Pregnancy and diabetes – how to control blood sugar while, Oprah is a registered trademark of harpo, inc.
Blood sugar – wikipedia, the free encyclopedia, The blood sugar concentration or blood glucose level is the amount of glucose (sugar) present in the blood of a human or animal. During muscular contraction the bloodflow is blocked, and the O2 tissue tension falls drastically.
Ophtalmoscopy for hypertonic changes of the retina also provides the diagnosis hypertension.
In some cases of hypertension there is a clear relation to the renin-angiotensin-aldosterone cascade (Chapter 24).
Some of the material on this page comes from the University of Kansas Medical Centre, with the kind permission of Prof George Helmcamp. Glucose is the single most important source of energy for almost all tissues being utilised for both glycolysis and the tricarboxylic acid (TCA) cycle. Following its absorption from the gut into the bloodstream any glucose that is not immediately required for energy production is transformed and stored either as glycogen or triglyceride via insulin-mediated processes. After a carbohydrate meal, the favoured metabolic pathways are glycogenesis and lipogenesis, leading to a increase in the storage of energy as glycogen and triglycerides.
During fasting, when exogenous glucose is unavailable, endogenous adipose tissue triglyceride is reconverted to free fatty acids (FFA) and glycerol by lipolysis. The ketone bodies are formed by a process known as ketogenesis and they become important sources of fuel and energy for peripheral tissues, including brain, heart and skeletal muscle.
Insulin is a hormone of the fed state and it is released in response to rising blood glucose. The intracellular second messages stimulated by insulin binding to its receptor cause multiple anabolic effects while slowing degradative or catabolic metabolism.
In diabetes, where insulin is deficient or where the cells are unresponsive to insulin, the uptake of glucose into muscle, liver and adipose tissue is significantly reduced, and, despite abundant glucose in the blood, the cells are metabolically starved. Insulin is a polypeptide hormone comprising two chains held together by two disulphide bridges. The precursor of insulin, preproinsulin, is synthesised by the ribosomes of the rough endoplasmic reticulum of the pancreatic b-cells. At the plasma membrane of the b-cells, insulin and C-peptide are released into the portal circulation in equimolar amounts.
The two conditions considered to demonstrate disordered glucose metabolism are hypoglycaemia and hyperglycaemia. The basic defect in diabetes mellitus is insulin deficiency (absolute or relative) which affects glucose, lipid, protein, potassium and phosphate metabolism. The main acute complications of diabetes are: Ketoacidosis Hyperosmolar non-ketotic coma Lactic acidosis Hypoglycaemia Ketoacidosis is due to the presence of large quantities of ketone bodies in the blood. The primary physiological role of insulin is the regulation of glucose levels in the circulation.
Site adapted by Bronwyn Carlisle from a design by Jason Tagg, driven by a custom FileMaker Pro solution. Myoglobin is important as a dynamic O2 store in muscle cells, although myoglobin is not totally saturated with O2. In the fasting state the plasma glucose level is maintained by glycogenolysis (glycogen breakdown) and gluconeogenesis (synthesis of glucose from non-sugar sources).


Where the effect is indicated in parentheses it is either indirect or dependent on other factors.
Both are transported to the liver where glycerol enters the gluconeogenic pathway at the triose phosphate stage. Although the brain normally uses glucose as its source of metabolic fuel it is capable of using ketone bodies as its major source of energy during periods of starvation. Insulin stimulates the uptake of glucose into cells, the synthesis of glycogen and lipogenesis, and several additional anabolic processes. Insulin both an anabolic hormone and growth factor which affects carbohydrate, lipid and protein metabolism. Preproinsulin comprises a single polypeptide chain of about 100 amino acids but it is not detectable in the circulation under normal conditions because it is rapidly converted by cleaving enzymes to proinsulin, an 84-amino acid polypeptide.Proinsulin is stored in the secretory granules of the Golgi complex of the b-cells, where proteolytic cleavage to insulin occurs. C-peptide has no known biological activity but appears necessary to ensure the correct structure of insulin. The principal manifestation is hyperglycaemia due to increased hepatic production of glucose and decreased peripheral glucose utilisation. The acidosis causes the patient to hyperventilate and may ld to loss of consciousness (ketoacidotic coma).Hyperosmolar non-ketotic coma usually occurs in the elderly and in patients with NIDDM.
This involves complex molecular mechanisms that control both glucose uptake and glucose metabolism. However, the brain is unusual in that it can only utilise glucose and ketone bodies (acetoacetate and b-hydroxybutyrate). The main regulators of these processes and, ultimately, of the plasma glucose level are four hormones - insulin, glucagon, adrenalin and cortisol.There are a number of metabolic processes involved in the maintenance of blood glucose levels, and their interplay can be complex, depending greatly on the hormonal state. In the fasting state, glycolysis and lipolysis are favoured, making use of the stored fuels to provide energy for the tissues. Glucose formed from glycerol in this way can be released into the bloodstream at a time when the plasma glucose concentration would otherwise tend to fall. Just as hormones regulate other pathways involved in glucose homeostasis, they also influence ketogenesis both directly and indirectly. Glucagon, on the other hand, is a hormone of the fasted state and stimulaste the breakdown of glycogen, while inhibiting several anabolic pathways.
In type I diabetes, increased gluconeogenesis consumes most of the available oxaloacetate, but breakdown of fat and, to a lesser extent, protein produces large amounts of acetyl-CoA. The shorter chain also has an internal disulphide bridge.Insulin is synthesised in the b-cells of the pancreatic Islets of Langerhans and is released from there into the bloodstream. After its release the insulin is transported in the blood to specific receptor sites in insulin-sensitive tissues such as muscle, adipose tissue and liver.
Glucose uptake into cells is controlled by proteins called glucose transporters that are present on the surface of all cells. Hence, the maintenance of an adequate plasma glucose concentration is especially important for the functioning of the central nervous system.Under normal circumstances the blood glucose level is maintained within a narrow range.
Most tissues other than the brain use FFA as an energy source by converting them to acetyl CoA which can enter the tricarboxylic acid cycle.However, when the rate of lipolysis is high, the liver receives more fatty acids than are needed to maintain its own activity.
In normal ketogenesis the transfer of acetyl-CoA into the mitochondria is controlled by the enzyme carnitine acyl transferase (CAT). This increased acetyl CoA would normally be directed into the tricarboxylic acid cycle but, with oxaloacetate in short supply, it is used instead for production of unusually large amounts of ketone bodies.


These are taken up by the liver and converted to ketone bodies and triglycerides which are released in the form of very low density lipoproteins.Severe untreated diabetes involves a pattern of metabolic fuel supply and consumption that is quite different from what occurs in healthy people or in controlled diabetics.
Several types of glucose transporters exist, but only one of these (GLUT4) is acutely regulated by insulin and is important in supplying glucose to skeletal and heart muscle and adipose tissue.
However, under some circumstances it may fall outside that range and remain consistently low or high.
They are:Glycolysisthe oxidation of glucose to pyruvate via glucose-6-phosphate with the formation of ATP. In this situation, the liver converts the excess acetyl-CoA into three other important metabolites which together are known as the ketone bodies. Acetone can often be detected on the breath of Type I diabetics, an indication of high plasma levels of ketone bodies.In uncontrolled severe diabetes, particularly insulin-dependent diabetes mellitus (IDDM), there can be excessive formation of ketone bodies leading particular form of metabolic acidosis known as ketoacidosis.
When glucose and insulin levels are low, the GLUT4 protein resides inside the cell in a specialized compartment and very little is present on the cell surface. Pyruvate is further metabolised by conversion to acetyl-CoA and entry into the TCA cycle with the production of more ATP.
The figures are for a 24 hour period under basal conditions, assuming a total energy output of 2400 kcal ( 10.0 MJoules). However, when glucose levels are elevated (for example, after a meal) and insulin is secreted from the pancreas, insulin stimulates the movement of GLUT4 transporters from their intracellular compartment to the cell surface, resulting in an increase in glucose uptake into these cells.
It should be noted that there is a heavy drain on muscle proteins for gluconeogenesis and that fatty acids and ketone bodies are used as the principal energy source for all tissues except the brain and blood cells. The mechanisms by which insulin regulates this trafficking of GLUT4 are poorly understood.Dr. It should also be noted that a large fraction of the glucose formed from muscle proteins is lost in the urine together with up to one-third of the ketone bodies formed from fatty acids in the liver. This develops when the activity of the tricarboxylic acid cycle decreases with a consequent fall in ATP production. Elevation of fasting plasma glucose levels over 7.8mM on more than one occasion is diagnostic of diabetes mellitus.
Muscle tissues do not contain this enzyme and therefore cannot produce glucose from endogenous glycogen stores.Gluconeogenesisformation of glucose from amino acids, lactate and triglyceride-derived glycerol.
By applying contemporary molecular and cell biological approaches to address these questions in cultured adipose cells, Dr. As a result, insulin levels are raised inappropriately when glucose levels are already low.As well as the acute complications described above there are additional chronic or long-term complications.
Cheatham and colleagues have been successful in identifying some of the proteins important in both of these processes. Indeed, it it were not for these long-term complications, controlled diabetes would not impose a great threat to the quality and longevity of life.




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