2. DIABETES MELLITUS

3. It is a syndrome of impaired carbohydrate, protein and fat metabolism caused by either lack of insulin secretion or decreased sensitivity of tissues to insulin.

4. TYPES Type 1 diabetes mellitus or insulin dependant diabetes mellitus.
Type 2 diabetes mellitus or non insulin dependant diabetes mellitus.

5. α- and β-cells in the islets of Langerhans of the pancreas

6. ENDOCRINE CELLS ALPHA or A Cells BETA or B Cells DELTA or D Cells
F Cells

7. Factors Affecting Insulin Secretion
Stimulators
Inhibitors
Glucose
Somatostatin
Mannose
2-Deoxyglucose
Intestinal hormones [GIP, GLP-1 (7-36), gastrin, secretin, CCK; others?]
α-Adrenergic stimulators [nor-epinephrine, epinephrine]
β-Keto acids
Acetylcholine
β-Adrenergic blockers [propranolol]
Cyclic AMP and various cAMP-generating substances
Diazoxide
Thiazide diuretics
β-Adrenergic stimulators
K+ depletion
Theophylline
Phenytoin
Sulfonylureas
Alloxan

9. Fasting [mg/dl] Blood Glucose 2 hrs after B/F [mg/dl] Blood Glucose
Normal
< 100
< 120
Borderline
< 130
< 150
Diabetic
> 130
> 150

10. ACTIONS OF INSULIN CHO Metabolism Fat Metabolism Protein Metabolism
Cell Growth

11. Principal Actions of Insulin
Rapid [seconds]
Increased transport of glucose, amino acids, and K+ into insulin-sensitive cells

12. Principal Actions of Insulin
Intermediate [minutes]
Stimulation of protein synthesis
Inhibition of protein degradation
Activation of glycolytic enzymes and glycogen synthase
Inhibition of phosphorylase and gluconeogenic enzymes

13. Principal Actions of Insulin
Delayed [hours]
Increase in mRNAs for lipogenic and other enzymes

17. ADIPOKINES Agent Effect on Insulin Resistance Leptin Decreases TNFα
Increases
Adiponectin
Resistin

18. Plasma Glucose Levels at Which Various Effects of Hypoglycemia Appear

19. Regulation of secretion of glucagon and insulin

20. Factors Affecting Glucagon Secretion
Stimulators
Inhibitors
Amino acids [particularly the glucogenic amino acids: alanine, serine, glycine, cysteine, and threonine]
Glucose
CCK, gastrin
Somatostatin
Cortisol
Secretin
Exercise
FFA
Infections
Ketones
Other stresses
Insulin
β-Adrenergic stimulators
Phenytoin
Theophylline
α-Adrenergic stimulators
Acetylcholine
GABA

22. PHYSIOLOGY OF DIAGNOSIS
Urinary glucose
Fasting blood glucose and insulin levels
Glucose tolerance test
Acetone breath

23. TREATMENT OF DIABETES Dieting Exercise Weight loss
Drugs to cause increased insulin sensitivity
Drugs to cause increased insulin secretion
Administration of insulin