As I inhaled a shareable Kit Kat bag of candy today, I thought I should make a post on some diabetes as I may develop it if I continue with this habit.
So we know there are two main types. But what is the general overview of Diabetes?
Diabetes occurs when there is an issue moving glucose from the blood to the cells which causes hyperglycemia. The body uses two main things to move glucose:
- Insulin (move glucose from the blood into the cells)
- Glucagon (move glucose from cells to the blood)
Insulin and glucagon are produced in our pancreas inside of specialized cells called the Islet of Langerhans. These cells use beta cells to produce insulin and alpha cells to produce glucagon. Insulin attaches to insulin receptors on cells throughout the body which causes glucose transporters to open and allow glucose to enter.
Glucagon heads to the liver where it produces glucose and glycogen. These molecules are then sent to the blood stream. This leads to an increase in our blood glucose levels.
As there is an increased amount of glucose in the blood, there will be an increased amount of urine output (polyuria) because glucose will follow water along with electrolytes. This happens because of osmosis. Water will flow from a higher concentration to a lower concentration so water will leave the cells and enter the blood stream. This increase in the amount of water in the blood stream causes the polyuria. You can test the urine of the patient for glucose to confirm. As the patient urinates more, the amount of fluid in the blood decreases which decreases blood volume. As the blood volume decreases, it will stimulate the hypothalamus and increase the need to drink water (polydipsia). Typically seen in Type 1 DM.
As there is a decreased amount of glucose in the cells, there is also a decrease in the amount of ATP produced. So the body undergoes lipolysis which breaks down triglycerides into free fatty acids and glycerol to make ATP; and proteolysis which breaks down proteins into amino acids to make ATP. This causes weight loss and increased hunger (polyphagia).
Type 1 Diabetes
Type 1 Diabetes occurs when the body can’t make enough insulin and is an autoimmune disease that has two major components:
- Environmental (they think due to a virus which infect cells that are expressed in MHC complexes)
- Genetics (HLA-DR3 and HLA-DR4)
The autoimmune part kicks in because our cytotoxic T cells have an issue with our pancreatic beta cells and attack them (cell mediated response). And normally we have something called “self tolerance” which allows the body to get rid of these angry T cells. But in Type-1 Diabetes, the genetic abnormality prevents this self tolerance. And because our beta cells create insulin, when there is a decrease in the amount of them it causes a decrease in the amount of insulin produced. Due to many complex things happening, these kinds of patients can go into Diabetic Ketoacidosis (DKA). I plan on making a post on DKA and HHS/HHNS next where I will go in-depth into each process.
Treatment of Type 1 Diabetes
- Frequent BGL monitoring
- Eating healthier (good carbs and fats) and maintaining a healthy weight
Type 2 Diabetes
Type 2 Diabetes is believed to be a metabolic syndrome which causes insulin resistance. The issue isn’t creating insulin, it is an issue with getting it into the cells. The insulin receptors don’t like to respond; so not a lot of insulin makes it into the cells. As the glucose doesn’t have a huge driving force to push them into the cells, the glucose gets nice and cozy inside the blood stream.
The glucose eventually gets bored and heads over to the pancreas and tries to make home in the pancreatic Beta cells which then cranks out more and more insulin and causes hyperinsulinemia. During this time, the body can have a normal BGL as the amount of insulin is higher and allows the glucose to enter the cells. It should be mentioned that when insulin is produced by the pancreatic Beta cells, they also releases Amylin. Increased amounts of Amylin will cause amyloid deposition. As this goes on for some time, the Beta cells become overworked and start to decrease the amount of insulin produced. So imagine your average Joe doing a marathon. He starts off fast but as time goes on, he slows down because he hates running and feels like death is upon him with every step.
This is exactly what is happening to our Beta cells. Why did I use that analogy? It’s because I am an average Joe and I detest running and I know how well I would do in any kind of running situation.
The decrease in the amount of insulin means less glucose will enter the cells and the patient will be hyperglycemic. These patients can go into HHS/HHNS which I will cover in the next post.
Treatment for Type 2 Diabetes
- Exercise and diet (so no more Kit Kats)
Chronic Complications with Diabetes
If you have worked in health care for a while, you have seen many diabetic patients and may notice a pattern in some of their complications.
- Slow wound healing
We are a site which loves to know WHY things happen. A high amount of glucose will bind with lipids and proteins in the body to produce proinflammatory molecules.
Proinflammatory molecules can then cause inflammation in our blood vessels which causes low-density lipoproteins (LDL) to adhere to the vessel walls. This causes decreased perfusion and gas exchange and can lead to an MI, ischemic stroke, peripheral artery disease, nephropathy which can lead to chronic kidney disease (CKD), and coronary artery disease (CAD). Basically, if there is an artery, it can be clogged up and the more stuff clogging the vessels leads to decreased amount of stuff being able to move from blood to cells.
As the amount of glucose increases, there can be an increase in the amount of glucose entering certain cells which converts it to sorbitol and then to fructose by the enzyme sorbitol dehydrogenase. What is important here, is that not all tissues have this enzyme such as the lens of the eye and kidney. So it leads to osmotic cell death because sorbitol causes extreme osmosis so water will rush into the cells. (Check out our post talking about osmosis).
So this can lead to cataracts and nephropathy.
Damage to our autonomic nerves can cause various issue such as neurogenic bladder and gastroparesis. Nerves that can also be damaged is the ones leading to our periphery that help us with feeling (sensory nerves). So if you have a difficulty feeling, it will be hard to know if you have a wound right? So you will be less likely to go to the hospital because you don’t realize your ulcer has eaten your entire foot off. Patients can also experience “pins and needles” and “burning”. The delay in wound healing in diabetics is because cells NEED glucose to heal. So if glucose can’t enter the cell, it is harder for it to heal so these patients may have extremely bad ulcers or wounds.
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–Scopeducation Team (Matt)