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 medicine is hard work, as most of them sit easy. It takes your lectures and notes to create a Personalized study plan with exclusive videos, practice questions, and flashcards. and so much more. Try it free today. In diabetes Melodies, your body has trouble moving glucose, which is a type of sugar from your blood into your cells. This leads to high levels of glucose in your blood and not enough of it in your cells. And remember that your cells need glucose. glucose as a source of energy. So not letting the glucose enter means that the cell's star for energy. this fight having glucose right on their doorstep. In general, The body controls how much glucose is in the blood relative to how much gets into the cells with two insulin and boogogon insulin is used to reduce bloke glucose levels and glucogannas used to increase bloke glucose levels. Both of these hormones are produced by clusters of cells in the pancreas called eyelets of longer Insulin is secreted by beta cells in the center of these islands, and Lukagan is secreted by Elfisels in the periphery of the islands. the amount of glucose in the blood by binding the insulin receptors embedded in the cell membrane is insulin-responseed tissues, like muscle cells in adipose tissue. When activated, the insulin receptors cause vesicles containing glucose transporter that are inside the cell to fuse with the cell membrane, allowing glucose to be transported into the cell. Who could go on does exactly the opposite? It raises the boy group of glucose levels by getting the liver to generate new molecules of glucose from other molecules. And also, break down glycogen into glucose so that it can all get dumped into the blood. Diabetes notice is diagnosed when blood glucose levels get too high and this is seen among 10% of the world population. There are two types of diabetes, type 1 in type 2. And the main difference between them is the underlying mechanism that causes the blood glucose level. to rise. About 10% of people with diabetes have type 1 and the remaining 9% 90% of people with diabetes have type 2. Let's start with type 1 diabetes. some times just called type 1 diabetes. In this situation the body doesn't make enough insulin. The reason this happens is that in type 1 diabetes there's type 4 hypersensitivity response or a cell mediated immune response, where a person own T-cells attack the pancreas. As a quick review, remember that the immune system has T cells that react to all sorts of antigens, which are usually small peptides. polysaccharides or lipids. And that's some of these antigens are part of our own body's cell. It doesn't make sense to allow T-cells that will attack our own cells to hang around. until there's this process to eliminate them called self-tolerance. In type 1 diabetes, there's a genetic abnormality that causes a loss of self-tolerance T cells that specifically target the beta cell antigens losing cell Lawrence means that these T-cells are allowed to recruit other immune cells, and coordinate on these beta cells, losing beta cells means less insulin. and less insulin means that glucose piles up in the blood, because it can't enter the body's cells. One really important group of genes involved in regulation of the immune response is the human glucoseide antigen system, or HLA system. Even though it's called a system, it's basically this group of genes on chromosome 6 that encode the major histocompatibility. complex or MHC, which is a protein that's extremely important in helping the immune system recognized foreign molecules, as well as maintaining self-tolerance. MHC is like the serving platter that antigenes are presented to the immune cells on. Interestingly, people with Type 1 diabetes often have specific HLA genes in common with each other. One called HLADR3 and another called HLADR4. But this is just a genetic clue, right? Because not every one of HLADR3 and HLADR3 and LATR4 develops diabetes. In diabetes mode, it's type 1. destruction of beta cells usually starts early in life. But sometimes up to 90% of the beta cells are destroyed before symptoms crop up. control diabetes that all sound similar are polyphasia, like osteoorosis. polyureka and polydipsia. Let's go through them one by one. Even though there's a lot of glucose in the blood, it cannot get into the cells, which leaves cell star for energy. So in response, Adobos tissue starts breaking down fat. called like policies and muscle tissue starts breaking down proteins. Both of which results in weight loss for someone with uncontrolled diabetes. This catabolic state leaves people viewing hungry. Also known as Polyphasia. Phasia means eating and Poly means Now with high glucose levels that means that when blood gets filter through the kidneys, some of it starts to spill into the urine, called glycosurio. first of glucose and urea the urine. Since glucose is asthma automatically active, water tends to follow it, resulting in an increase in urination or polyurethane Allie again refers to a lot and you're yeah again refers to urine Finally, because there's so much urination, people with uncontrolled diabetes. become dehydrated and thirsty, or polydipsia. Poly means a lot. dipcr means thirst. Even though people with diabetes are not able to to produce their own insulin, they can still respond to insulin. So treatment involves life long. insulin therapy to regulate their blood glucose levels and basically enable their cells to use glucose. One really serious complication with type one diabetes is called diabetic keto acidosis or D.K.A. Don't understand it, let's go back to the video. the process of light policies, or fat is broken down into free fatty acids. After that happens, the liver turns the fatty acids into ketone bodies. Like a silo, a silo. acid and beta hydroxypeteric acid. A cdoc acid is a keto acid. because it has a ketone group and a carboxylic acid group. Beta hydroxy beturus. acid on the other hand, even though it's still one of the ketone bodies, isn't technically a keto acid. so that's keytown group has been reduced to a hydroxyl group is keytown bodies are important because they can be used by cells for energy, but they also increase the acidity of the blood, which is why it's called keto acidosis, and the blood coming really acidic can have major effects throughout the body. Individuals can develop a small respirator. which is a deep and labored breathing as the body tries to move carbon dioxide out of the blood. In an effort to reduce its acidity, cells also have a transport order that exchanges hydrogen ions or protons for potassium. When the blood gets acidic, it's by definition loaded with protons, like it's said in the cells while potassium gets sent into the fluid outside cells. And keep in mind is that in addition to helping glucose enter cells, insulin stimulates async ATPases, which help potassium get into the cells, and so without insulin more potassium stays in the fluid outside cells. Both of these mechanisms lead to increased potassium in the fluid outside cells, which quickly makes it into the blood and causes hyperphysis. The potassium is then extruded, so over time, even though the blood potassium levels remain high. Overall stores of potassium in the body, which include potassium inside cells starts to run low. Individuals will also have a high anion gap, which reflects a large difference in the unmeasured negative and positive ions in serum largely due to the buildup of keto acids, diabetic keto Asadosis can happen even in people who've already been diagnosed with diabetes and currently have some sort of of insulin therapy. This is up in that frame, which in turn stimulates the release of Glucogon. Too much Glucogon. can tip the delicate hormonal balance of Boopagonan insulin in favor of elevating blood sugars and can lead to a cascade of events we just described. Increase glucose in the blood. loss of glucose in the urine, loss of water, dehydration, and in parallel and need for alternative energy, generation of ketone bodies, and keto acidosis. Interestingly, both ketone bodies break down into acetone, and escape as a gas by getting breathed. out the lungs, which gives us sweet, fruity smell to a person's breath. Although that's the only sweet thing about this illness, which also causes nausea, vomiting and if severe, mental status changes in acute cerebral edema. Treatment of a DKA episode involves giving plenty of fluids, which helps with dehydration. insulin which helps lower blood glucose levels and replacement of electrolytes like potassium. All of which help to reverse the acidosis. Now let's switch gears and talk about type 2 diabetes, which we're at the body makes instance. but the tissues don't respond as well to it. The exact reason why cells don't respond isn't fully understood. Essentially the body is providing the of insulin, but the cells don't move their glucose transporters to their membrane in response. Which remember is needed for the glucose to get into the cells? These cells therefore have insulin resistance. Some risk factors for insulin resistance are obesity. city, lack of exercise, and hypertension. The exact mechanisms are still being explored. For example, an excess of adipose tissue or fat. It's not to cause the release of free fatty acids and so-called adabokines, which are signaling fuel-second cause inflammation, which seems related to insulin resistance. However, many people that are obese are not diabetic, so genetic will play a major role as well. We see this when we look at twin studies as well. We're having a twin with Type II Diabetes increased at the risk of developing Type II Diabetes. completely independently of other environmental risk factors. And type 2 diabetes. Since tissues don't respond as well to normal levels of insulin, the body ends up producing more insulin in order to get the same effect and move glucose out of the blood. through beta cell hyperplasia and increased number of beta cells. and beta cell hypertrophy, where they actually grow in size. All in this attempt to pump out more insulin. This works for a while and by keeping insulin levels higher than normal, but glucose levels can be kept normal, called normal glycemia. Now, along with insulin, beta cells also secret eyelet and alloy polypeptide. So while Beta cells are cranking out insulin, they also secrete an increase. the amount of amuline. Over time, amuline builds up and aggregates in the islands. This beta cell compensation, though, is not sustainable. and over time those maxed out beta cells get exhausted, they become dysfunctional, and high-potrophy and get smaller, as well as high-boa-plasia and die-off. As beta cells are lost in insulin levels decrease, glucose levels in the blood start to increase in patients develop hyper glycemia, which leads to similar clinical signs that we mentioned before, like Polyphasia, Bikosuria, Polyuria. and polydipsia. But unlike type 1 diabetes, there's generally some circulating insulin and type 2 diabetes from the beta cells that are trying to compensate for the insulin resistance. This means that the insulin book gun balances such that diabetic ketoacidosis is not usually developed. Having said that, a complication called hyper-osmola hyper glycemic state, or HHS, is much more common in type 2 diabetes than type one diabetes and it causes increased plasma ultimately due to extreme dehydration. and concentration of the blood. To help understand this remember that glucose is a pull their molecule that cannot passively diffuse across cell membranes, which means that it is a solid. So when levels of glucose are super high in the blood, meaning it's a high for Osmolir State, water starts to leave the body cells and enter the blood vessels. Even the cells relatively dry and trival, rather than plump in juicy. blood vessels that are full of water lead to increased urination and total body dehydration. This is a very serious situation because the dehydration of the body cells and in particular the brain can cause a number of symptoms, including mental status changes. In HHS, you can sometimes see mild hedonemia and acidosis. but not to the extent that it's seen in DKA. And in DKA, you can see some hyper-oscalary. So there's definitely overlap between these two syndromes. type 1 and type 2 diabetes are also a couple other sub types of diabetes melodies. The stational diabetes is when pregnant women have increased blood glucose, which is particularly during the third trimester. Although ultimately unknown, because it's thought to be related it's a pregnancy hormones that interfere with insulin action on insulin receptors. Also, sometimes you build and develop drug-induced diabetes, which is where medications have side effects that tend to increase blood glucose levels. for both of these is thought to be related to insulin resistance, like type 2 diabetes. an autoimmune destruction process like in type 1 diabetes, diagnosing type one or type 2 diabetes is done by getting a sense for how much glucose is floating around in the blood. and has specific standards that the World Health Organization uses. and glucose tests is taken where the person doesn't eat or drink. Except the water, that's okay. for a total of eight hours and then has their blood tested for glucose levels levels of 100 milligrams per deciliter to 125 milligrams per deciliter indicates pre-dite. and 126 milligrams per dec leader or higher indicates diabetes. A non-fasting or random glucose test can be done at any time. with 200 milligrams per deciliter or higher being a red flag for diabetes. Another test is called an oral glucose tolerance test, where a person is giving glucose and then blood samples are taking at time intervals to figure out how well it's being cleared from the blood. And most importantly, interval being 2 hours later. Levels of 140 milligrams per desuiter to 109 99 milligrams per deswitter indicate pre-diabetes. 200 or above indicates diabetes. Another thing to know is that when blood the glucose levels get high, the glucose can also stick to proteins that are floating around in the blood or in cells. So that brings us to another type of test that can be done, which is the HBA1C. test, which tests for the proportion of hemoglobin and red blood cells that has glucose stuck to it. to it, of glycated hemoglobin, HPA1C levels of 5. 0.7% to 6.4% indicate pre-diabetes and 6.5% are higher indicates diabetes. This proportion of glycated hemoglobin doesn't change day to day So it gives a sense for whether the blunt glucose levels have been high over the past two to three months. Finally, we have the CPATH diet test, which tests for bi-products. of insulin production. If the level of CPF tied is low or absent, it means the pancreas the level of CPF tied is low or absent. no longer producing enough insulin, and the glucose cannot enter the cells. For type 1 diabetes, insulin is the only treatment option. For type 2. two diabetes on the other hand. Lifestyle changes like weight loss and exercise. along with the healthy diet and oral anti-diabetic medication, like met for women in several other classes. in some times to be enough to reverse some of that insulin resistance and keep blood sugar levels in However, if oral anti-diabetic medications fail, I have two different types of medications. diabetes can also be treated with insulin. Something to bear in mind is that insulin treatment comes with a risk of hypoglycemia, especially if insulin is taken without a meal. Symptoms of hypoglycemia can be mild, like weakness, hunger, and shaking, but they can progress to a loss of consciousness in seizures in severe cases. In mild cases, drinking juices or eating candy or sugar, might be enough to bring blood sugar up, but in severe cases intravenous glucose should be given as soon as possible. The FDA is also recently approved the treatment for severe hypobacemia. All right, now over time, high glucose levels can cause damage to tiny blood vessels, while the micro-abache of the turret. across this called high line arteriolosthlerosis is where the walls of the arteriolos develop deposits, which are deposits of proteins, and these make them hard and inflex In capillaries, the basement membrane can flick it, and make it difficult for oxygen. to easily move from the capillary to the tissues, causing hypoxia. One of the most significant effects is that diabetes increases the risk of medium and large arterial wall damage, and subsequent atherosclerosis, which can lead to heart attack. and strokes, which are major causes of morbidity and mortality for patients with diabetes. In the eyes diabetes can lead to retinopathy and evidence of that can be seen on to find a scopic example that shows cotton wool spots or flare hemorrhages and can eventually In the kidneys, the afferent and e-ferrent arterioles as well as the glimmerialist itself can get damaged, which can lead to a nephrodic syndrome that's slowly damaged. diminishes the kidney's ability to filter blood over time, and can ultimately lead to dialysis. Diabetes can also affect the function of nerves causing symptoms like a decrease in sensation in the toes and fingers. Sometimes called a stock and glove distribution. As well as causes the autonomic nervous system to malfunction. That system controls a number. of body functions, everything from sweating to passing gas. about the poor blood supply and nerve damage can lead to ulcers, typically on the feet. And don't heal quickly and can get pretty severe and need to be amputated. These are some of the complications of uncontrolled diabetes, which is why it's important to diagnose and control diabetes. IPDs through a healthy lifestyle, medications to reduce insulin resistance. and even insulin therapy if beta cells have been exhausted. Well, type 1 diabetes kidney. not be prevented. Type 2 diabetes can. In fact, many people diabetes can control their blood sugar levels really effectively and live a full and active life without any of the complications. patients. Thanks for watching. If you're interested in the deeper dive on this topic. Take a look at us most is.org where we have flashcards, questions, and tools to help you learn medicine.