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Lecture 16

HLSC 2110U Lecture Notes - Lecture 16: Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Beta Cell

Course Code
HLSC 2110U
Fawwaz Shakir Al-Joudi

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- Heterogeneous group of syndromes
- Elevation of fasting blood sugar caused by relative or absolute insulin deficiency
Significance of DM
- Leading cause of adult blindness, amputations, kidney failure, heart attack, stroke
Two Types
- Type 1 Insulin Dependent DM
- Type 2 Non-Insulin Dependent DM
- 100000 new cases of Type 1 Diabetes and 700000 new cases of Type 2 Diabetes occur in North
America every year
Increasing Incidence
- Incidence and prevalence of Type 2 is on the increase
- Possibly due to the growing aging population and increasing prevalence of obesity and
sedentary lifestyles
- Rise in Type 2 Diabetes is children as well
Type 1
- Autoimmune attack on beta cells of pancreas
- Islets of Langerhans become infiltrated with active T cells which leads to insulitis
- Over years, the autoimmune attack leads to the depletion of beta cells
- Symptoms appear suddenly when 80-90% of beta cells are gone
- Pancreas fails to respond to glucose
- Insulin therapy is required
- Beta cell destruction requires stimulus from the environment (ex. virus) and a genetic
determinant that allows beta cells to be seen as foreign
- With identical twins, if one twin has it then the other has a 30-50% chance of developing it as
- Genetics is stronger in type 2, if an identical twin has the disease then the other will too
- Abrupt appearance of polyuria, polydipsia, polyphagia, often triggered by stress or illness

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- Symptoms come with fatigue, weight loss, and weakness
Lab Diagnosis
- Made in a clinical chem lab by measuring fasting blood glucose elevated fasting blood glucose
and ketoacidosis confirms it
- If diagnosis is uncertain, testing for circulation islet-cell antibodies is recommended
- Oral glucose tolerance test has fallen in popularity because it takes a lot of time and the results
are highly variable
Metabolic Changes
- Due to deficiency of insulin
- Greatly affects metabolism in 3 tissues
- Liver
- Muscle
- Fat
Hyperglycemia and Ketoacidosis
- High blood sugar and ketone bodies are the signs of untreated type 1 DM
- High blood sugar results from increased liver production of glucose with decreased peripheral
- Ketosis results from an increase in the movement of fatty acids from fat and an increase in liver
fatty acid beta-oxidation and synthesis of 3-hydroxybutyrate and acetoacetate
- Metabolic acidosis
- Occurs in 25%-40% of people who are newly diagnosed with type 1 DM
- May reoccur if the patient becomes ill or does not comply with therapy
- Treated by replacing fluids with electrolytes, followed by administration of low-dose insulin to
correct high blood sugar without causing low blood sugar
- Not all of the fatty acids that flood the liver can be disposed of through oxidation or ketone
body synthesis
- Excess fatty acids are converted to triacylglycerol which is packaged and secreted in VLDL
- Chylomicrons are synthesized from dietary lipids in the intestinal mucosal cells after a meal
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