Homeostasis and Homeostasis and Diabetes L2Diabetes L2

What is Homeostasis?What is Homeostasis?

Body cells work best if they have the Body cells work best if they have the correctcorrect TemperatureTemperature Water levelsWater levels

Glucose concentrationGlucose concentration

Your body has mechanisms to keep Your body has mechanisms to keep the cells in a constant environment.the cells in a constant environment.

What is Homeostasis?What is Homeostasis?

The maintenance The maintenance of a constant of a constant

environment in environment in the body is called the body is called

HomeostasisHomeostasis

Controlling Glucose Controlling Glucose levelslevels

Your cells (muscles, brain, etc) need an exact Your cells (muscles, brain, etc) need an exact level of glucose in the blood. level of glucose in the blood. ((normal serum normal serum level 65 – 105 mglevel 65 – 105 mg))

Excess glucose gets turned into glycogen in the Excess glucose gets turned into glycogen in the liverliver

Blood glucose levels are regulated by 2 Blood glucose levels are regulated by 2 hormones (chemical messengers) from the hormones (chemical messengers) from the pancreaspancreas called: called:

InsulinInsulin

GlucagonGlucagon

Normal Maintenance of Normal Maintenance of Blood Glucose LevelsBlood Glucose Levels

Eat a meal: Eat a meal: Pancreas detects increased glucose levels Pancreas detects increased glucose levels

in blood and secretes INSULINin blood and secretes INSULIN This results in uptake of GLUCOSE by:This results in uptake of GLUCOSE by:

Cells that need it for energy (including brain)Cells that need it for energy (including brain) Liver and muscle cells to be stored as glycogenLiver and muscle cells to be stored as glycogen

Pancreas stops release of InsulinPancreas stops release of Insulin Glucose levels return to normal (80-120)Glucose levels return to normal (80-120)

Time

Glucose Concentration

Meal eaten

Insulin is produced and glucose levels fall to normal again.

Glucose levels rise after a meal.

Normal

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

Glycogen

Insulin

Glucose in the blood

When blood glucose becomes highWhen blood glucose becomes high INSULIN allows glucose to enter cellsINSULIN allows glucose to enter cells

LiverLiver Produce & store glycogenProduce & store glycogen Inhibits glycogen breakdownInhibits glycogen breakdown

MusclesMuscles Promotes protein and glycogen synthesisPromotes protein and glycogen synthesis

Fat cellsFat cells Promotes storage of triglyceridesPromotes storage of triglycerides

Hyperglycemia= high blood Hyperglycemia= high blood glucose levelsglucose levels

DrowsyDrowsy FlushedFlushed ThirstyThirsty

Normal Maintenance of Normal Maintenance of Blood Glucose Levels, cont.Blood Glucose Levels, cont.

Blood glucose drops due to NOT Blood glucose drops due to NOT eatingeating

Pancreas detects and releases Pancreas detects and releases glucagon glucagon stimulates the release of glycogen stimulates the release of glycogen

(broken down to glucose)(broken down to glucose) Glucose is released into the blood Glucose is released into the blood

and levels return to normal.and levels return to normal.

Time

Glucose Concentration

Meal eaten

Insulin is not produced so glucose levels stay high

Glucose levels rise after a meal.

Diabetic

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

Glycogen

Glucagon

Glucose in the blood

Hypoglycemia= LOW blood Hypoglycemia= LOW blood sugarsugar

Glucagon: causes release Glucagon: causes release of glucose from liverof glucose from liverbreakdown of glycogen breakdown of glycogen to glucoseto glucose

HypoglycemiaHypoglycemia

Weak, sweatyWeak, sweaty Confused/Confused/

irritable/ irritable/ disorienteddisoriented

DiabetesDiabetes

Some people do not produce enough Some people do not produce enough insulin.insulin.

When they eat food, the glucose levels When they eat food, the glucose levels in their blood cannot be reduced.in their blood cannot be reduced.

This condition is known as DIABETES.This condition is known as DIABETES. Diabetics sometimes have to inject Diabetics sometimes have to inject

insulin into their blood. They have to insulin into their blood. They have to be careful of their diet.be careful of their diet.

The glucose in the blood increases,

Glycogen

Insulin

Glucose in the blood

but there is no insulin to tell the liver to convert it into glycogen.Glucose concentration rises to dangerous levels.

Diabetes MellitusDiabetes Mellitus(problem with glucose (problem with glucose

metabolism)metabolism) Major health problem US/worldwideMajor health problem US/worldwide Complications [lousy blood vessels]Complications [lousy blood vessels]

BlindnessBlindness Renal failureRenal failure AmputationsAmputations [heart attacks and strokes][heart attacks and strokes] [OB/neonatal complications][OB/neonatal complications]

Diabetes MellitusDiabetes Mellitus

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

Diabetes MellitusDiabetes Mellitus

Absence (or ineffectiveness of ) Absence (or ineffectiveness of ) insulininsulin

Cellular resistanceCellular resistance Cells can’t use glucose for Cells can’t use glucose for

energyenergy Starvation modeStarvation mode

Compensatory breakdown of body Compensatory breakdown of body fat/proteinfat/protein

Diabetes MellitusDiabetes Mellitus

HYPERGLYCEMIAHYPERGLYCEMIA: fluid/electrolyte : fluid/electrolyte imbalance.imbalance. Sodium, chloride, potassium excreted Sodium, chloride, potassium excreted

(frequent urination)(frequent urination) Dehydration (thirsty all the time)Dehydration (thirsty all the time) cells are starving, so person feels cells are starving, so person feels

hungry despite eating huge amounts of hungry despite eating huge amounts of food. Starvation state remains until food. Starvation state remains until insulin is available. (eats too much)insulin is available. (eats too much)

Diabetes MellitusDiabetes Mellitus

Complications of chronic hyperglycemiaComplications of chronic hyperglycemia MacrovascularMacrovascular complications complications

Cardiovascular disease (heart attack)Cardiovascular disease (heart attack) Cerebrovascular disease (strokesCerebrovascular disease (strokes))

MicrovascularMicrovascular Blindness (retinal proliferation, macular Blindness (retinal proliferation, macular

degeneration)degeneration) AmputationsAmputations Diabetic neuropathy (diffuse, generalized, or Diabetic neuropathy (diffuse, generalized, or

focal)focal) Erectile dysfunctionErectile dysfunction

Classifying Diabetes Classifying Diabetes MellitusMellitus

Type I Diabetes: autoimmuneType I Diabetes: autoimmune Beta cell destruction in genetically Beta cell destruction in genetically

susceptible personsusceptible person

Some viral infectionsSome viral infections

Classifying Diabetes Classifying Diabetes MellitusMellitus

Type II DiabetesType II Diabetes Reduction in ability of most cells to Reduction in ability of most cells to

respond to insulinrespond to insulin Poor control of liver glucose outputPoor control of liver glucose output Decreased beta-cell function (eventual Decreased beta-cell function (eventual

failure)failure)

Diabetes MellitusDiabetes Mellitus

Major risk factorsMajor risk factors Family historyFamily history ObesityObesity Origin (Afro-American, Hispanic, Native Origin (Afro-American, Hispanic, Native

American, Asian-American)American, Asian-American) Age (older than 45)Age (older than 45) History of gestational diabetesHistory of gestational diabetes High cholesterolHigh cholesterol HypertensionHypertension

Diabetes MellitusDiabetes Mellitus

Prevention of effects: Prevention of effects: combination approachcombination approach Increased exerciseIncreased exercise

Decreases need for insulinDecreases need for insulin Reduce calorie intakeReduce calorie intake

Improves insulin sensitivityImproves insulin sensitivity Weight reductionWeight reduction

Improves insulin actionImproves insulin action

Triad of TreatmentTriad of Treatment

DietDiet MedicationMedication

Oral Oral hypoglycemicshypoglycemics

InsulinsInsulins

ExerciseExercise

Diabetes treatmentDiabetes treatment

ExerciseExercise Under physician supervisionUnder physician supervision Check glucose priorCheck glucose prior

Diabetes treatmentDiabetes treatment

DietDiet Lower calorieLower calorie Fewer foods of “high glycemic Fewer foods of “high glycemic

index”index” Spread meals evenlySpread meals evenly

Diabetes treatmentDiabetes treatment

Anti-Diabetic medicationsAnti-Diabetic medications Oral hypoglycemic agentsOral hypoglycemic agents

InsulinsInsulins

Stimulate pancreas to secrete insulinStimulate pancreas to secrete insulin GlyburideGlyburide

Adverse reactionsAdverse reactions HypoglycemiaHypoglycemia Water retention/edemaWater retention/edema PhotosensitivityPhotosensitivity

May need to add insulin in times of May need to add insulin in times of stressstress

InsulinInsulin

Made in Made in beta beta cells of the pancreascells of the pancreas Moves glucose into cells (thus acts Moves glucose into cells (thus acts

like growth hormone in a way)like growth hormone in a way) Moves potassium into cells (can buy Moves potassium into cells (can buy

time in emergencies)time in emergencies)

Insulin preparationsInsulin preparations

Rapid actingRapid acting Short actingShort acting

(regular)(regular) Intermediate Intermediate

actingacting (NPH) (NPH) Long actingLong acting

Some things to knowSome things to know

Insulin moves potassium into cellsInsulin moves potassium into cells Good for emergency situationsGood for emergency situations Dangerous if potassium level already Dangerous if potassium level already

lowlow

Some things to know…Some things to know…

Dawn Phenomenon vs Somogi’s Dawn Phenomenon vs Somogi’s effecteffect Dawn phenomenonDawn phenomenon

Blood sugar rises in early morningBlood sugar rises in early morning

Somogi’s (rebound) effectSomogi’s (rebound) effect Blood sugar rise in morning as reaction to Blood sugar rise in morning as reaction to

hypoglycemic time during the nighthypoglycemic time during the night

Some things to know…Some things to know…

Diabetic foot careDiabetic foot care Dry, cracked skin + poor circulation Dry, cracked skin + poor circulation

could = loss of a limbcould = loss of a limb

For the most part nurses don’t trim For the most part nurses don’t trim nails of diabetic clients. Refer to nails of diabetic clients. Refer to Podiatrist.Podiatrist.

Typical diabetic foot Typical diabetic foot ulcerulcer

Quick Quiz:Quick Quiz:

1. Give name of the very important 1. Give name of the very important anabolic hormone that builds up anabolic hormone that builds up glucose and stores it as glycogen.glucose and stores it as glycogen.

2. What is the 2. What is the usable form of sugarusable form of sugar in in the blood called?the blood called?

3. What are the cells associated with 3. What are the cells associated with insulin production called?insulin production called?

4. What is the main problem 4. What is the main problem (physiologically) that exists in people (physiologically) that exists in people that are diabetic?that are diabetic?

.5. Low blood sugar will stimulate what .5. Low blood sugar will stimulate what to be released?to be released?

6. Describe how someone would look/act 6. Describe how someone would look/act if they were hyperglycemicif they were hyperglycemic

7.Describe someone who is hypoglycemic7.Describe someone who is hypoglycemic

8. List 3 treatments/preventions for 8. List 3 treatments/preventions for diabetes and label if they are for Type diabetes and label if they are for Type 1, 2 or both1, 2 or both

9. What is the good news for diabetes?9. What is the good news for diabetes?