Homeostasis and Diabetes L 2 What is Homeostasis

Homeostasis and Diabetes L 2

What is Homeostasis? n Body cells work best if they have the correct Temperature n Water levels n n Glucose n concentration Your body has mechanisms to keep the cells in a constant environment.

What is Homeostasis? The maintenance of a constant environment in the body is called Homeostasis

Controlling Glucose levels n n n Your cells (muscles, brain, etc) need an exact level of glucose in the blood. (normal serum level 65 – 105 mg) Excess glucose gets turned into glycogen in the liver Blood glucose levels are regulated by 2 hormones (chemical messengers) from the pancreas called: Insulin Glucagon

Normal Maintenance of Blood Glucose Levels n Eat a meal: Pancreas detects increased glucose levels in blood and secretes INSULIN n This results in uptake of GLUCOSE by: n n Cells that need it for energy (including brain) n Liver and muscle cells to be stored as glycogen Pancreas stops release of Insulin n Glucose levels return to normal (80 -120) n

Glucose Concentration Glucose levels rise after a meal. Insulin is produced and glucose levels fall to normal again. Normal Meal eaten Time

Glycogen Insulin Glucose in the blood If there is too much glucose in the blood, Insulin tells the liver to convert some of it to glycogen

Hyperglycemia n When blood glucose becomes high n INSULIN allows glucose to enter cells n Liver n Produce & store glycogen n Inhibits glycogen breakdown n Muscles n Promotes n Fat protein and glycogen synthesis cells n Promotes storage of triglycerides

Hyperglycemia= high blood glucose levels n n n Drowsy Flushed Thirsty

Normal Maintenance of Blood Glucose Levels, cont. Blood glucose drops due to NOT eating n Pancreas detects and releases glucagon n stimulates the release of glycogen (broken down to glucose) Glucose is released into the blood and levels return to normal.

Glucose Concentration Glucose levels rise after a meal. Diabetic Insulin is not produced so glucose levels stay high Meal eaten Time

Glycogen Glucagon Glucose in the blood If there is not enough glucose in the blood, Glucagon tells the liver to convert glycogen into glucose.

Hypoglycemia= LOW blood sugar n Glucagon: causes release of glucose from liver nbreakdown of glycogen to glucose

Hypoglycemia n Weak, sweaty n Confused/irritabl e/ disoriented

Diabetes Some people do not produce enough insulin. n When they eat food, the glucose levels in their blood cannot be reduced. n This condition is known as DIABETES. n Diabetics sometimes have to inject insulin into their blood. They have to be careful of their diet. n

Glycogen Insulin Glucose in the blood The glucose in the blood increases, but there is no insulin to tell the liver to convert it into glycogen. Glucose concentration rises to dangerous levels.

Diabetes Mellitus (problem with glucose metabolism) Major health problem US/worldwide n Complications [lousy blood vessels] n Blindness n Renal failure n Amputations n [heart attacks and strokes] n [OB/neonatal complications] n

Diabetes Mellitus The good news: n Blood glucose control reduces complications of Diabetes!

Diabetes Mellitus n Absence (or ineffectiveness of ) insulin n Cellular resistance n Cells can’t use glucose for energy n Starvation mode n Compensatory fat/protein breakdown of body

Diabetes Mellitus n HYPERGLYCEMIA: fluid/electrolyte imbalance. Sodium, chloride, potassium excreted (frequent urination) n Dehydration (thirsty all the time) n cells are starving, so person feels hungry despite eating huge amounts of food. Starvation state remains until insulin is available. (eats too much) n

Diabetes Mellitus n Complications of chronic hyperglycemia Macrovascular complications n Cardiovascular disease (heart attack) n Cerebrovascular disease (strokes) n Microvascular n n Blindness (retinal proliferation, macular degeneration) n Amputations n Diabetic neuropathy (diffuse, generalized, or focal) n Erectile dysfunction

Classifying Diabetes Mellitus n Type I Diabetes: autoimmune n Beta cell destruction in genetically susceptible person n Some viral infections

Classifying Diabetes Mellitus n Type II Diabetes Reduction in ability of most cells to respond to insulin n Poor control of liver glucose output n Decreased beta-cell function (eventual failure) n

Diabetes Mellitus n Major risk factors Family history n Obesity n Origin (Afro-American, Hispanic, Native American, Asian-American) n Age (older than 45) n History of gestational diabetes n High cholesterol n Hypertension n

Diabetes Mellitus n Prevention approach n Increased of effects: combination exercise n Decreases n Reduce calorie intake n Improves n Weight need for insulin sensitivity reduction n Improves insulin action

Triad of Treatment n Diet n Medication Oral hypoglycemics n Insulins n n Exercise

Diabetes treatment n Exercise n Under physician supervision n Check glucose prior

Diabetes treatment n Diet n Lower calorie n Fewer foods of “high glycemic index” n Spread meals evenly

Diabetes treatment n Anti-Diabetic n Oral medications hypoglycemic agents n Insulins

n Stimulate pancreas to secrete insulin n n Glyburide Adverse reactions Hypoglycemia n Water retention/edema n Photosensitivity n n May need to add insulin in times of stress

Insulin Made in beta cells of the pancreas n Moves glucose into cells (thus acts like growth hormone in a way) n Moves potassium into cells (can buy time in emergencies) n

Insulin preparations n n Rapid acting Short acting (regular) Intermediate acting (NPH) Long acting

Some things to know n Insulin moves potassium into cells Good for emergency situations n Dangerous if potassium level already low n

Some things to know… n Dawn Phenomenon vs Somogi’s effect n Dawn phenomenon n Blood n sugar rises in early morning Somogi’s (rebound) effect n Blood sugar rise in morning as reaction to hypoglycemic time during the night

Some things to know… n Diabetic foot care n Dry, cracked skin + poor circulation could = loss of a limb n For the most part nurses don’t trim nails of diabetic clients. Refer to Podiatrist.

Typical diabetic foot ulcer

Quick Quiz: 1. Give name of the very important anabolic hormone that builds up glucose and stores it as glycogen. 2. What is the usable form of sugar in the blood called? n 3. What are the cells associated with insulin production called? n 4. What is the main problem (physiologically) that exists in people that are diabetic? n

. 5. Low blood sugar will stimulate what to be released? 6. Describe how someone would look/act if they were hyperglycemic 7. Describe someone who is hypoglycemic 8. List 3 treatments/preventions for diabetes and label if they are for Type 1, 2 or both 9. What is the good news for diabetes?