DIABETES MELLITUS

A Report on Physiology

Submitted to:

Claire Berbano, M.D.

Submitted by:

Pullan, Gizelle

Robles, Kristina

Salmorin, April

Tinio, Carla

DBC
DEFINITION

Diabetes mellitus

 is a disorder in which blood sugar (glucose) levels are abnormally high because the body
does not produce enough insulin to meet its needs.
 chronic metabolic disorder in which utilization of carbohydrate is impaired and that of
lipid and protein enhanced; it is caused by an absolute or relative deficiency of insulin
 chronic disease that causes serious health complications including renal (kidney) failure,
heart disease, stroke, and blindness.
 It is fasting blood glucose of 126 milligrams per deciliter (mg/dL) or more.

Insulin

 is a hormone produced in the pancreas that controls the amount of sugar in the blood.
When people eat or drink, food is broken down into simpler substances that the body
needs to function. Sugar is absorbed into the bloodstream and stimulates the pancreas to
produce insulin.
 Insulin allows sugar to move from the blood into the cells. Once inside the cells, it is
converted to energy, which is either used immediately or stored as fat or glycogen until it
is needed.

The levels of sugar in the blood vary normally throughout the day. They rise after a meal
and return to normal within about 2 hours after eating. Once the levels of sugar in the blood
return to normal, insulin production decreases. The variation in blood sugar levels is usually for
about 70 to 110 milligrams per deciliter (mg/dL) of blood. If people eat a large amount of
carbohydrates, the levels may increase more. People older than 65 years tend to have slightly
higher levels, especially after eating.

PREDIABETES

 is a condition in which blood sugar levels are too high to be considered normal but not
high enough to be labeled diabetes.
 People have prediabetes if their fasting blood sugar level is between 101 mg/dL and 126
mg/dL or if their blood sugar level, 2 hours after a glucose tolerance test, is between 140
mg/dL and 200 mg/dL.
 Identifying people with prediabetes is important because the condition carries a higher
risk for future diabetes as well as heart disease. Decreasing body weight by 5 to 10 %
through diet and exercise can significantly reduce the risk of developing future diabetes.
 People with pre-diabetes are at increased risk for developing type 2 diabetes, heart
disease and stroke, and have one of these conditions:

 impaired fasting glucose (100 to 125 mg/dL)

 impaired glucose tolerance (fasting glucose less than 126 mg/dL and a glucose level
between 140 and 199 mg/dL two hours after taking an oral glucose tolerance test)
EFFECTS

A diabetic person may have these following effects:

 Increased urination and thirst

 Loss of weight when they are not trying to.
 Damage to the nerves and blood vessels
 Have problems with sensation.
 Increases the risk of heart attack, stroke, and kidney failure.

There are two types of Diabetes: Type 1 and Type 2.

1. Type 1 diabetes or also called insulin-dependent diabetes or juvenile-onset diabetes

 usually occurs in children and young adults. More than 90% of the insulin-
producing cells of the pancreas are permanently destroyed.
 pancreas produces little or no insulin. And without daily injections of
insulin, people with type 1 diabetes won’t survive. Only about 10% of all
people with diabetes have type 1 disease.
 Most people who have type 1 diabetes develop the disease before 30 years
of age.

*Scientists believe that an environmental factor like a viral infection or a nutritional factor in
childhood or early adulthood causes the immune system to destroy the insulin-producing cells of
the pancreas.

2. Type 2 diabetes or formerly called non-insulin-dependent diabetes or adult-onset

diabetes
 is the most common form. In this condition, the pancreas continues to
produce insulin, sometimes even at higher-than-normal levels.
 appears most often in middle-aged adults. About 15% of people older than
70 have type 2 diabetes.
 People of certain racial and ethnic backgrounds are at increased risk of
developing type 2 diabetes: blacks, Native Americans, and Hispanics who
live in the United States have a twofold to threefold increased risk.
 also tends to run in families or genetic factor.
 develops when the body doesn’t make enough insulin and doesn’t
efficiently use the insulin it makes.

RISK FACTORS

Research has shown that some people who develop diabetes have common genetic
markers.
In Type I diabetes, the immune system, the body's defense system against infection, is
believed to be triggered by a virus or another microorganism that destroys cells in the pancreas
that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role.
 In Type II diabetes, the pancreas may produce enough insulin, however, cells have
become resistant to the insulin produced and it may not work as effectively. Symptoms of Type
II diabetes can begin so gradually that a person may not know that he or she has it. Early signs
are lethargy, extreme thirst, and frequent urination.
Other symptoms may include sudden weight loss, slow wound healing, urinary tract
infections, gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected
while a patient is seeing a doctor about another health concern that is actually being caused by
the yet undiagnosed diabetes.
Individuals who are at high risk of developing Type II diabetes mellitus include people who:

 are obese (more than 20% above their ideal body weight)
 have a relative with diabetes mellitus
 belong to a high-risk ethnic population (African-American, Native American,
Hispanic, or Native Hawaiian)
 have been diagnosed with gestational diabetes or have delivered a baby weighing
more than 9 lbs (4 kg)
 have high blood pressure (140/90 mmHg or above)
 have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or
a triglyceride level greater than or equal to 250 mg/dL
 have had impaired glucose tolerance or impaired fasting glucose on previous testing

PATHOPHYSIOLOGY

Carbohydrates are broken down into glucose molecules in the small intestine. Glucose is
absorbed into the bloodstream elevating blood glucose levels. The increase in the blood glucose
level stimulates the secretion of insulin from the beta cells of the pancreas. Insulin binds to
specific cellular receptors and facilitates entry of glucose into the cell, which uses the glucose for
energy. The increased insulin secretion from the pancreas and the subsequent cellular utilization
of glucose results in lowered of blood glucose levels. Lower glucose levels then result in
decreased insulin secretion.

If insulin production is decreased, glucose will be inhibited to enter the cells, resulting in
hyperglycemia. If insulin secretion is increased, blood glucose levels may become very low
(hypoglycemia) as large amounts of glucose enter tissue cells and little remains in the
bloodstream.

After every meal, the amount of glucose available from carbohydrate breakdown often
exceeds the cellular need for glucose. Excess glucose is stored in the liver in the form of
glycogen, which serves as a ready reservoir for future use. When energy is required, glycogen
stores in the liver are converted into glucose via glycogenolysis, elevating blood glucose levels
and providing the needed cellular energy source. The liver also produces glucose from fat (fatty
acids) and proteins (amino acids) through the process of gluconeogenesis. Glycogenolysis and
gluconeogenesis both increase blood glucose levels. Thus, sugar is controlled by a complex
interaction between the gastrointestinal tract, the pancreas, and the liver.
 Multiple hormones may affect glycemia. Insulin is the only hormone that lowers blood
glucose levels. The counter-regulatory hormones such as glucagon, catecholamines, growth
hormone, thyroid hormone, and glucocorticoids all act to increase blood glucose levels, in
addition to their other effects.

SYMPTOMS

The two types of diabetes have very similar symptoms. The first symptoms are related to
the direct effects of high blood sugar levels. When the blood sugar level rises above 160 to 180
mg/dL, sugar spills into the urine. When the level of sugar in the urine rises even higher, the
kidneys excrete additional water to dilute the large amount of sugar.

 Because the kidneys produce excessive urine, people with diabetes urinate large volumes
frequently (polyuria). The excessive urination creates abnormal thirst (polydipsia).
 Because excessive calories are lost in the urine, people lose weight.betes, the symptoms
often begin abruptly and dramatically. A condition called diabetic ketoacidosis may
quickly develop. Without insulin, most cells cannot use the sugar that is in the blood.
Cells still need energy to survive, and they switch to a back-up mechanism to obtain
energy. Fat cells begin to break down, producing compounds called ketones. Ketones
provide some energy to cells but also make the blood too acidic (ketoacidosis).

The initial symptoms of diabetic ketoacidosis include

 excessive thirst and urination, weight loss, nausea, vomiting, fatigue, and—particularly in
children—abdominal pain.
 Breathing tends to become deep and rapid as the body attempts to correct the blood's
acidity.
 The breath smells like nail polish remover, the smell of the ketones escaping into the
breath.
 Without treatment, diabetic ketoacidosis can progress to coma and death, sometimes
within a few hours.

Type 2: People with type 2 diabetes may not have any symptoms for years or decades
before they are diagnosed. Symptoms may be subtle. Increased urination and thirst are mild at
first and gradually worsen over weeks or months. Eventually, people feel extremely fatigued, are
likely to develop blurred vision, and may become dehydrated.

Sometimes during the early stages of diabetes, the blood sugar level is abnormally low, a
condition called hypoglycemia.

Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually
develop. However, the blood sugar levels can become extremely high (often exceeding 1,000
mg/dL). Such high levels often happen as the result of some superimposed stress, such as an
infection or drug use. When the blood sugar levels get very high, people may develop severe
dehydration, which may lead to mental confusion, drowsiness, and seizures, a condition called
nonketotic hyperglycemic-hyperosmolar coma.

COMPLICATIONS

People with diabetes may experience many serious, long-term complications. Some of
these complications begin within months of the onset of diabetes, although most tend to develop
after a few years. Most of the complications are progressive. The more strictly people with
diabetes are able to control the levels of sugar in the blood; the less likely it is that these
complications will develop or become worse.

Most complications are the result of problems with blood vessels. High sugar levels over
a long time cause narrowing of both the small and large blood vessels. The narrowing reduces
blood flow to many parts of the body, leading to problems. There are several causes of blood
vessel narrowing. Complex sugar-based substances build up in the walls of small blood vessels,
causing them to thicken and leak. Poor control of blood sugar levels also tends to cause the levels
of fatty substances in the blood to rise, resulting in atherosclerosis and decreased blood flow in
the larger blood vessels. Atherosclerosis is between 2 and 6 times more common in people with
diabetes than in people who do not have diabetes and tends to occur at younger ages.

Over time, elevated levels of sugar in the blood and poor circulation can harm the heart,
brain, legs, eyes, kidneys, nerves, and skin, resulting in angina, heart failure, stroke, leg cramps
on walking (claudication), poor vision, kidney failure, damage to nerves (neuropathy), and skin
breakdown. Heart attacks and strokes are more common among people with diabetes.

Poor circulation to the skin can lead to ulcers and infections and causes wounds to heal
slowly. People with diabetes are particularly likely to have ulcers and infections of the feet and
legs. Too often, these wounds heal slowly or not at all, and amputation of the foot or part of the
leg may be needed.

People with diabetes often develop bacterial and fungal infections, typically of the skin.
When the levels of sugar in the blood are high, white blood cells cannot effectively fight
infections. Any infection that develops tends to be more severe.

Damage to the blood vessels of the eye can cause loss of vision. Laser surgery can seal
the leaking blood vessels of the eye and prevent permanent damage to the retina. Therefore,
people with diabetes should have yearly eye examinations to check for damage.

The kidneys can malfunction, resulting in kidney failure that may require dialysis or
kidney transplantation. Doctors usually check the urine of people with diabetes for abnormally
high levels of protein (albumin), which is an early sign of kidney damage. At the earliest sign of
kidney complications, people are often given angiotensin-converting enzyme (ACE) inhibitors,
drugs that slow the progression of kidney damage.

Damage to nerves can manifest in several ways. If a single nerve malfunctions, an arm or
leg may suddenly become weak. If the nerves to the hands, legs, and feet become damaged
(diabetic polyneuropathy), sensation may become abnormal, and tingling or burning pain and
weakness in the arms and legs may develop. Damage to the nerves of the skin makes repeated
injuries more likely because people cannot sense changes in pressure or temperature.

DIAGNOSIS

The diagnosis of diabetes is made when people have abnormally high levels of sugar in
the blood. Blood sugar levels are often checked during a routine physical examination. Checking
the levels of sugar in the blood annually is particularly important in older people, because
diabetes is so common in later life. People may have diabetes, particularly type 2 diabetes, and
not know it. Doctors may also check blood sugar levels in people who have symptoms of
diabetes such as increased thirst, urination, or hunger. Doctors may also check blood sugar levels
in people who have disorders that can be complications of diabetes, such as frequent infections,
foot ulcers, and yeast infections.

To measure the blood sugar levels, a blood sample is usually taken after people have
fasted overnight. However, it is possible to take blood samples after people have eaten. Some
elevation of blood sugar levels after eating is normal, but even after a meal the levels should not
be very high. Fasting blood sugar levels should never be higher than 126 mg/dL. Even after
eating, blood sugar levels should not be higher than 200 mg/dL.

Doctors can also measure the level of a protein in the blood, hemoglobin. Glycosylated
hemoglobin forms when the blood has been exposed to high blood sugar levels over a period of
time. Doctors do not usually use this test to diagnose diabetes, but the test can help confirm the
diagnosis when blood sugar levels are not extremely high. The test demonstrates long-term
trends in blood sugar levels.

Another kind of blood test, an oral glucose tolerance test, may be done in certain
situations, such as in routine screening of pregnant women for gestational diabetes or in older
people who have symptoms of diabetes but normal glucose levels when fasting. However, it is
not routinely used for testing for diabetes, including in pregnant women at very low risk. In this
test, people fast, have a blood sample taken to determine the fasting blood sugar level, and then
drink a special solution containing a large, standard amount of glucose. More blood samples are
then taken over the next 2 to 3 hours and are tested to determine whether the level of sugar in the
blood rises abnormally high

TREATMENT

When diabetes is detected, a doctor may prescribe changes in eating habits, weight
control and exercise programs, and even drugs to keep it in check. It's critical for people with
diabetes to have regular checkups. Work closely with your healthcare provider to
manage diabetes and control any other risk factors. For example, blood pressure for people with
diabetes and high blood pressure should be lower than 130/80 mm Hg. If people with diabetes
strictly control blood sugar levels, complications are less likely to develop. The goal of diabetes
treatment, therefore, is to keep blood sugar levels within the normal range as much as possible.
Treatment of high blood pressure and cholesterol levels can prevent some of the complications of
diabetes as well.

People with diabetes benefit greatly from learning about the disorder, understanding how
diet and exercise affect their blood sugar levels, and knowing how to avoid complications. A
nurse trained in diabetes education can provide information about managing diet, exercising,
monitoring blood sugar levels, and taking drugs.

People with diabetes should always carry or wear medical identification (such as a
bracelet or tag) to alert health care practitioners to the presence of diabetes. This information
allows health care practitioners to start life-saving treatment quickly, especially in the case of
injury or altered mental status.

Diet management is very important in people with both types of diabetes. Doctors
recommend a healthy, balanced diet and efforts to maintain a healthy weight. Some people
benefit from meeting with a dietitian to develop an optimal eating plan.

People with type 2 diabetes may be able to avoid the need for all drugs by achieving and
maintaining a healthy weight. Some people who have been unsuccessful in losing weight through
diet and exercise may take drugs to help them lose weight or may even undergo stomach
reduction surgery.

In general, people with diabetes should not eat much sweet food. They should also try to
eat meals on a regular schedule. Long periods between eating should be avoided. People with
diabetes also tend to have high levels of cholesterol in the blood, so limiting the amount of
saturated fat in the diet is important. Drugs may also be needed to help control the level of
cholesterol in the blood.

Appropriate amounts of exercise can also help people control their weight and maintain
blood sugar levels within the normal range. Because blood sugar levels go down during exercise,
people must be alert for symptoms of low blood sugar. Some people need to eat a small amount
of food with sugar during prolonged exercise, decrease their insulin dose, or both. People with
diabetes should stop smoking and consume only moderate amounts of alcohol (up to one drink
per day for women and two for men).