A LATERAL VIEW OF DIABETES FROM THE CARIBBEAN

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A LATERAL VIEW OF DIABETES FROM THE CARIBBEAN

• The Hon. Errol Y. St. A. Morrison, OJ
• MD, PhD, FRCP (Glasg), FACP, FRSM (UK)
• Professor of Biochemistry and Endocrinology
• Pro Vice Chancellor and Dean
• School for Graduate Studies and Research
• UNIVERSITY OF THE WEST INDIES
• Mona Campus, Jamaica W.I.

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THE WORLD
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THE CARIBBEAN AND CENTRAL AMERICA
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Hugh Jones 1955 Zuidema 1956 Morrison
1981 Atypical Diabetes Undernutrition Bush teas
(CAM) Staple root crops

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• Atypical Diabetes
• - hyperglycaemic aglycosuric
• asymptomatic hyperglycaemia
• intermittent insulin requirement
• aketonuric
• 13 of Diabetes Outpatient Clinic at UHWI,
  Mona, Jamaica

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Francis Bacon
If a man will begin with certainties, He shall
end in doubts But if he will be content to begin
with doubts, He shall end in certainties!
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS
FOOD TOXINS, UNDERNUTRITION
FREE RADICALS
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
FR
DAMAGE TO CELL MEMBRANE
Level 1
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
DAMAGE TO CELL MEMBRANE
VIRAL INFECTIONS
INDUCED ANTIGENS
EXPOSED ANTIGENS
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
EA
IA
Level 2
ANTIBODIES
DIRECT TOXICITY
INSULIN RECEPTORS
GLUCOSE TRANSPORTERS
ISLET CELLS
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
IC
IR
OBESITY
GT
INSULIN INSUFFICIENCY
Level 3
INSULIN RESISTANCE
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
INSULIN RESISTANCE
INSULIN INSUFFICIENCY
TYPE 1 INSULIN DEPENDENT DIABETES MELLITUS
PIDDM PHASIC INSULIN DEPENDENT DIABETES MELLITUS
TYPE 2 NON-INSULIN DEPENDENT DIABETES MELLITUS
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
Level 1 Membrane damage Level 2 Antibody
production Level 3 Insulin resistance
insufficiency
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
N.B.
If the processes at levels 1, 2 or 3 remit, then
TEMPORARY DIABETES would result!
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AN HYPOTHESIS FOR THE AETIOLOGY OF DIABETES
MELLITUS (contd.)
N.B.
GESTATIONAL DIABETES (GDM) IMPAIRED GLUCOSE
TOLERANCE (IGT)possible manifestations of level
3 activity.
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The Unitarian Hypothesis
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THE UNITARIAN HYPOTHESIS FOR THE AETIOLOGY OF
DIABETES MELLITUS
HERESY TODAY? FACT TOMORROW!
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CONSENSUS ON THE AETIOLOGY OF TYPE 2 DIABETES
MELLITUS
SRI LANKA, JULY 2002
OVERNUTRITION ? UNDERNUTRITION ?
Increase in type 2 DM in childhood and
adolescence Low birth weight ? increase in type 2
DM
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CONSENSUS ON THE AETIOLOGY OF TYPE 2 DIABETES
MELLITUS (contd.)

• There is a strong association between
• Truncal Obesity
• Diabetes Mellitus
• Impaired Glucose Tolerance
• Cardiovascular Disease

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Hugh Jones 1955 Zuidema 1956 Morrison
1981 Atypical Diabetes Undernutrition Bush teas
(CAM) Staple root crops

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ROOT CROPS a case study.
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CYANOGLUCOSIDES
E.g. Linamarin, lotaustralin (toxic cyanide
radical) Found in root crops Cassava, yucca
(Manihot esculenta), Yams (Dioscorides group)
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CASSAVA (manihot esculenta)
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YAM (Dioscorides GROUP)
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YAM (Dioscorides GROUP)
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ENZYMATIC DEGRADATION OF LINAMARIN
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MAIN METABOLIC PATHWAY OF CYANIDE WITH RHODANESE
S
S
S SO3
E
E

(S SO3)2-
S
S
rhodanese
thiosulphate
CN
S
E
SCN
SO32-


S
thiocyanate
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METABOLIC PATHWAY OF CYANIDE WITH 3 -
MERCAPTOPYRUVATE
TRANSAMINATION
L CYSTEINE SHCH2CH(NH2)COOH
3 MERCAPTOPYRUVATE HSCH2COCOOH
CN SULPHUR TRANSFERASE
SCN
PYRUVATE

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Louis Pasteur
Chance favours the prepared mind!