2. content sugar glucose Sources Absorption Diabetes Metabolism OF Carbohydrate The control of blood sugar Insulin Diagnosis of Diabetes Sugar level in the blood Different types of diabetes Genetic Testing

3. sugar Glucose (Glc), a monosaccharide or simple sugar where The living cell uses it as a source of energy and metabolic intermediate. glucose Sources All major dietary carbohydrates contain glucose, either as their only building block, as in starch and glycogen.

4. Absorption

5. Diabetes is a condition that results when the pancreas produces little or no insulin, or when the cells of the body cannot use the insulin produced effectively.

6. Metabolism OF Carbohydrate

7. carbohydrate glycogen liver Sugar in the Blood Glycogen muscles Lactic Acid Sugar is stored as a fat oxidation Co 2 < H 2 o out

8. The control of blood sugar Hormones of the Pancreas

10. alphaalpha cells, which secrete glucagons beta cells, which secrete insulin deltadelta cells, which secrete somatostatin gamma cells, which secrete a polypeptide of unknown function

11. Insulin Insulin is a protein hormone which is secreted into the blood by the beta cells of the pancreatic islets when the blood sugar level is high

12. Insulin Functions take up glucose and convert it into glycogenglycogen

13. Insulin Functions Stimulate adipose toadipose take of glucose and the synthesis of fat.fat Stimulate liver cell to take up glucose from the blood and convert it into glycogen inhibiting production of the enzymes involved in breaking glycogen back down ("glycogenolysis")glycogenolysis inhibiting "gluconeogenesis"; that is, the conversion of fats and proteins into glucose.gluconeogenesis

14. HormonesFunctionStimulated by Result INSULIN Glucose up take Glycogen synthesis Glycogenolysis Gluconeogenesis High level of sugar Blood sugar GLUCAGON Glycogenolysis Gluconeogenesis Low level of sugar > 3mmol/l Blood sugar ADRENALIN Glycogenolysis Glucose up take GROWTH HORMONE Glucose up take

16. Diagnosis of Diabetes TestNormal Mg/dl (mmol/L) Diabetic Mg/dl (mmol/L) Urine Glucose (UGT) Renal threshold 180 (10) >180 (>10) Fasting plasma Glucose (FBGT) <100 (<6.4) >126 )>7.3) Random plasma Glucose (RPGT) <140 (<7.8) >200 (>11) Oral Glucose Tolerance75g (OGTT) <140 (<7.8) After 2 hrs >200 (>11) After 2 hrs

17. Sugar level in the blood Normal, Fasting Pre-Diabetes, Fasting Diabetes, fasting Below 100 mg/dl Between 100- 125 mg/dl Higher than 126 mg/dl

18. Different types of diabetes Type 1 diabetes is caused by destruction of the insulin-producingcells of the pancreas. Persons with type 1 diabetes must receive daily injections of insulin. Type 1 diabetes can be hereditary and lose weight

19. Type 2 diabetes is a disorder resulting from the body’s inability to produce insulin or use insulin properly. This type of diabetes usually affects persons who are more than 45 years of age, are overweight, and who do not exercise. Persons with type 2 diabetes may take medication they may require insulin injections.

20. Symptoms Polyuria. Polyphagia. fatiguePolydepsia. Blurred vision.

22. Complications of diabetes Blindness - A condition known as diabetic retinopathy is the leading cause of new cases of blindness in people between the ages of 20 and 74. Kidney disease - Diabetes is the leading cause of diabetic nephropathy, an end-stage renal disease. Persons with diabetes account for 40% of all new cases.

23. Nerve disease and amputations -About 60-70% of people with diabetes have mild to severe nerve damage. Persons with severe nerve damage often undergo lower limb amputations. Heart disease and stroke – Persons with diabetes are two to four times more likely to suffer a stroke or todevelop heart disease.

24. Childbirth - Women with diabetes have an increased risk of giving birth to a baby with congenital malformations if they do not receive preconception care having a large birth-weight baby.

25. Genetic factors

26. Some rare forms of diabetes result from mutations in a single gene and are called monogenic. Monogenic forms of diabetes account for about 1 to 5 percent of all cases of diabetes in young people. In most cases of monogenic diabetes, the gene mutation is inherited. Most mutations in monogenic diabetes reduce the body’s ability to produce insulin.

27. forms of monogenic diabetes. Neonatal diabetes mellitus (NDM) maturity-onset diabetes of the young (MODY )

28. Neonatal diabetes mellitus (NDM) NDM is a monogenic form of diabetes that occurs in the first 6 months of life. do not produce enough insulin, leading to an increase in blood glucose. NDM can be mistaken for the much more common type 1 diabetes, but type 1 diabetes usually occurs later than the first 6 months of life.

29. In about half of those with NDM, the condition is life long and is called permanent neonatal diabetes mellitus (PNDM). In the rest of those with NDM, the condition is disappears during infancy but can reappear later in life; this type of NDM is called transient neonatal diabetes mellitus (TNDM). Two types of Neonatal diabetes mellitus (NDM)

30. maturity-onset diabetes of the young (MODY) occurs during adolescence or early adulthood. MODY sometimes remains undiagnosed until later in life. A number of different gene mutations have been shown to cause MODY, all of which limit the ability of the pancreas to produce insulin This process leads to the high blood glucose levels characteristic of diabetes

31. People with MODY may have only mild or no symptoms of diabetes and their hyperglycemia may only be discovered during routine blood tests. both type 2 diabetes and MODY can run in families, people with MODY typically have a family history of diabetes in multiple successive generations

32. genetic testing and counseling Testing for monogenic diabetes involves providing a blood sample from which DNA is isolated. Abnormal results can determine the gene responsible for diabetes in a particular individual or show whether someone is likely to develop a monogenic form of diabetes in the future.

33. Most forms of monogenic diabetes are caused by dominant mutations meaning that the condition can be passed on to children when only one parent is affected. In contrast, if the mutation is a recessive mutation, a disease gene must be inherited from both parents for diabetes to occur.

36. Humulin is used by more than 4 million people with diabetes around the world every day. the CD3 antibody helped stimulate the patients’ natural insulin production and decreased their need for insulin drug therapy.

37. insulin pump An insulin pump can improve blood glucose control and quality of life with fewer hypoglycemic episodes than multiple injections. The pumps correct for the “dawn phenomenon” (sudden rise of blood glucose in the morning) and allow quick reductions for specific situations, such as exercise. Many different brands are available.

38. injection within 5 minutes after injection. Insulin peaks in about 4 hours and continues to work for about 4 hours. This rapid action reduces the risk for hypoglycemic events after eating (postprandial hypoglycemia). Optimal timing for administering this insulin is about 15 minutes before a meal, but it can be also taken immediately after a meal (but within 30 minutes). Fast-acting insulins may be especially useful for meals with high carbohydrates.

39. How can we produce insulin?