Unit 2

Diabetes Mellitus
The Medical Examiner
noted Anna was wearing a
Medical Alert Bracelet
labeling her as Diabetic
Diabetes is a life long
disease characterized by
High Blood Glucose
Levels (blood sugar)
Glucose is the molecule
that all carbohydrates are
broken into. Your body
uses Glucose for energy!

Historical Diabetes
Diabetes Mellitus is a Greek word that translates as
Diagnosis
sweet honey flow and stems from a time in which

tasting a patient's urine was still part of the physician's

diagnostic repertoire.
Diabetes washistorically diagnosed by a sweet urine
taste and is
caused by a build up of glucose sugar in the blood!
This extra glucose is urinated out of body!

What is Diabetes
Mellitus?
Glucose is the source of fuel for our
cells/body and comes from the food we
eat and digest.
Blood contains trace amounts of glucose
but in urine, its normally is too low to be
detected
Insulin is a type of protein called a
hormone.
Insulin is produced in the pancreas in
the area of the pancreas called the Islet
of Langerhans
Insulin functions to control glucose
levels in plasma opening the cells
channels to allow glucose to enter the
cells from the blood for energy

Diabetes is caused by
insufficient insulin or the

Glucose is the
Primary Source
C6H12O Energy for cells
6
Body gets glucose
from ingesting
Carbohydrates and
converting them to
Insulin is an
ATP (energy) in your
important
cells
Protein (hormone)
Regulates the
flow of glucose
from the blood
stream into the
body cells

Diabetes Statistics
National Institute of Heath (NIH)

According to the National Institute of Health (NIH),

Diabetes is one of the Top 3 health issues facing
Americans in 21st century.
NIH scientists estimates of the 320 million Americans,
24 million currently have diabetes and another 79
million are pre-diabetic

Every 24 hours in the USA complications from

diabetes lead to:
5082 new cases
238 amputations of feet or legs
120 new diagnoses kidney disease
48 cases of vision loss/blindness

Billions of dollars are spent each

Why Is Too Much Blood

Glucose Bad?
Normal Glucose level is 70-115 mg/dL
Anna Garcias Glucose level was 425 mg/dL
High Glucose levels leads to diabetes.
Symptoms & Effects on
Body
Frequent urination
Unusual thirst
Extreme hunger
Extreme fatigue
Irritability
Cuts/bruises slow to heal
Tingling/numbness in hands
or feet
Recurring skin or gum
infections

Type 1 Diabetes

Type 2 Diabetes

Complications of
Diabetes
Rapid shifts in Glucose have severe consequences

75% of diabetics will have heart disease, coronary artery disease,

arteriosclerosis (hardening of the arteries)
80% of diabetics will suffer serious vision loss eye damage
(retinopathy) if the disease is untreated over 10 years

Nerve damage (neuropathy)

Kidney damage (nephropathy)
Eye damage (retinopathy)
Osteoporosis (weak bones)
Alzheimer's disease (memory loss)
1/10 of U.S. health care dollars are spent to treat diabetes
(10%)

Symptoms Of Diabetes
In Feet
Excessive Blood Glucose

levels result in nerve

damage to feet or hands
(neuropathy)
Loss of sensation means
people are unable to feel
injury or pain.
Diabetes causes foot blood
vessels to constrict &
harden causing

Arteriolosclerosis
!!!
This results in reduced

Gangrene- Rotting
Tissue

Gangrene occurs when arteries harden

(arteriolosclerosis)
The tissue dies (necrosis) because the blood supply
is interrupted and oxygen is not transported to the
tissue by Red Blood Cells
High Glucose (blood sugar) levels damage blood
vessels, resulting in
poor blood supply to the area causing depletion of
food & oxygen!
Less blood means less nutrients and oxygen for the
tissue cells, and
fewer white blood cells & T-cells to fight infection from
injuries.

Gangrene Necrosis of Tissue

Gangrene: tissue smells like

rotting meat

Diabetes Foot & Hand

Amputation

Treatments For
Diabetes

Type 1 Diabetes
Treatments

Taking insulin
Carbohydrate counting
Frequent blood sugar
monitoring
Eating healthy foods
Exercising regularly
The goal is to keep your blood
sugar level as close to normal as
possible to delay or prevent
complications.
Insulin is the medication
prescribed for Type 1 Diabetes.
Since people with Type 1
Diabetes have defective Beta
cells in their pancreas, they dont

Type 2 Diabetes Treatments

Healthy eating
Regular exercise
Possibly, diabetes medication or
insulin therapy
Blood sugar monitoring
These steps will help keep blood
glucose level closer to normal, which
can delay or prevent complications.
Metformin is the first medication
prescribed for type 2 diabetes. It
works by improving the sensitivity of
insulin receptors on the bodys cells
so body uses insulin more effectively
.

History of Insulin
Prior to the discovery of insulin in 1922, people with diabetes had no
chance of living
Doctors, at that time, knew about insulin so they fed patients pancreas
from corpses
In 1922, Fredrick Banting extracted insulin from the pancreas of a dog
(brown mucky stuff)
Banting injected the insulin into a 14 year old boy dying from diabetes
(Leonard Thompson)
His glucose level was 525mg/dL and dropped to 120mg/dL (He died of
pneumonia at 27yrs)
Fredrick Banting won the Nobel Prize in 1923 for his discovery &
extraction of insulin
Commercial productionof insulin for treating diabetes in 1923
For many years, drug companies derived the hormone using pancreases
that came from stockyards, taken from slaughtered cows/ pigs. People
developed allergies to animal insulin
In 1978, a biotechnology company named Genetech produced the first
synthetically manufactured insulin that could be made in large amounts.
Using bacteria or yeast as miniature "factories," the gene forhuman
insulinwas inserted into bacterial DNA.

History of Insulin
Prior to 1922, doctors
fed patients pancreas
from corpses to treat
diabetes

Banting with
insulin dog
donors in 1922

Commercial
Production of Pig
& Cow Insulin
began in 1923. By
1970s people
were developing
allergic reactions
to animal insulin

Genetically
Modified Insulin
produced in
1978 by splicing
the insulin gene
into bacteria

Management & Treatment

Options
People with diabetes must
monitor their glucose levels
and may need to inject
insulin or wear an insulin
pump
Monitor Glucose Levels
Regularly
Insulin Injections or
computerized
pump that dispensed the
insulin
Oral Medications, diet &
exercise

Diagnosing Diabetes

When the doctor orders a diabetes test, a

Phlebotomist will draw blood from a vein
in your arm by a process called
venipuncture. Phlebotomist must make
sure the location of the puncture is sterile,
the blood tubes are labeled correctly and
the blood flow is stopped once the blood is
collect for testing.

A fasting plasma glucose test measures

your blood glucose level after you have
gone at least 8 hours without eating. This
test is used to detect diabetes.
An oral glucose tolerance test measures
your blood glucose level after you have
gone at least eight hours without eating
and two hours after you drink a glucose
solution. This test is used to diagnose
diabetes by determining the rate at which
your body uses glucose.

All communication in cells

How
Does Insulin Work?
depends on molecules traveling
from cell to cell
This chemical communication
involves protein molecules that carry
messages

(signal
molecule)
ligand

These proteins are Signal molecules

that carry messages to signal a chemical
reaction.
The Signal molecule binds to
Receptor Site on the second cell and a
chemical reaction occurs sending a
signal to the cell
Once a Signal molecule binds to a
Receptor Site, a chemical reaction
occur within to induce the cell to act on
message.
Insulin (Signal Molecule) carries
message to Insulin Receptor Site

Insulin Protein-Signal
Molecule
Insulin Receptors Accepts
Insulin
GLUT 4 -Receptor that comes
to the surface of the cell
membrane when signaled by
insulin receptor and allows
glucose to enter the cell to be
converted into energy for cell

Insulin Glucose Transport

System
Signal
Molec
ule

Type 1 & Type 2 Diabetes

Brain cells are the only cells in your body
that dont need insulin to allow glucose into
the cells to make ATP.
All others need Insulin (Signal Molecule)
to attach to the Insulin Receptor Site on
the cell membrane. This triggers a message
to be sent to the GLUT4 to surface to the cell
membrane. GLUT4 channels (4 of them)
open to allow glucose to enter the cell to be
metabolized to ATP by the mitochondria.
If the Pancreas Beta Cells dont produce
enough insulin the GLUT4 doesnt receive the
message indicating them to surface to the
cell membrane to allow glucose in cells Type
1 Diabetes
In Type 2 Diabetes, Insulin Receptors
Sites become resistant to insulin, so GLUT4
will not be signaled to surface to the cell
membrane and the glucose doesnt enter
cells; builds up in blood!

Insulin Resistance Type 2

Diabetes
The Pancreas has Beta cells
(2%) which sense glucose in
the blood and release the
necessary amount of insulin to
maintain normal blood glucose
levels.
In Type 2 Diabetes, the
pancreas Beta cells still make
the necessary Insulin.
However, the cells of the body
have become resistant to the
insulin as a signal molecule.
Therefore, the Glut 4
transporters are not activated
and Glucose does not enter
the cells. Glucose builds up in
the blood stream!