Lecture 1/31

• Everything except lipids are shuttled to the liver
• glucose is either used for energy or converted to glycogen
• glucose's energy uses include

  • being used by cells
  • conversion to cholesterol or triglycerides
• the goal of glucose regulation is to keep plasma glucose at regular levels
• glands for glucose regulation release either hypoglycemic or hyperglycemic agents
• hypoglycemic agents lower blood glucose levels
• hyperglycemic agents increase glucose levels when it gets low
• islets of langerhans are clusters of 3 cell types: alpha, beta, delta
• glucagon - most antagonist hormone to insulin
• glucose cannot be obtained from lipiids
• epinephrine is released in response to stress

  • part of sympathetic nervous system, or "flight or flight" response
• the sympathetic and parasympathetic nervous system is controlled by the vagus nerve
• epinephrine gets as much sugar to the skeletal muscles as possible in as little time as possible
• cortisol increases liver glycogenesis
• cortisol is also called the stress hormone

  secreted during stress, not flight or fight
• diabetes resulting from hyperthyroidism or being extremely stressed is called secondary diabetes melitus
• cortisol suppresses the immune system
• diabetes insipidus - lack of ADH causes reabsorption of water in kidneys
• hyperglycemia

  • excess glucose in plasma
  • caused by imbalance of regulatory hormones
  • diabetes mellitus is defined as consistent hyperglycemia
• diabetes means opens faucet, refers to polyuria
• mellitus refers to the sweet, honey like taste in the urine of diabetic patients
• hypoglycemia

  • low plasma glucose levels
  • sometimes transient (until hyperglycemic agents kick in), sometimes permanent
  • can be wide ranging
• see decrease in mental cognition at glucose levels ~50 mg/dl
• Of the disease states involving blood sugar, hypoglycemia is a more urgent matter, as is can cause the central nervous system to shut down
• chronic hyperglycemia has more long term effects
• type 1 diabetes is insuline dependent diabetes melitus
• type 1 diabetes is called juvenile diabetes since most patients are diagnoses as children or teens
• the incidence of type 1 diabetes is lower than type ii
• type type 1 diabetes defining characteristic is the lack of insulin secretion
• type 1 diabetes is an autoimmune disease
• the antibodies destroying the beta cells are cross- reactive, may have originally been created against antigen similar to beta cells
• type 1 Diabetes

  • genetics - is family related, exact gene unknown
  • onset - sudden, acute; often when younger
  • signs and symptoms
  • 3 "polys" - polyuria, polydypsia, polyphagia
  • progression - see rapid weight loss; if glucose low enough, exhibit mental confusion
  • it not resolved, patient can go into a coma and die
• resolution of type 1 diabetes

  endocrinologist gives insulin, proper diet, consistent glucose testing; once insulin levels satisfactory, prescribed insulin and given direction to follow
• polyuria - pee alot
• polydypsia - constant thirs
• polyphagia - constant hunger
• type 1 diabetes

  • long term complications
  • nephropathy - kidney disease
  • protein (albumin smallest protein) seeps into urine because glomerular pores become bigger
• type 1

  • in beginning stages, the dipstick is not sensitive enough to pick up protein
  • more sensitive test called microalbumin is one of the earliest indicators of renal disease in diabetes
• neuropathy - irritation of sensory peripheral nerves

  • patient feels constant pain of the extremeties
• retinopathy - vasculature in retina of eye is affected