03.17.16 Diabetes Mellitus - Diabetes Mellitus Definition of Diabetes Mellitus A chronic multisystem disease related to Abnormal insulin production

03.17.16 Diabetes Mellitus - Diabetes Mellitus Definition...

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Diabetes Mellitus Definition of Diabetes Mellitus A chronic multisystem disease related to: Abnormal insulin production Impaired insulin utilization Or both Leading cause of End-stage renal disease Adult blindness Non-traumatic lower limb amputations Major contributing factor Heart disease Stroke Etiology and Pathophysiology Theories link cause to single/ combination of these factors Genetic Autoimmune Viral Environmental (diet, activity, etc) Two most common types Type 1 Type 2 Normal insulin metabolism Produced by the β cells Islets of Langerhans Released continuously into bloodstream in small increments with larger amounts released after food Stabilizes glucose range to 70 to 120 mg/dL Insulin Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell It allow glucose into the cell to give your body energy Decreases glucose in the bloodstream ↑ insulin after a meal Stimulates storage of glucose as glycogen in liver and muscle for later use Inhibits gluconeogenesis Enhances fat deposition ↑ protein synthesis Skeletal muscle and adipose tissue—Insulin-dependent tissues Other tissues (brain, liver, blood cells) do not directly depend on insulin for glucose transport. They have receptors for insulin; insulin is required to “unlock” receptor sites to allow transport of glucose into cells Although liver cells are not considered insulin-dependent tissue, insulin receptor sites on the liver facilitate the hepatic uptake of glucose and its conversion to glycogen. Counterregulatory hormones Oppose effects of insulin Increase blood glucose levels
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Provide regulated release of glucose for energy Help maintain normal blood glucose levels Examples Glucagon, epinephrine, growth hormone, cortisol Classifications of Diabetes Mellitus Type 1, Insulin-Dependent Diabetes Mellitus (IDDM) Usually a rapid onset; seen in younger people Connected in many cases to viral destruction of the beta cells of the pancreas Type 2, Non–Insulin-Dependent Diabetes Mellitus (NIDDM) Usually occurs in mature adults Has a slow and progressive onset Type 1 Diabetes Mellitus Etiology and Pathophysiology End result of long-standing process Immune mediated; progressive destruction of pancreatic β cells by body’s own T cells Autoantibodies cause a reduction of 80% to 90% in normal β-cell function before manifestations occur. Causes (2) Genetic predisposition-Idiopathic Related to human leukocyte antigens (HLAs) Exposure to a virus Idiopathic diabetes is form of Diabetes 1 not related to autoimmunity but inherited (genetic) “Idiopathic” meaning “we don’t know” Most often seen in African or Asian ancestry Latent: slow progressing, autoimmune Over the age of 35 and often mistaken for obesity Onset of Disease
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