Diabetes Mellitus

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Diabetes Mellitus

• Failure to control blood glucose
• Long term health complications
• Atherosclerosis
• Stroke
• Neuropathy (damaged nerves)
• Retinopathy, glaucoma

Scottish perspective
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Control of Blood glucose

• If blood glucose rises
• Excess is stored in muscles liver as glycogen
• If blood glucose falls
• Deficit remediated by breaking glycogen down in
  liver and releasing into blood stream
• Two hormones
• Insulin Glucagon

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Control of Blood glucose

• Insulin
• Synthesised by ? cells of Islet of Langerhans in
  pancreas
• Glucagon
• Synthesised by ? cells of Islet of Langerhans in
  pancreas
• Blood glucose level sensed in pancreas
• Regulates secretion of insulin/ glucagon directly
• Negative feedback system (p54)

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INSULIN target cells

• Insulin acts on
• Liver
• Adipose tissues (fat)
• Skeletal muscle cells
• Insulin increases permeability of fat/ skeletal
  muscle cell membrane to glucose
• So stimulates glucose uptake into these tissues
• Liver already very permeable
• Insulin stimulates glycogen formation glucose
  uptake

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INSULIN

• Insulin acts via an insulin receptor
• Diabetes occurs through two mechanisms
• 1 Loss of insulin
• 2 Loss of insulin receptors

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Diabetes in Young Adults (15-30 years)
Type 2
Type 1
5 10 15 20 25 30 35 40 45
50 55 60 65 70 75 80 85 90
Age of diagnosis
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unusual genetic type of diabetes called
maturity onset diabetes of the young 6
different genes causing this type of
diabetes. genetically defined subtype present
different clinical course. one subtype
responds to sulphonylureas patients replace
insulin treatment sometimes after being on
insulin for over 30 years, finding the genetic
cause of their diabetes has had a major impact on
their treatment.
Genetic Nurses in Diabetes treatment
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Type 1 Diabetes Insulin dependent

• Type 1- Diabetes (5-10)
• Loss of insulin destruction of pancreatic ?
  cells
• Early onset
• Weight loss, fatigue, polydypsia, polyuria,
  glucosuria, hyperglycaemia
• Ketosis (sweet breath due to acetone)
• Treat with injections of insulin

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Glucose tolerance test

• A large bolus dose of glucose administered (100g
  glucose drink)
• Blood glucose monitored
• Rapid fall after peak (9-10mM) levels reached
• If diabetes clearance is very slow in urine,
  peak blood glucose level higher

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Type 2 Diabetes Insulin Independent

• 90-95 cases of diabetes
• Late onset (after 40yrs age)
• 3-7 population affected
• 60 SUMO wrestlers c.f. 5 Japanese population
• Mainly occurs in overweight individuals

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Insulin Resistance
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Symptoms

• Insulin resistance
• Normal or elevated blood insulin levels
• Failure of insulin to act on target tissues
• Deficiency in insulin receptors
• Can lead to ? cell function becoming compromised
  due to excessive insulin production
• Hyperglycaemia, polydypsia, polyuria, glucosuria

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Progression

• Elevated blood glucose associated with diabetes
  damages blood vessels and nerves
• Small blood vessel damage causes blindness,
  kidney failure amputation
• Larger blood vessel damage can cause heart
  disease, high blood pressure stroke
• 75 of Type 2 patients die of cardiovascular
  disease

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Exercise NIDDM

• Insulin sensitivity in fit individuals is greater
• i.e. cells better able to uptake glucose from
  blood
• Insulin sensitivity decreases with age
• This decrease reduced by exercise
• 5-7 days after exercise insulin sensitivity
  starts to decline
• Regular, moderate, aerobic exercise is important
  in preventing onset of NIDDM
• Diseases control in 80-90 patients achieved by
  reducing calorie intake/ exercise
• Glasgow Research

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Osteoporosis

• Osteoprosis long term progressive increase in
  bone porosity/ brittleness
• Risk of fractures (shatter)
• Loss of height
• Curvature of spine
• Back pain
• Post menopausal women
• 20-50 over 50s
• 75 over 90s

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Bone growth

• Childhood and early adolescence bones extend
• Late adolescence bones increase in density
• Peak bone density in late twenties/early thirties
• 1/yr (female) decline in density thereafter
• 2-3/yr decline post menopausal
• Male bone density declines 0.4/ yr and only when
  over age 50
• Extra calcium/ Vitamin D in childhood teens
  produce greater bone density
• Margaret Thatcher cause of osteoporosis in
  2010-2020?

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Risk Factors

• Elderly
• Early menopause
• Amenorrhoea
• Genetics
• Low body fat
• Low calcium in diet
• Vit. D deficiency
• High alcohol/ caffeine/ fizzy drinks
• High salt

• Age related reduction in bone density
• Oestrogen promotes calcium uptake
• Low oestrogen
• Enzymes in fat produce oestrogen from circulating
  precursors
• Body raids calcium stores in bones
• Poor calcium absorption
• Promote bone loss by using calcium stores to
  balance pH
• Calcium removed along with Na in the urine

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Exercise Osteoporosis Prevention

• Mechanical stress increases bone strength
  (density)
• Astronauts have lowered bone density following
  zero gravity because no mechanical stress
• Weight bearing or resistance exercise will
  benefit women in late twenties/ early thirties
  (swimming will not!)
• Also benefits coordination reducing risk of falls

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Exercise Osteoporosis Treatment

• 45 min moderate exercise 3 times weekly increases
  calcium deposition in osteoporosis patients
• In conjunction with HRT

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Risk of Exercise in Women

• Excessive exercise particularly in young women
  can cause osteoporosis
• Reduction in body fat leads to reduction in
  oestrogen synthesis
• Menstruation ceases
• Oestrogen falls further, reducing calcium
  absorption
• Bone loss is irreversible

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Advice from Osteoporosis Soc.

• It's a good idea to avoid
• Too much protein
• Excessive protein upsets acid balance.
• Calcium from bones neutralises it.
• Eating plenty fruit and veg should keep your
  body's acid balance stable.
• Lots of salt
• high sodium increases calcium lost in urine.
• Drinking lots of fizzy drinks
• phosphoric acid gives flavour to a lot of fizzy
  drinks
• too much can cause the body to use calcium to
  balance levels.
• Drinking too much caffeine
• high caffeine intake affects the balance of
  calcium in the body.
• Milk in coffee will counteract this, limit intake
  to one or two cups a day.
• Letting your weight drop too low
• Being underweight increases the risk of broken
  bones when you fall.
• In younger women, severe weight loss may stop
  menstrual periods because hormone levels drop
  which can also increase your risk of breaking a
  bone