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Inability of the body to use glucose for energy due to inadequate amounts of or loss of sensitivity to the hormone insulin.
Diabetes mellitus is one of the most common chronic diseases occurring in the US, affecting more than 1 in 20 people. Normally, insulin is produced by the pancreas and enables the body’s cells to absorb the sugar glucose (their main energy source) from the bloodstream. There are two main forms of diabetes mellitus, designated as type 1 diabetes and type II diabetes. TYPE I DIABETES This form of diabetes occurs when the pancreas produces far too little insulin or produces none at all.
Type 1 diabetes is usually caused by an abnormal bodily reaction, in which the immune system destroys insulin- secreting cells in the pancreas.
The causes of type II diabetes are less well understood, but genetics and obesity are important factors. Diabetes can also be caused by corticosteroid drugs or excess levels of natural corticosteroid hormones, which oppose the action of insulin. Although some of the symptoms of both forms of diabetes mellitus are similar, type I diabetes tends to develop more quickly and become more severe.
The development of these symptoms is a medical emergency because they can lead to severe dehydration and coma if not treated urgently.
SHORT-TERM COMPLICATIONS Poorly controlled or untreated type I diabetes may lead to ketoacidosis, the symptoms of which are described at left.
One very common complication of insulin treatment for either type of diabetes is hypoglycemia, a disorder in which the blood sugar falls to abnormally low levels. LONG-TERM complications Certain long-standing problems pose the main health threat to people with diabetes and eventually affect even people with well-controlled diabetes.
Other long-term complications result from damage to small blood vessels throughout the body.
Damage to small blood vessels in the kidneys may lead to chronic kidney failure or end-stage kidney failure, which requires lifelong dialysis or a kidney transplant.
Your doctor will first ask you to provide a urine sample, which will be tested for glucose.
For anyone with diabetes mellitus, the aim of treatment is maintain the level of glucose in the blood within the normal range without marked fluctuations. TYPE 1 DIABETES This form of diabetes mellitus is nearly always treated with insulin injections. The only way to cure type I diabetes is by a pancreas transplant, but this surgery is not routinely offered because the body may reject the new organ and because lifelong treatment with immunosuppressant drugs is needed afterward.
TYPE II DIABETES Many people with this form of diabetes can control their blood glucose levels by exercising regularly and following a healthy diet to maintain ideal weight. You should follow general guidelines for a healthy diet and seek the guidance of a dietitian if necessary. When diet is not sufficient to control your blood sugar, one or more medications maybe prescribed. Since 2000, genetic association studies have provided incontrovertible levels of statistical evidence that many loci contribute to the development of type 2 diabetes. Diabetes treatment is complicated by the vast number of treatment options available and, possibly even more, by the varied inter-patient responses to each treatment option.
Race and ethnicity have long been recognized as a significant risk factor for type 2 diabetes and related complications.
Now let's consider the example of incretinic therapy as an instrument in choosing personalized T2DM treatment.
Some guide line suggests to use this therapy as a second or third line medication , after the failure of metphormine, or the association metphormine+ sulphonyluree , others to use it in some selected patients that need to control ponderal augmentation or ipoglycemical events.This because the high cost of the therapy would be absorbed, and considered economically convenient by the sanitary sistem or by the patient's own wallet only if the reduction of patient's weight, comorbidity, secondary effects to be cured and cronic disease development prevented, was granted. Eventually incretins , due to the features of easy calibration on patient’s age, weight, medication response, socio-economical characteristics, will find a place in the individualisation of treatment of T2DM.Infact considering the first type of developed incretin, the GLP-1 analogs, we can see that the appetite reduction, that can avoid the clear bynomius diabetes-obesity without imposing a strict diet regimen, is a great instrument in treating great-obese and compulsive eaters T2DM patients.
This glucose is transported around the body in the bloodstream to the various bodily tissues to be used as energy. When our bodies detect a rise in blood glucose, it responds by getting the beta cells of the pancreas to release insulin. Insulin levels influence the creation and storage of carbohydrate, fat and protein in the body.
At certain times though, these nutrients may not be needed immediately and so we may end up storing them. When insulin acts on fat cells, it allows them to take in glucose in much the same way as it does with muscle cells. Insulin also does a similar job taking fatty acids that are circulating in the bloodstream and storing them within fat cells (i.e. Poor nutrition, a toxic environment and bad lifestyle choices can cause a breakdown in how we respond to insulin. Our cells respond to the presence of insulin because they have something called an insulin receptor on their surface. When things are ‘normal’ and the insulin receptors react with insulin as they should, we are said to be insulin sensitive.
If there is a breakdown in communication between the receptors and insulin itself then we are insulin resistant. This state of insulin resistance means that the cell won’t recognise the presence of insulin and so the usual actions that insulin triggers are not carried out. In response to the still high blood glucose levels, the pancreas is told to release more insulin in order to clear it. There are many potential causes of insulin resistance and still great debate over which are the main players.
In my opinion, this is where the conventional advice to eat small meals based around low-glycaemic carbohydrates throughout the day in order to keep blood sugar and insulin production ‘stable’ is counter-productive, especially to those trying to lose body fat.
Insulin turns on anabolic processes like glycogen and fat storage and turns off catabolic processes such as releasing fat from fat cells. By extension, the larger and more consistent the insulin production, the more likely we are to be in an energy storing mode. As insulin is an anti-catabolic hormone, elevated insulin will help prevent muscle breakdown. A spike in insulin also means that the elevation above normal will drop off quicker than would a steadier rise (and therefore fall) in insulin. If we then develop some resistance to the effects of insulin then it can no longer efficiently carry out it’s function.


Presentation on theme: "Endocrine Pancreas Adipose hormores Diabetes mellitus and hypoglycemia ??.
Glucose transporters Active transport Facillitated transport Insulin sensitive Insulin insensitive Most tissues eg. Adiponectin Energy metabolism Adiponectin level inversely correlate with adipose tissue percentage Impair adipocyte differentiation Increase energy expenditure Increase fatty acid ebeta- oxidation and reduce fat mass Inhibit hepatic gluconeogenesis Anti-inflammatory response Inversely correlate with inflammatory cytokines Suppress DM, obesity, atherosclerosis. Central resistin nullifies central leptin action, induces hyperinsulinemia, and prevents obesity. The condition may also occur when someone without diabetes takes a medicine used to treat diabetes.
In this disorder, either the pancreas produces insufficient amounts of the hormone insulin or body cells become resistant to the hormone’s effects. In diabetes mellitus, the cells have to use other sources of energy, which may lead to a buildup of toxic by-products in the body. Among people treated for diabetes mellitus, 1 in 10 depends on self-administered injections of insulin for life. In this condition, the pancreas continues to secrete insulin, but cells in the body become resistant to its effects. This condition is called gestational diabetes and is usually treated with insulin to maintain the health of the mother and baby.
The child of a person who has type I diabetes is at greater risk of developing the same type of diabetes. The symptoms of type II may not be obvious or may go unnoticed until a routine medical checkup. In some people, the first sign of the disorder is ketoacidosis, a condition in which toxic chemicals called ketones build up in the blood.
Emergency treatment for ketoacidosis includes intravenous infusion of fluids to correct dehydration and restore the chemical balance in the blood and insulin injections to enable cells to absorb glucose from the blood. Short-term problems are usually easy to remedy, but long-term complications are hard to control and can lead to premature death.
Close control of the blood sugar level reduces the risk of developing these problems, and early recognition of complications helps in their control.
Large blood vessels may be damaged by atherosclerosis, which is a major cause of coronary artery disease and stroke.
Damage to blood vessels in the light-sensitive retina at the back of the eye may cause diabetic retinopathy. There may be a gradual loss of sensation, starting at the hands and feet and sometimes gradually extending up the limbs.
This aim may be achieved with dietary measures, a combination of diet and insulin injections, or diet and pills that lower blood glucose levels.
However, some people are given a pancreas transplant at the same time as a kidney transplant.
Try to keep fat intake low, and obtain energy from complex carbohydrates (such as bread and rice) to minimize fluctuations in the blood glucose level. If the glucose level is higher or lower than recommended, you may need to alter your diet or adjust your insulin or drug dose with the help of your doctor. You will probably begin with oral drugs, such as sulfonyl ureas, which stimulate the pancreas to release insulin, or metformin, which helps body tissues absorb glucose.
However, advances in monitoring blood glucose levels, combined with a healthy lifestyle, have made I diabetes easier to control, allowing people to lead a more normal life. Treatment response heterogeneity is seen in patients with various characteristics including varied metabolic capabilities, diverse socioeconomic and environmental issues, and varying degrees of illness severity.
Minorities tend to have much higher rates of diabetes-related complications and death, in some instances as much as 50% more than the total population. The medication consists in the administration of subcutaneous infusion of GLP-1 (glucagon-like peptide 1) or gliptins (DPP-4 inhibitors). Still this medication requires a daily subcutaneous infusion, that can inficiate patient life quality like insulin in insulin dependent Diabetes 1, and may be disadvantaging even for elder patients.
It is involved in allowing these nutrients to be taken into cells and used for many different things.
For example, if glucose is not required for energy immediately, it can be converted into glycogen and stored in the liver or muscle tissue. Once in the fat cell, glucose can be converted into fatty acids and subsequently stored as body fat. It should be clear that it is very important that we produce insulin in certain situations in order to control blood sugar, build and repair muscle, and provide our various cells with nutrition. We know that insulin is released into our bloodstream in response to a rise in blood glucose.
Eat some food, break it down into glucose, transport it around the body in the blood and then move it from the blood into muscle and fat cells where we can either use it for energy or store it for use at another time. This vicious circle of events continues leading to glucose and insulin levels in the blood being chronically high. Obesity, nutrient overload in the mitochondria, excessive refined carbohydrate consumption, fructose consumption, leptin resistance, and inactivity have all been linked with insulin resistance.
Then after a meal have just enough insulin released to allow us to get certain nutrients into our cells for energy or storage. Although this advice prevents big ‘spikes’ in blood glucose and therefore insulin, it still results in constant low-level insulin production. When insulin is elevated our bodies are not in a hormonal state that is particularly helpful for fat loss. But with that in our minds, it is easy to fall into to the trap of then thinking the more elevated it is (i.e. This means it will return to normal relatively quickly and so we can still spend most of the day at baseline insulin levels.
Unused glucose accumulates in the blood and urine, causing symptoms such as excessive urination and thirst.
This form of diabetes mainly affects people over age 40 and is more common in overweight people. Gestational diabetes usually disappears after childbirth; however, women who have had it are at increased risk of developing type II diabetes in later life. In some cases, destruction of the insulin-secreting tissues occurs after inflammation of the pancreas.
These chemicals are produced when body tissues are unable to lake up glucose from the blood, due to inadequate production of insulin, and have to use fats for energy.


The disorder is more common in people with type I diabetes but may also affect people with type II diabetes who take sulfonylurea drugs.
Elevated levels of cholesterol in the blood, which accelerates the development of atherosclerosis, is more common in people with diabetes. Treatment is usually lifelong, and you will have to take responsibility for the daily adjustment of your diet and medication. Insulin is available in various forms, including short-acting, long-acting, and combinations of both forms.
A method is currently being devised to transplant insulin-secreting cells isolated from a normal pancreas, but this technique is still at an experimental stage.
Effective monitoring is especially important if you develop another illness, such as influenza, and in other situations, such as exercising or planning to eat a larger meal than usual.
You may also be given acarbose, which slows the absorption of glucose from the intestine and prevents fluctuations in the blood level. The transcription factor 7-like 2 (TCF7L2) has the strongest evidence demonstrating a genetic link to type 2 diabetes. In one study, Hispanics and African Americans were less likely to have A1C, glycated hemoglobin levels <7% (35-37%) compared to Caucasians (49%). Important things like supplying muscles with an energy source, repairing muscle tissue, and supplying cell membranes with necessary fatty acids are all reliant on the action of insulin. Thus a reason to re-think consuming lots of carbohydrate when our glycogen stores are already full as we may get some of this energy “spillover”. When insulin sticks to the receptor on the cell, this sends a message to the cell to start some process, for example to take glucose into the cell. The idea of ‘stable blood sugar’ is commonly discussed but it is perhaps efficient insulin production that should be the real goal.
In fact, I am of the belief it only a side effect of a bigger metabolic problem starting at the mitochondria but again that’s a topic for another day! This may even be more beneficial than experiencing smaller elevations in insulin, as these tend to stay above baseline for a longer period of time.
In such societies, food intake increases, leading to a rise in the number of overweight people and the prevalence of this condition. Ketoacidosis can also occur in people with type I diabetes who are taking insulin if they miss several doses or develop another illness (because any form of illness increases the body’s requirement for insulin). Diabetes is also associated with hypertension, another risk factor for cardiovascular disease.
People with diabetes mellitus should have their eyes examined yearly by an ophthalmologist. Loss of feeling, combined with poor circulation, makes the legs more susceptible to ulcers and gangrene. Your blood may also be tested for glycosylated hemoglobin, an altered form of the pigment in red blood cells, which increases in concentration when the blood glucose level has been high for several weeks or months. Treatment regimens need to be individually tailored and they may include combinations of insulin and oral drugs.
The proportions of protein, carbohydrate, and fat must be consistent to keep a balance between food intake and medication.
Many of these loci are currently being studied for their usefulness in diagnosis, prediction, prevention, and treatment.
Other studies have also shown increased insulin resistance and beta-cell dysfunction in Hispanics and African Americans. Great adventages are granted using this oral medication simply by its way of administration, and sometime ponderal control effect are comparable with GLP-1 analogs.
This is useful to us as we can breakdown this glycogen back into glucose at a later stage to be used for energy, say during a workout. However, now the insulin doesn’t trigger the insulin receptors as it should and the process of taking the glucose that is in the blood into the cells does not take place as it should.
So there is one key time when we can manipulate a large insulin spike to work FOR us, rather than against us. The doctor will review your diabetes treatment plan to help prevent future problems. Outlook (Prognosis) The outlook is good if the hypoglycemia is promptly detected and treated. However, in many cases, complications eventually develop, although their onset may be delayed by treatment.
Sometimes the condition maybe treated with dietary measures alone, but oral drugs and sometimes insulin injections may become necessary.
Your doctor will talk to you about your needs and arrange for you to learn how to inject yourself. However, results have not demonstrated a clear role in the clinical care of type 2 diabetes today, Although research is ongoing. Nonetheless during clinical trials GI secondary effects and cefalea have turned out followed by one of the most undesirable collateral effects of classical T2DM therapies: Ipoglycemia. Complications include problems with the eyes, kidneys, cardiovascular system, and nervous system. This study demonstrated that Hispanics and African Americans have different metabolic responses to insulin therapy than Caucasians, dependent upon insulin type and regimen intensity.
The differences in between GLP-1 and DPP4 inhibitors, regarding therapeutic and collateral effects both, lead us to considerate the two medications equally valuable in T2DM treating, inviting us to base our choice of incretinic medication on patient need and capability of tolerating the differents undesired effects.
Be sure to mention any medications you believe may be affecting the condition. Prevention For people with diabetes, strict control of blood sugar is important. Diabetes mellitus also weakens the immune system and thus increases susceptibility to infections such as cystitis.
If the diabetes is difficult to control, you may be given an insulin pump, which dispenses insulin through a catheter that is inserted into your skin.
These findings should thus be taken into consideration when clinicians are tailoring treatment plans to meet the individual needs of their patients. This makes of incretin the remarkable example of a therapy choice to be personalized on patient needs. These peculiarities of incretin therapy have positive effects on the patient's life-style and self confidence, on his metabolic compensation and longlasting glycemic control.
We can't consider easily and superficially both positive (less collateral effects, comparable glycemic effects) and negative (costs, GI disease still presenting) implications that follow the introduction of this new therapy; but in the ability to choose a specific medication depending on patient peculiarity stands the probability to improve his way of living the disease and tollerate the treatment.




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