- How many Years?
- Note the medicines
- Is the blood sugar controlled
- Latest report of BSL- F&PP
- Adv- GHb A1C
- What are the complaints?
Diabetes mellitus is defined as a state of chronic hyperglycemia with disturbances
of carbohydrate, fat & protein metabolism due to insulin deficiency or its‟ action.
Pancreas
Is situated in the C of duodenum. It has Endocrine & Exocrine functions.Exocrine function is to
secrete digestive enzymes. Endocrine function is to secrete hormones. (Endocrine gland is the
gland which secretes hormone which
is released in blood)
Endocrine part is 1% of weight of Pancreas. out of which 70% constitute Beta cells which secrete
Insulin. 25% are alpha cells which secrete Glucagon. 5% are Delta cells which secrete
Somatostatin.
Insulin
Is a polypeptide hormone, secreted by Beta cells of islets of Langerhans. It is released in the
venous (portal) blood in response to increased blood glucose, amino acids, & small intestine
secreting gut hormones called Incretins.
(GIP - Gastric inhibitory polypeptide & GLP 1 - Glucagonlike polypeptide )
- 50% of Insulin is taken up by the liver & the remaining is circulated in the body.
- Other two main target organs for Insulin are muscles & adipose tissue.
- Its action is receptor mediated. The receptor is a cell membrane protein to which Insulin binds & activates it.
- Activated Insulin receptor brings about its multiple actions by activating one enzyme.
- It has actions on all three metabolisms, namely Carbohydrate, Fat and Proteins
Actions of Insulin on, Carbohydrate metabolism
a) It allows the entry of Glucose inside the cell.
b) Muscles use glucose for energy supply. (Instead of fatty acids)
c) It promotes Glycogenesis. synthesis of glycogen from glucose
d) It prevents Glycogenolysis i.e., Breakdown of glycogen into glucose
Lack of Insulin or its action causes high blood Glucose Level Complications-Diabetes Mellitus with uncontrolled blood sugar leads to many complications.
- They are classified as micro-vascular-(Due to damage to capillaries) Nephropathy,
Retinopathy & Neuropathy leading to kidney failure, blindness or nerve pain.
- Other group is macro-vascular-(Due to high levels of Cholesterol enhancing Atherosclerosis)
Coronary artery disease,
Cerebrovascular accident, Peripheral vascular disease which leads to heart attack, stroke,
and death of any part of body
These complications are not reversible, hence, should be prevented by strict glycemic
control.
Type II DM is well managed by
- Proper diet,
- Moderate exercise
- Medicines
- Medical Yoga therapy.
One can lead a
normal life with a disciplined approach.
Proper diet suggested is 50-60 % of complex carbohydrates with low glycemic index, 15-20 %
proteins, 10% fat which has minimum saturated fatty acids, rich in omega 3 fatty acids, in
addition, food should have ample amount of fibers.
Glycemic Index is the degree of hyperglycemia, plotted against time, with reference to one
fixed carbohydrate substance (white bread) e.g., Potato/ Corn flex 80-90, White rice 70-80,
Brown rice 60, Wheat, peas 50, Legumes, milk, peanuts 40
Trans fatty acids lead to rapid synthesis of cholesterol ( They are formed by reheating the
oil again and again) hence should be avoided ).
Selective vegetables which have a lot of fibers, lead to excessive bile secretion which
leads to excretion of cholesterol.
Exercise advised is brisk walking for 20-30min.
Medicines advised by physician should never be stopped