(DM) Diabetes Mellitus:
DM: Storage of Glucose:
A Complex & chronic Disorder
t/f once they have it è IT is
Incurable & Characterized by
ABN’LLY Elevated levels of
Glucose in the Blood
(hyperglycemia)è resulting from
1) Insufficient insulin production
from the pancreas or 2) from
insulin resistance of the cells of
the body
Diabetes is characterized by a
level of Glucose in the blood that
is above the NL parameters
UNLESS appropriate trx’t is
instituted
WHO dx’c Criteria for DM:
o 1) Fasting Blood Glucose
level = ≥126 mg/dL
o 2) Random (pt is not fasting)
blood Glucose of >200
mg/dL
o 3) Pre-Diabetes (impaired
Glucose Tolerance) --a 2 hr
Blood Glucose Tolerance
Test (OGTT) of ≤200 mg/dL
N’lly: blood glucose levels: 70-100
mg/dL
Prediabetes means that pt’ 3’s in a
gray are & have NOT reached the
126 mg/dL criteria level for
Diabetes
FBG = 100-125
2HR fast = 140-199 – pt heading
toward Developing DM’s
DM’s dx’c criteria = 129-146 mg/dL
Feedback Mechanism in
Maintenance of B.G. Levels:
1) Insulin is secreted è blood
stream in response to food
intake & digestion which
causes the BG levels to rise
2) Amount of Insulin secreted
depends on the amount &
type of food(s) eaten t/f
CHO’s causes a higher ↑ in
BG levels than do Fats or
PRO’s
In persons who DO NOT have
Diabetes & have N’LLY fx’ning
pancreases: IT is almost IMPOSSIBLE
to raise BG levels above NL values no
Physiology of DM:
Pancreas is located below & behind the
stomachà weighs about ½ lb àresembles an
elongated cone on its side à broadest part of
organ = HEAD & next to the curve of the
duodenum) à tapers off to a point = TAIL &
near the spleen & L-kidney
Pancreas – functions: Important for NL
Homeostasis
Exocrine: pancreas secretes “pancreatic
Juices” for digestion
**Endocrine: (ċ DM’c is the MAIN FACTOR)
pancreas manufactures & Secretes the
hormone insulin fromà Beta cells = beta’s are
located in the Islets of Langerhans (mostly
found in the TAIL of the pancreas)
**Beta Cells: What they do:
1) Manufacture Insulin in the pancreas
– a very important fx’n àdamage to
Beta’s means NO more Insulin
prodx’n
2) Senses blood sugar/glucose levels
& levels in blood tells Beta cells how
much insulin to produce
Determines the amount needed to be released
and secretes the correct amount
Types of DM: Type I:
Presently referred to as: AutoImmune Diabetes
of Adulthood (LADA)
1) Result of: significantly ↓’d or absent insulin
prodx’n by the Pancreas t/f is a BETA Cell
issue where they probably stopped
producing insulin or not enough insulin/↓’d
amounts of insulin>>even c some Beta’s
fxn’ing >>eventually all BETA’s stop
functioning hence –Insulin Dependency
2) Type I DM Occurs = b/c the beta cells Stop
fxn’ing
3) Theory it is an Autoimmune process b/c
N’lly the body’s Immune system directs
antibodies against foreign substances but in
Type I DM the body directs antibodies
What does Insulin do, exactly?
1) Glucose ingested: the digestive
process transfers Insulin from the GI
tract to the blood stream. Glucose is
derived from our diets = the result of
CHO (98%), PRO (59%) & Lipid (10%)
& in the process is converted to glucose
2) Once the Glucose enters the
bloodstreamà it needs to enter body
cells to provide them c the energy they
need to fx’n
3) INSULIN: is needed to signal the cell
membrane to allow glucose to enter
body cells by way of the Insulin
receptors
4) by Insulin receptors: Insulin acts on
cell receptors in order for glucose to
enter the cells, insulin literally unlocks
the cell receptors, and Insulin mediates
glucose’s entry into the cell
WHY Important c type I or II DM?
the pt doesn’t have enough Beta Cell fx’n t/f
glucose is unable to enter the cells, Serum
Glucose levels rise b/c Insulin is not present
to lower it back down to a NL or a problem c
increased Insulin Resistance àenough
insulin produced BUT the cells b/come
resistant to UNLOCKING the Cell’s Insulin
receptors to let glucose in
Types of DM: Type II DM’sà Formerly called
Non-Insulin Dependent DM
1) NIDDM Caused by: resistance of cell of the
body to the NL actions of Insulin. The
Pancreas secretes a ↓’d amount of Insulin, a
NL amount of Insulin or an ↑’d amount of
Insulin
2) Insulin resistance: Only a couple of the
Insulin Cell Receptors are fxn’ing on the cell
verses All should be fxn’ing t/f NOT a lot of
glucose enters the cells b/c their body cells
are resistant to the action of Insulin or are
Insulin Resistant
Less glucose enters cell & more stays in
the Blood stream b/c BETA’s eventually
wear out from overprodx’n of Insulin d/t
If glucose gets into the cell c a NL fx’ning pancreas the
body simply req’s no more glucose at a certain level & Ĉ
the help of INSULIN; any excess Glucose that is not
needed for cellular fx’ning is stored in 3 areas of the body:
1) Liver: glucose àconverted to glycogen
2) Muscle tissue àstored as glycogen
3) Adipose tissue à Insulin promotes the entrance of
glucose into FAT cells for fuel & promotes the storage of
fat in adipose tissues
DM: Storage of Glucose: ALPHA CELLS of Pancreas:
**Release GLUCAGONàGlucagon raises blood
glucose levels by stimulating the liver to release
stored glucose (glycogenolysis) &/or produce
glucose (gluconeogenesis)
Glucagon acts to chiefly Raise blood glucose levels by
converting glycogen to glucose in the liver. B’s pg 1346
**Note any problem c the following will create a problem c
BG levels
Alpha Cells of pancreas: Releases Glucagon to raise
BG levels by stimulating the Liver to releases its stored
glucose (glycogenolysis) &/or for the liver to produce
glucose (gluconeogenesis)
The ANS: Epi gets released in response to low BG levels
to stimulate the release of Stored Glucose from the
Muscles or Liver t/f the ANS pulls from the body
reserves/stores of Glucose into the blood stream to try to
raise the BG levels
Delta Cells: they produce the hormone Somatostatin
and this controls & regulates the levels of Insulin &
Glucagon in the body t/f Delta cells & Somatostatin stops
prodx’n & “pulling from body reserves” of insulin &
glucagon è a finely tuned mechanism of interactive
processes (yields a Hypoglycemic effect on prodx’n)
Other DM Classifications:
1) DM d/t 2’dary causes:
Pancreatic ca: tumor grows in pancreas & destroys the
Beta cells t/f no longer properly fx’n è Pancreatitis:
infx’n & inflammation inhibits physiological fxn’ing of
the pancreas èSurgical removal of pancreas: c
surgical removal of pancreas NO more insulin is
produced t/f pt is NOW an INSTANT Diabetic!! è
Rx’s can cause Temporary DM – until the Rx’s are
D/C’d (often pt on L-Term steroids dev. A 2’dary DM
b/c of it
2) Impaired Glucose Tolerance: BG levels elevated
above NL but are not elevated enough to be definitely
dx’d c DM –formerly known as
Created by: Karen Eberhardt, 6/2008

Yellow Highlighter for Headings; Blue is for “Mrs. T.” lecture = Key points & Pink highlighter = Key factors/differences to make special note
Key notes to abbreviations: ex [glucose] = glucose concentration, [blood] blood concentration; BG or BS = Blood glucose or blood sugar,
DM = diabetes or DM’c = diabetic; ** this Greek letter à φ is used for the word = after; C/V or N/V= cardio vascular or neurovascular;
MICRO/V & MACRO/V = micro & macro Vascular