Diabetes Mellitus
Failure to control blood glucose
 Long term health complications
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Atherosclerosis
 Stroke
 Neuropathy (damaged nerves)
 Retinopathy, glaucoma
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Scottish perspective
Control of Blood glucose
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If blood glucose rises
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If blood glucose falls
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Excess is stored in muscles & liver as glycogen
Deficit remediated by breaking glycogen down in
liver and releasing into blood stream
Two hormones:
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Insulin & Glucagon
Control of Blood glucose
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Insulin:
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Synthesised by  cells of Islet of Langerhans in
pancreas
Glucagon
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Synthesised by  cells of Islet of Langerhans in
pancreas
Blood glucose level sensed in pancreas
 Regulates secretion of insulin/ glucagon
directly
 Negative feedback system (p54)
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INSULIN – target cells
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Insulin acts on
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Insulin increases permeability of fat/ skeletal
muscle cell membrane to glucose
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Liver
Adipose tissues (fat)
Skeletal muscle cells
So stimulates glucose uptake into these tissues
Liver already very permeable
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Insulin stimulates glycogen formation & glucose
uptake
INSULIN
Insulin acts via an insulin receptor
 Diabetes occurs through two
mechanisms
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1 – Loss of insulin
 2 – Loss of insulin receptors
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Diabetes in Young Adults (15-30
years)
Type 2
Type 1
5
10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
Age of diagnosis
Genetic Nurses in Diabetes treatment
unusual genetic type of diabetes called
maturity onset diabetes of the young
6 different genes causing this type of diabetes.
genetically defined subtype present different clinical course.
one subtype responds to sulphonylureas
patients replace insulin treatment sometimes after being on
insulin for over 30 years, finding the genetic cause of their diabetes
has had a major impact on their treatment.
Type 1 Diabetes – Insulin
dependent

Type 1- Diabetes (5-10%)
Loss of insulin – destruction of pancreatic 
cells
 Early onset
 Weight loss, fatigue, polydypsia, polyuria,
glucosuria, hyperglycaemia
 Ketosis (sweet breath – due to acetone)
 Treat with injections of insulin
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Glucose tolerance test
A large bolus dose of glucose
administered (100g glucose drink)
 Blood glucose monitored
 Rapid fall after peak (9-10mM) levels
reached
 If diabetes clearance is very slow – in
urine, peak blood glucose level higher
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Type 2 Diabetes – Insulin
Independent
90-95% cases of diabetes
 Late onset (after 40yrs age)
 3-7% population affected
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60% SUMO wrestlers c.f. 5% Japanese
population
Mainly occurs in overweight individuals
Insulin Resistance
Symptoms

Insulin resistance
Normal or elevated blood insulin levels
 Failure of insulin to act on target tissues
 Deficiency in insulin receptors
 Can lead to  cell function becoming
compromised due to excessive insulin
production
 Hyperglycaemia, polydypsia, polyuria,
glucosuria
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Progression
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Elevated blood glucose associated with
diabetes damages blood vessels and
nerves
Small blood vessel damage causes
blindness, kidney failure & amputation
 Larger blood vessel damage can cause
heart disease, high blood pressure & stroke
 75% of Type 2 patients die of
cardiovascular disease
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Exercise & NIDDM
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Insulin sensitivity in fit individuals is greater
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Insulin sensitivity decreases with age
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i.e. cells better able to uptake glucose from blood
This decrease reduced by exercise
5-7 days after exercise insulin sensitivity
starts to decline
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Regular, moderate, aerobic exercise is important in
preventing onset of NIDDM
Diseases control in 80-90% patients achieved
by reducing calorie intake/ exercise
 Glasgow Research
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Osteoporosis
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Osteoprosis – long term progressive increase
in bone porosity/ brittleness
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Risk of fractures (shatter)
Loss of height
Curvature of spine
Back pain
Post menopausal women
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20-50% over 50s
75% over 90s
Bone growth
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Childhood and early adolescence bones
extend
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Late adolescence bones increase in density
Peak bone density in late twenties/early thirties
1%/yr (female) decline in density thereafter
 2-3%/yr decline post menopausal
 Male bone density declines 0.4%/ yr and only
when over age 50
 Extra calcium/ Vitamin D in childhood & teens
produce greater bone density
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Margaret Thatcher – cause of osteoporosis in 20102020?
Risk Factors
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Elderly
Early menopause
Amenorrhoea
Genetics
Low body fat
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Low calcium in diet
Vit. D deficiency
High alcohol/
caffeine/ fizzy drinks
High salt
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Age related reduction in bone density
Oestrogen promotes calcium uptake
Low oestrogen
Enzymes in fat produce oestrogen
from circulating precursors
Body raids calcium stores in bones
Poor calcium absorption
Promote bone loss by using calcium
stores to balance pH
Calcium removed along with Na in
the urine
Exercise & Osteoporosis –
Prevention

Mechanical stress increases bone
strength (density)
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Astronauts have lowered bone density
following zero gravity because no
mechanical stress
Weight bearing or resistance exercise
will benefit women in late twenties/
early thirties (swimming will not!)
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Also benefits coordination reducing risk of falls
Exercise & Osteoporosis –
Treatment
45 min moderate exercise 3 times
weekly increases calcium deposition in
osteoporosis patients
 In conjunction with HRT
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Risk of Exercise in Women
Excessive exercise particularly in young
women can cause osteoporosis
 Reduction in body fat leads to reduction
in oestrogen synthesis
 Menstruation ceases
 Oestrogen falls further, reducing
calcium absorption
 Bone loss is irreversible
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Advice from Osteoporosis Soc.
It's a good idea to avoid:
 Too much protein –
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Lots of salt –
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phosphoric acid gives flavour to a lot of fizzy drinks
too much can cause the body to use calcium to balance levels.
Drinking too much caffeine –
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high sodium increases calcium lost in urine.
Drinking lots of fizzy drinks –
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Excessive protein upsets acid balance.
Calcium from bones neutralises it.
Eating plenty fruit and veg should keep your body's acid balance stable.
high caffeine intake affects the balance of calcium in the body.
Milk in coffee will counteract this, limit intake to one or two cups a day.
Letting your weight drop too low –
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Being underweight increases the risk of broken bones when you fall.
In younger women, severe weight loss may stop menstrual periods because
hormone levels drop which can also increase your risk of breaking a bone