiazolidinediones Dangerous Avandia restricted use heart damage Actose linked to bladder cancer Resulin liver damage Increases insulin action at receptors in liver and peripheral tissue to store more glucose in liver CHRONIC COMPLICATIONS Macrovascular larger vessels CAD cerebrovascular disease hypertension peripheral vascular disease Occur years before symptoms of DM even appear Tight glucose control minimizes this Retinopathy Nephropathy Caused by lack of oxygen from occluded vessels Damage to smaller blood vessels No symptoms early Late symptoms swelling proteinuria renal failure Checking urine protein is important Neuropathic complications MOST COMMON PROBLEM Numbness tingling pain Cycle of foot wound 1 Neuropathy 2 Minor trauma 3 Ulceration 4 Poor healing 5 Gangrene Smooth shiny red skin with a small digital ulcer and a Terry s nail pale with a distal band of reddish brown color due to chronic renal failure This combination is highly suspicious of diabetic complications