Spotlight A
Wednesday, September 25, 2019
10:13
Diabetes Mellitus - group of diseases that affect how body uses glucose
→ Untreated --> glucose spills into urine, serious health complications
→ Type 1
○ Insulin producing cells in the pancreas are destroyed by the immune system
○ Autoimmune - destroys producing cells, leads to insulin deficiency/absence
○ Muscle and fat tissue cannot take glucose - hyperglycemia
○ Lack of insulin --> liver releases more glucose in blood
○ Fatty acids released from fat tissue
§ Liver converts this to ketones used for cell energy
§ Untreated --> ketones increase --> blood acidity increases -->
ketoacidosis
○ Treated with insulin injections (discovered in 1921 by Banting and dogs)
○ Requires regular insulin delivery (injections, pumps)
○ Monitor blood glucose (glucometer)
○ Track food and activity to align insulin dose to desired levels
→ Type 2 - most common
○ Cells are less sensitive/resistant to insulin effects (despite pancreas
producing insulin)
○ w/o insulin to tell cell to let in glucose, glucose builds in blood stream, cause
more insulin release, increase blood pressure
○ Fasting blood glucose >125 mg/dL - OGTT >200 mg/dL
○ Risk factors
§ Obesity
§ Overeating
§ Decreased exercise
§ Sedentary behaviors
○ 90-95% of diabetics / 9 out of 10
→ Gestational
○ 18% of pregnant women
○ Elevated blood glucose during pregnancy
○ Risk increase by obesity, exercise
○ High fiber / low-glycemic diet helps
m
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○ 90-95% of diabetics / 9 out of 10
→ Gestational
○ 18% of pregnant women
○ Elevated blood glucose during pregnancy
○ Risk increase by obesity, exercise
○ High fiber / low-glycemic diet helps
○ Increases pregnancy complication risk
○ Causes baby to grow too big
○ Resolves after delivery
○ Remaining increased risk of type 2
○ Risk Factors
§ Obese prior to pregnancy
§ 25+ years old
§ Prediabetes
§ Family history of type 2
§ Non-white
○ Higher incidence of C-section
○ High BP
○ Increased risk of diabetes
○ Infant effects
§ Risk of shoulder injury during birth
§ Increased risk of breathing problems
§ Increased risk of obesity in childhood
§ Increased risk of diabetes in adulthood
2030: 550 million affected projection
→ Prediabetes
○ 33% of American adults (higher in older)
○ Early stage of insulin resistance
○ w/o intervention = type 2
○ Lower levels than type 2 but still elevated
○ Oral Glucose Tolerance Test (OGTT): 140 to 199 mg/dL
○ Increased risk for type 2, heart disease, stroke
○ Reduce risk w/ weight control, exercise, diet. Mod.
→ Elevated blood glucose
○ Short-term / hyperglycemia
§ Blurred vision, freq. urination, weight loss, infection, delayed healing,
extreme hunger/thirst, fatigue
○ Long-term
§ Cell/organ damage, heart disease, hypertension, nerve damage,
blindness, kidney failure, stroke, amputation
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§ Blurred vision, freq. urination, weight loss, infection, delayed healing,
extreme hunger/thirst, fatigue
○ Long-term
§ Cell/organ damage, heart disease, hypertension, nerve damage,
blindness, kidney failure, stroke, amputation
Damages: heart, blood vessels, kidneys, eyes, nerves
Highest in the US
2030: 550 million affected projection
Lifestyle, diet, weight components
○ Excess calories
○ High refined grains/added sugars intake
○ Decrease exercise
○ Sedentary behavior
Genetic predisposition
Environmental impact on gene function
HISTORY
○ Used to be a death sentence = waste to nothing
○ 1922 insulin is isolated
○ Insulin - *see notes in CHAPTER 4 on Blood Glucose Regulation*
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