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Chapter033
1.
Chapter 33 Diabetes
Mellitus and the Metabolic Syndrome Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
2.
Anabolism and Catabolism
Anabolism Insulin, anabolic steroids Catabolism glucagon, epinephrine, cortisol available foodstuffs (in blood) glucose amino acids free fatty acids stored foodstuffs Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins (in cells) glycogen proteins triglycerides liver can convert amino acids and free fatty acids into ketones
3.
Insulin and Glucagon
Are the Main Controls Anabolism Insulin , anabolic steroids Catabolism Glucagon , epinephrine, cortisol available foodstuffs (in blood) glucose amino acids free fatty acids stored foodstuffs Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins (in cells) glycogen proteins triglycerides liver can convert amino acids and free fatty acids into ketones
4.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Anabolic reactions release energy.
5.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Anabolic reactions use energy to build/produce/synthesize (like building proteins from amino acids). Catabolic reactions break down substances, releasing energy in the process (like digestion).
6.
Scenario Two women
have benign pancreatic tumors... • In one, the tumor is an insulinoma that secretes insulin • In the other, the tumor is a glucagonoma that secretes glucagon Question • What differences do you expect to see between these two women? Why? • Both of the women have arthritis, but only one is being treated with corticosteroids. Which one? Why is the other not receiving corticosteroids? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
7.
The Pancreas Pancreas
Exocrine pancreas releases digestive juices through a duct to the duodenum Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Endocrine pancreas releases hormones into the blood
8.
Endocrine pancreas: Islets
of Langerhans Alpha cells Beta cells Delta cells PP cells Insulin and amylin Somatostatin Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Pancreatic Glucagon polypeptide
9.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins
10.
Functions of Pancreatic
Hormones • Glucagon: causes cells to release stored food into the blood • Insulin: allows cells to take up glucose from the blood • Amylin: slows glucose absorption in small intestine; suppresses glucagon secretion • Somatostatin: decreases GI activity; suppresses glucagon and insulin secretion Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
11.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins
12.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which pancreatic hormone decreases blood glucose levels? a. Glucagon b. Insulin c. Amylin d. Somatostatin
13.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. Insulin Insulin allows cells to take glucose from the blood and use it for energy/to make ATP. Because it stimulates movement of glucose out of the blood and into the cells, blood levels decrease when insulin is released.
14.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Discussion Think back on your day so far. • When do you think you had your highest insulin levels? • When do you think you had your lowest insulin levels? • When did you have your highest glucagon levels?
15.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins
16.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Discussion Review the figure on Insulin's Actions • If someone lacks insulin, what happens to his: – Blood glucose levels? – Blood amino acid levels? – Blood pH? – Intracellular fat levels? – Intracellular protein levels? – Cell growth?
17.
Discussion Review the
following diagrams on anabolism/catabolism and insulin's mechanism of action Question • Identify five things that could go wrong to cause increased blood glucose • Which of the cases you identified would be least likely to respond to insulin? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
18.
Anabolism and Catabolism
Anabolism Insulin, anabolic steroids Catabolism glucagon, epinephrine, cortisol available foodstuffs (in blood) glucose amino acids free fatty acids stored foodstuffs Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins (in cells) glycogen proteins triglycerides liver can convert amino acids and free fatty acids into ketones
19.
Types of Diabetes
Mellitus • Type 1: pancreatic beta cell destruction predominantly by an autoimmune process • Type 2: a combination of beta cell dysfunction and insulin resistance • Other – Genetic defects in insulin production – Genetic defects in insulin action – Diabetes secondary to other diseases – Drug interactions • Gestational diabetes mellitus Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
20.
Pathogenesis of Type
2 Diabetes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
21.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Type 2 DM is more common than Type 1 DM.
22.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Type 1 DM is autoimmune (juvenile diabetes is Type 1), and affects only 5% to 10% of the diabetic population. Type 2 DM is associated with risk factors like obesity, poor diet, and sedentary lifestyle; 90% to 95% of diabetics suffer from this type.
23.
Metabolic Syndrome •
Abdominal obesity • Increased blood triglyceride levels • Decreased HDL levels • Increased blood pressure • Increased fasting plasma glucose Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
24.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins
25.
Acute Complications of
Diabetes • Diabetic ketoacidosis • Hyperglycemic hyperosmolar nonketotic coma • Hypoglycemia • Somogyi effect • Dawn phenomenon Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
26.
Acute Complications of
Diabetes (cont.) Discussion • How would hyperglycemia with ketoacidosis cause: – Heavy breathing? – Polyuria? – Dehydration? • Which of these would you not see in hyperglycemia without ketoacidosis? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
27.
Scenario You find
a man collapsed on the sidewalk… • He is wearing a diabetic alert bracelet and has an insulin syringe in his briefcase Question • Does he need insulin? • Why or why not? • What signs might help you tell whether he has a hyperglycemic or hypoglycemic problem? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
28.
Chronic Complications of
Diabetes Mellitus • Increased glucose levels allow glucose to bind to proteins in: – Hemoglobin Hb A1C has higher O2 affinity – Basement membranes of blood vessels º Nephropathy º Retinopathy º May cause increased risk of atherosclerosis – Lens cataracts Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
29.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins
30.
Osmolarity in Diabetes
Mellitus • When blood glucose is high, increased blood osmolarity can cause cells to shrink • Nerve cells produce intracellular osmoles to keep their osmolarity balanced with the blood • When the client brings blood glucose back to normal, the nerve cells are hyperosmolar to the blood and gain water, swelling • Nerve damage may be caused by swelling, demyelination, and lack of O2 secondary to vascular disease Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
31.
Diabetic Neuropathy •
Somatic neuropathy – Diminished perception of vibration, pain, and temperature – Hypersensitivity to light touch; occasionally severe “burning” pain • Autonomic neuropathy – Defects in vasomotor and cardiac responses – Impaired motility of the gastrointestinal tract – Inability to empty the bladder – Sexual dysfunction Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
32.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is not a complication of diabetes mellitus? a. Nephropathy b. Retinopathy c. Neuropathy d. All of the above are complications of DM.
33.
Copyright © 2011
Wolters Kluwer Health | Lippincott Williams & Wilkins Answer d. All of the above are complications of DM. Nephropathy and retinopathy are caused by increased blood glucose levels that cause binding of excess glucose to the basement membranes of the blood vessels of the kidneys and eyes. Neuropathy is due to swelling and demyelination of nervous tissue.
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