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Glucose Homeostasis
Balance between 2 sets of factors
Addition in Blood
Absorption from intestine
Hepatic Glycogenolysis
Gluconeogenesis in Liver
Glucose obtained from other
CHO
Synthesis of Glycoprotein,
Glycolipid, Lactose, Ribose,
Fructose
Synthesis of Non-Essential a.a.
Fate of Glucose and its Utilization
Oxidation
HMP-Shunt Pathway
Ribose, Deoxyribose
Fructose
Galactose
Too High
Release Insulin
Glucose filtered into Kidney
(excretion in the urine)
Liver (3 things)
Gluconeogenesis
Glycogen Synthesis
Ketone Bodies
Diabetes Mellitus
Definition
Metabolic disorder of Multiple Etiology
Characterized by
Chronic Hyperglycaemia
Disturbances of Carbohydrate, Fat, Protein Metabolism
Results from
Defects in Insulin Secretion
Defects in Insulin Action
Classification
Type 1 (T1DM)
Type 2 (T2DM)
Gestational Diabetes (GDM) CHO intolerance,
Hyperglycaemia, Pregnancy
Type 1 (T1DM)
Type 2 (T2DM)
cell destruction
Insulin Resistance
Leading to Absolute Insulin
(predominantly)
Deficiency
Relative Insulin Deficiency
Autoimmune
Secretory Defect
Idiopathic
(with/ without Insulin
Resistance)
Genetic defects of -cell
function
Genetic defects in Insulin
Action
Disease of Exocrine Pancreas
Endocrinopathies
Drug, Chemical Induced
Infection
5 10% of Diabetic Population
Older onset (40 y/o)
Juvenile Onset Diabetes
Majority (90% of Diabetics)
No pancreatic reserve of
Some Residual Pancreatic
Insulin
function
(must receive Insulin Therapy)
Prone to develop Ketosis
Wide fluctuation in blood
Obese, Sedentary Lifestyle
glucose
Prone to Toxic Ketones in
Blood
Diabetes Mellitus
mmol/L
< 11.1
mmol/L
> 11.1
mmol/L
< 7.8
mmol/L
7.8 11.0
mmol/L
> 11.1
mmol/L
Insulin Secretion
ATP:ADP ratio
ATP-gated K+ channels are closed
K+ (+ve charged) are prevented from leaving -cell
+ve charge
Cause -cell Depolarization
Intracellular [Ca]
Trigger Secretion of Insulin (via exocytosis)
Stimulates PFK
(via production of F2, 6, BP)
Glycogen (Glycogenolysis)
Protein (Gluconeogenesis)
Generation of Fatty Acids (via -oxidation)
Hormones
Glucagon
Cortisol
Growth Hormone
Retinopathy
Nephropathy
Neuropathy
Sexual Dysfunction
Risk
o
Cardiovascular Disease
o
Peripheral Vascular Disease
o
Cerebrovascular Disease
Biochemistry of Diabetes Mellitus
Hyperglycaemia
Hepatic Glucose Production
Gluconeogenesis, Glycogenolysis
TG
TG Breakdown in Liver
FFA
Results in Hyperkalemia
When Insulin Administered
Insulin Deficiency