Diabetes Mellitus

 Failure to control blood glucose

 Long term health complications
 Atherosclerosis
 Stroke

 Neuropathy (damaged nerves)

 Retinopathy, glaucoma

Scottish perspective
Control of Blood glucose
 If blood glucose rises
 Excess is stored in muscles & liver as glycogen
 If blood glucose falls
 Deficit remediated by breaking glycogen down in
liver and releasing into blood stream
 Two hormones:
 Insulin & Glucagon
Control of Blood glucose
 Insulin:
 Synthesised by  cells of Islet of Langerhans in
pancreas
 Glucagon
 Synthesised by  cells of Islet of Langerhans in
pancreas
 Blood glucose level sensed in pancreas
 Regulates secretion of insulin/ glucagon
directly
 Negative feedback system (p54)
INSULIN – target cells
 Insulin acts on
 Liver
 Adipose tissues (fat)
 Skeletal muscle cells
 Insulin increases permeability of fat/ skeletal
muscle cell membrane to glucose
 So stimulates glucose uptake into these tissues
 Liver already very permeable
 Insulin stimulates glycogen formation & glucose
uptake
INSULIN
 Insulin acts via an insulin receptor
 Diabetes occurs through two
mechanisms
 1 – Loss of insulin
 2 – Loss of insulin receptors
 Diabetes in Young Adults (15-30
years)

Type 2

Type 1

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90

Age of diagnosis
Genetic Nurses in Diabetes treatment

unusual genetic type of diabetes called

maturity onset diabetes of the young
6 different genes causing this type of diabetes.
genetically defined subtype present different clinical course.

one subtype responds to sulphonylureas

patients replace insulin treatment sometimes after being on
insulin for over 30 years,
finding the genetic cause of their diabetes has had a major impact on
their treatment.
Type 1 Diabetes – Insulin
dependent
 Type 1- Diabetes (5-10%)
 Loss of insulin – destruction of pancreatic 
cells
 Early onset

 Weight loss, fatigue, polydypsia, polyuria,

glucosuria, hyperglycaemia
 Ketosis (sweet breath – due to acetone)

 Treat with injections of insulin

Glucose tolerance test
 A large bolus dose of glucose
administered (100g glucose drink)
 Blood glucose monitored
 Rapid fall after peak (9-10mM) levels
reached
 If diabetes clearance is very slow – in
urine, peak blood glucose level higher
Type 2 Diabetes – Insulin
Independent
 90-95% cases of diabetes
 Late onset (after 40yrs age)
 3-7% population affected
 60% SUMO wrestlers c.f. 5% Japanese
population
 Mainly occurs in overweight individuals
Insulin Resistance
Symptoms
 Insulin resistance
 Normal or elevated blood insulin levels
 Failure of insulin to act on target tissues
 Deficiency in insulin receptors
 Can lead to  cell function becoming
compromised due to excessive insulin
production
 Hyperglycaemia, polydypsia, polyuria,
glucosuria
Progression
 Elevated blood glucose associated with
diabetes damages blood vessels and
nerves
 Small blood vessel damage causes
blindness, kidney failure & amputation
 Larger blood vessel damage can cause
heart disease, high blood pressure & stroke
 75% of Type 2 patients die of
cardiovascular disease
Exercise & NIDDM
 Insulin sensitivity in fit individuals is greater
 i.e. cells better able to uptake glucose from blood
 Insulin sensitivity decreases with age
 This decrease reduced by exercise
 5-7 days after exercise insulin sensitivity
starts to decline
 Regular, moderate, aerobic exercise is important in
preventing onset of NIDDM
 Diseases control in 80-90% patients achieved
by reducing calorie intake/ exercise
 Glasgow Research
Osteoporosis
 Osteoprosis – long term progressive increase
in bone porosity/ brittleness
 Risk of fractures (shatter)
 Loss of height
 Curvature of spine
 Back pain
 Post menopausal women
 20-50% over 50s
 75% over 90s
Bone growth
 Childhood and early adolescence bones extend
 Late adolescence bones increase in density
 Peak bone density in late twenties/early thirties
 1%/yr (female) decline in density thereafter
 2-3%/yr decline post menopausal
 Male bone density declines 0.4%/ yr and only
when over age 50
 Extra calcium/ Vitamin D in childhood & teens
produce greater bone density
 Margaret Thatcher – cause of osteoporosis in 2010-2020?
 Risk Factors
 Elderly
 Early menopause
 Amenorrhoea
 Genetics
 Low body fat
 Low calcium in diet
 Vit. D deficiency
 High alcohol/ caffeine/
fizzy drinks
 High salt
 Age related reduction in bone density
 Oestrogen promotes calcium uptake
 Low oestrogen
 Enzymes in fat produce oestrogen from
circulating precursors
 Body raids calcium stores in bones
 Poor calcium absorption
 Promote bone loss by using calcium stores
to balance pH
 Calcium removed along with Na in the
urine
Exercise & Osteoporosis –
Prevention
 Mechanical stress increases bone
strength (density)
 Astronauts have lowered bone density
following zero gravity because no
mechanical stress
 Weight bearing or resistance exercise
will benefit women in late twenties/
early thirties (swimming will not!)
 Also benefits coordination reducing risk of falls
Exercise & Osteoporosis –
Treatment
 45 min moderate exercise 3 times
weekly increases calcium deposition in
osteoporosis patients
 In conjunction with HRT
Risk of Exercise in Women
 Excessive exercise particularly in young
women can cause osteoporosis
 Reduction in body fat leads to reduction
in oestrogen synthesis
 Menstruation ceases
 Oestrogen falls further, reducing
calcium absorption
 Bone loss is irreversible
Advice from Osteoporosis Soc.
 It's a good idea to avoid:
 Too much protein –
 Excessive protein upsets acid balance.
 Calcium from bones neutralises it.
 Eating plenty fruit and veg should keep your body's acid balance stable.
 Lots of salt –
 high sodium increases calcium lost in urine.
 Drinking lots of fizzy drinks –
 phosphoric acid gives flavour to a lot of fizzy drinks
 too much can cause the body to use calcium to balance levels.
 Drinking too much caffeine –
 high caffeine intake affects the balance of calcium in the body.
 Milk in coffee will counteract this, limit intake to one or two cups a day.
 Letting your weight drop too low –
 Being underweight increases the risk of broken bones when you fall.
 In younger women, severe weight loss may stop menstrual periods because hormone
levels drop which can also increase your risk of breaking a bone