1. In your own words, explain the pathophysiology of Type 1 and Type 2 diabetes mellitus.

- Type 1 DM is autoimmune destruction which is characterized by the destruction of the pancreatic

beta cells. The common underlying factor under the development of the type 1 diabetes is a
genetic susceptibility. The auto immune destruction of the pancreatic beta cells leads to a
deficiency of insulin secretion. It is this loss of insulin secretion that leads to the metabolic
derangements associated with Insulin Dependent Diabetes Mellitus (IDDM). The glucose taken
from food cannot be stored in the liver anymore but remains in the blood stream. Then, the
kidneys will not reabsorb the glucose once it has exceeded the renal threshold, so it will appear in
the urine and be called glycosuria. Excessive loss of fluids is accompanied by excessive
excretion of glucose in the urine leading to osmotic diuresis.

- Type 2 DM is a disorder that is characterized by high blood glucose in the context of insulin
resistance and relative insulin deficiency. Insulin could not bind with the special receptors, so
insulin becomes less effective at stimulating glucose uptake and at regulating the glucose release.
There must be increased amounts of insulin to maintain glucose level at a normal or slightly
elevated level. However, there is enough insulin to prevent the breakdown of fats and production
of ketones. Uncontrolled type 2 diabetes could lead to hyperglycemic, hyperosmolar nonketotic
syndrome.

2. Explain the normal glucose regulation in the body

- Insulin triggers the uptake of the glucose from the bloodstream. Soon after a meal, the digestive
system begins to break down the food you have eaten. The carbohydrates in the food you take are
broken down into a simple sugar called glucose as this glucose is absorbed from the digestive
system into the blood stream the blood sugar levels increase. The circulatory muscle that carries
glucose to muscle cells throughout the body where it used to generate energy. To get that glucose
that’s in the bloodstream into the muscle cells you need to have insulin present to trigger the
uptake event. Insulin is a small protein hormone produced by pancreas. As the concentration of
glucose in the bloodstream rises, the pancreas senses this increase and is stimulated to release
insulin into the bloodstream. The newly release insulin plays a key role in regulating the
concentration of glucose in the blood, a process known as glucose homeostasis. The insulin that is
now released in the blood stream binds to the extracellular domain of receptor proteins found on
the surface of liver muscle and fat cells. This binding triggers the auto phosphorylation of the
intracellular domains which in turn phosphorylate as specific substrate signaling protein. This
protein the phosphorylates other downhill signaling proteins leading to an amplification of the
signal at each step. This overall signaling process is known as a signal transduction cascade. One
important consequence of this signal cascade is the movement of glucose transport proteins called
gluts towards the cell surface as these storage vesicles fuse with the cell membrane the number of
GLUTS present on the surface of the cells increase which allowing the glucose to enter the cell.
As a result, the glucose concentration in the bloodstream decreases. The glucose is now inside the
cell where it can be metabolized to generate the energy in the form of ATP that is needed in all
the cells.

3. Weight loss, polyuria, polydipsia, and polyphagia are common manifestation of diabetes,
explain how patients develops these symptoms.

 Weight loss
 o Insufficient insulin prevents the body from getting glucose from the blood into the
body’s cells to use as energy. The body starts burning fat and muscle for energy,
causing a reduction in overall body weight.

 Polyuria
o The glucose exerts high osmotic pressure within the renal tubules, which leads to an
increase need to urinate.
 Polydipsia
o Due to increase blood glucose levels. When blood glucose levels get high, the
kidneys produce more urine to remove the extra glucose from the body. Meanwhile,
the body is losing fluids, the brain tells to drink more to replace which leads to the
feeling of intense thirst.
o Also, this may result from ECF/ICF dehydration.
 Polyphagia
o The glucose cannot enter cells to be used for energy. Due to either low insulin levels
or insulin resistance. The body cannot convert this glucose to energy which can lead
to feel very hungry.

4. If the primary concern of diabetic patients in their weight, what groups of medication is
preferred and why? Explain its mechanism of action.

5. Explain the mechanism of the basal bolus regimen. Site an example.