All You Need to Know About Diabetes Mellitus! Physiology, Pathology, Types and Treatment.

Diabetes mellitus Also known as an increase in sugar levels is one of the diseases of high importance and prevalence Before describing the disease, let’s discuss the anatomy and structures of the endocrine system Which are glands that secrete their their hormones into the bloodstream the endocrine system consists of many major glands such as the hypothalamus the pituitary the pineal adrenal thyroid Thymus testes and ovaries and pancreas which is of our main concern and diabetes mellitus Normally the pancreas consisting of a head body and tail is made up facing I that has an exocrine function Which means that they secrete their hormones and ducts between these sni There are millions of clusters called Oilers flanger hands or pancreatic islets. These islets are of four main types 15% made up by alpha islets important for the secretion of the hormone glucagon 80% made up by beta cells are important for the secretion of insulin 5% made up by Delta cells important for the secretion of somatostatin and the remainder F cells that release pancreatic polypeptide Normally each hormone has a specific function Once food containing carbohydrates is taken in it will reach the stomach and intestines in which it will be degraded to Glucose which is the major sugar in the body Glucose is taken up by the intestines by active transport this glucose will circulate in the blood before reaching the pancreas by splenic artery and pancreaticoduodenectomy Glucose we will reach the beta cells and to unbound a specific cell receptor called blood through receptor or glucose transporter to receptor this causes potassium channel inhibition leading to depolarization that cause opening of calcium channels secreting insulin Now insulin binds the third tyrosine kinase receptor in the liver adipose tissue and muscle the main function of insulin is the decreased blood glucose levels in blood by the following mechanisms It causes uptake of glucose by blood flow into cells to be used up as energy Meaning that it will be removed from the blood It also promotes formation of glycogen, which is the main glucose store and inhibits the process of glycogen arises Which is the breakdown of glycogen into glucose molecules? It decreases the process of gluconeogenesis, which is the formation of glucose and deliver all these mechanisms decreased the blood glucose levels This is the anatomy and physiology of the pancreas now moving on to our main subject of this video, which is diabetes mellitus Diabetes mellitus is not a single disease rather. It’s a group of metabolic disorders that she shares the same feature of elevated blood glucose levels also known as Hyperglycemia, there are two main types, which are type 1 and type 2 diabetes start off type 1 diabetes, which is less common this type Hyperglycemia is due to absolute insulin deficiency in which the beta cells lack release of insulin So the patient will have zero insulin production This loss of beta cell function is due to a chronic lung lasting community in which the body attacks the beta cells this autoimmunity occurs via the following mechanisms first of all cd4 plus which are normal T cells found in the body will cause beta cell damage by activating macrophages which can cause tissue injury by engulfing the cells in addition cd8 positive cells also normal T cells will directly kill beta cells by secreting their weapons called cytokines like interleukin 1 and interferon gamma More over the body There will be Auto antibodies against insulin and glutamic acid So type 1 diabetes is strongly associated with genetic predisposition including class 2 MHC on chromosome sex in addition to HL ADR 3 and actual ADR 4 Which are markers your body uses to know what cells belong to it now a patient with type 1 diabetes will develop hyperglycemia because no more insulin means no more glucose in the blood will be dealt with This patient will also present with ketoacidosis, which is a high level of ketone bodies in the blood because normal fatty acids are converted to Triacylglycerols, but in the case of insulin deficiency, these fatty acids will be converted to ketone in the liver and transported to the blood Moving on to type 2 diabetes, which is more common genetically type 2 diabetes is more associated than type 1 in which there is a concordance rate of 50 to 90 percent between identical twins and 20 to 40 percent between relatives This step of the appeal of diabetes starts off due to peripheral peripheral a deceptive resistance So receptors would no longer react or burn to insulin. So the beta cells will increase production in order to compensate in a chronic condition Once insulin is not producing an effect The pancreas will stop synthesizing insulin because it cannot meet with the high demands required by the body Therefore it starts with insulin resistance in tissues and and ends up with beta cell destruction Now most diabetic patients are obese with a high body mass. Index. What’s the reason behind this phenomena? Start off obese patients have increased fatty acids and muscles and the liver and other tissues It’s believed that fatty acids can affect the insulin signaling proteins resulting in no effect of insulin Second of all adipose tissue which is the fat storage container or Mons called adipocytes coins divided into adiponectin leptin and resistant now adiponectin and Leptin are good hormones while resistant is a bad hormone that can cause insulin resistance so in a case of type 2 diabetes adiponectin and leptin will decrease while resistant will increase Third fold a family of proteins called situates are believed to have a good effect on insulin secretion However, this mechanism is not well understood The loss of insulin secretion can be you two pathways The first one is qualitative beta cell dysfunction which occurs due to the abnormal release of insulin in small amounts that are not enough to overcome the hyperglycemia The second type is quantitative with cell dysfunction, which is due to the beta cell mass decrease Before discussing the complications of the diabetes. Let’s explain why these complications occur? These complications are due to metabolic changes mostly due to the elevated blood glucose in the blood The first one is called non enzymatic glycosylation meaning that glucose will bond to three amino acids in the blood spontaneously This will produce advanced glycosylation and products or cold ages These are measured by the hba1c tests, which reflect blood glucose levels for the past 120 days These ages forming on proteins like collagen cross links with polypeptides trapping non glycosylated proteins And enhance the deposition of cholesterol Hence, accelerating atherosclerosis, which is a formation of plaque in the blood vessels that can lead to MI Another metabolic reaction is that insulin activates a protein kinase C? Once it binds to its receptor this protein kinase C will induce vascular endothelial growth factor causing formation of new blood vessels The last metabolic reaction is interfering interfering with the polyol pathway Some tissues that like the lens nerves kidneys and blood vessels. Do not require insulin for glucose transport So an increase in glucose causes its it flux to these tissues where glucose will be transformed to sorbitol and fructose Causing an influx of water that will lead to complications discussed later Now, how do we diagnose a patient whether he is diabetic or not in? Order to diagnose the patient as diabetic or not We use a Lancet device in which a drop of blood is taken from the patient Usually the index finger had inserted on a disposable strip and glucose levels are measured Now F random blood glucose level which which is measured at any time of the they if The reading is more than 200 milligram per deciliter. Then the patient is diabetic fasting blood glucose level which is measured after 8 hours of fasting with a reading of 126 milligrams per deciliter or higher means that the patient is diabetic oral glucose tolerance test in which a patient is given 75 grams of glucose with a reading of more than 200 milligram per deciliter After 2 hours of taking the glucose suggest that the patient is diabetic Complications now with any disease comes complications with signs and symptoms the onset which are early Complications of the of diabetes or polyuria, which is excessive being polydipsia which is excessive thirst and polyphagia, which is excessive eating as For long-standing diabetes, which is left. Untreated many problems may take place first of all on the cardiovascular system myocardial infarction can occur due to the accelerated rate of atherosclerosis Second of all on the kidneys it can cause nephropathy which is a renal disease requiring regular dialysis on The eyes it can cause visual impairment and sometimes total blindness in addition to glaucoma and cataract formation Due to the sorbitol and fructose On the nervous system it can cause neuropathy with the loss of feeling in extremities and loss of bladder control it can also cause an increase in Susceptibility to infections like gangrene or even infections in the bladder because glucose is a favorable environment to microorganisms After discussing diabetes mellitus and it’s complications How can we how can we prevent it or treat it as for the treatment it differs between type 1 and type 2 Starting off with type 1 since there is absolute insulin deficiency Hence, the treatment will be replacing the missing insulin These are given as in as an insulin pen Syringe or pump which senses the body glucose levels and accordingly pumps insulin at the needed turn These insulin shots are of four types according to the onset of action they are either rapid regular in to mediate or long acting a patient with type 1 diabetes is given two shots of a mixture of 50 to 50 or 75 to 25 intermediate regular two-thirds of this dose is given in the morning to prevent fasting hyperglycemia and One-third is given in the evening to prevent nighttime hypoglycemia they are given subcutaneous at 45-degree angle in the buttock with the slowest absorption or in the abdomen with the fastest absorption or it can also be given in the toys or arms as For a type-2 diabetic patient there is insulin. However, there is peripheral resistance So we give agents that increase the secretion of insulin Furthermore to decrease the resistance or we give agents that deal with glucose and the blood first of all biguanide or known as metformin with the market name of Glueck feet it can increases the uptake of glucose in the blood also decreases the uptake of glucose in the gastrointestinal tract and Decreases the Brooke the process of making glucose, which is gluconeogenesis in the liver Metformin is known as an oral insulin sensitizer because it deals with the glucose in blood So it does not cause hypoglycemia, which is severe drop in blood glucose below normal levels. It’s off-label use is for weight loss The second class of drugs also known as sulfonylureas known as glimepiride Globe gyro glipizide sold under the trade name Amaral the mechanism of action is oral Insulin criticals meaning they increase the secretion of insulin by blocking the potassium pump Therefore it will cause depolarization of the cell that increases the calcium influx, which in turns creates more insulin This can cause hypoglycemia and weight gain Incretin mimetics Is the third class of drugs they are also known as eggs ana toyed They increase the increasing effect Which is when taken glucose the gastrointestinal system will stimulate the release of products called glp-1 and GIP Which increase insulin the injectable and they’re off-label uses weight loss The fourth class of drugs is dpp-4 antagonists also known as citta Lipton Normally dpp-4 is an enzyme that breakdown the aforementioned glp-1 and GIP So this drug will stop the action of dpp-4 which will increase the amount of insulin the fifth class of drugs is known as sodium glucose transporters two inhibitors also known as DiPaola flossin that works on inhibiting blood Transporters in the proximal tubules of the kidney hence stopping the reabsorption of glucose and decreasing its amount in the blood However, this type of drugs can cause infections This is all you need to know about diabetes mellitus. Its anatomy physiology. It’s a pathology and The treatment of it. Thank you for watching

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