Diabetes Mellitus is a metabolic disease in which the patient blood glucose level goes higher due to two possible reasons:
- Pancreatic cells called beta cells stops producing enough Insulin,
- Cells are not responding to the hormone insulin.
Insulin is a peptide hormone produced by the beta cells of the pancreases, which regulates the metabolism of carbohydrate and fat in the body. It helps the cells except brain cells to uptake the blood glucose through the glucose transporter. Insulin activates the insulin receptor, which in turn actives the glucose transporter.
Based on the insulin failure, there are three main types of Diabetes mellitus:
Type I Diabetes Mellitus (Insulin Dependent Diabetes Mellitus)
The patient’s body fails to produce insulin because the beta cells of the islets of langerhans are destroyed by the self immune cells like T cells or genetic defects in beta cells function. Therefore it is considered as autoimmunity disease.
Type II Diabetes Mellitus (Non Insulin Dependent Diabetes Mellitus)
The patient’s body fails to accept the insulin produced by the beta cells of the islets of langerhans, because the target cells lose their sensitivity, which often referred as insulin resistance.
Blood Glucose Profile:
The normal blood glucose level before and after the meal is 70 -110 mg/dL and 140 mg/dL.
In Type I diabetes: after the meal the level increases to 162 mg/dL.
In Type II diabetes: after the meal the level increases to 153 mg/dL.
Apart from increase in blood glucose level, there is also increase utilization of fats for energy and for formation of cholesterol by the liver and also depletion in body’s proteins.
Ketone bodies à Ketone bodies produced from acetyl CoA, which is excessively formed by the breakdown of fatty acids by β oxidation for energy production. Since NADH levels increases, Citric acid cycle shuts down and therefore acetyl CoA cant enter the cycle. But they take another route and form three endogenous ketone bodies: acetone, acetoacetic acid, and beta-hydroxypentanoate. In normal condition, their level in blood is maintained at 1 mg/dL. If it increase beyond this, then it leads to ketosis (Ketonemia and Ketouria).
Ketosis or ketoacidosis leads to damage of organs as well as lowers the pH in blood.
The lipid profile of a normal person is
Total Cholesterol à 150-250 mg/dL
LDL: 130 mg/dL
HDL: For men: 30-60 mg/dL; For women: 40-70 mg/dL
TG: 10-190 mg/dL
LDL (bad cholesterol) is elevated in the blood of diabetic patient, but HDL (good cholesterol) is found less compared to the normal. Elevated LDL causes atherosclerosis, and leads to blockage of blood vessels to heart. Therefore, diabetic patients are more prone to heart attack.
High level of glucose in the bloods shows three basic symptoms in the diabetic patient:
Polyuria à Frequent urination
Polydipsia à Increased thirst
Polyphagia à Increased hunger
What is the reason behind the occurrence of these symptoms in diabetic patient?
Polyuria and polydipsia: Glucose does not diffuse easily through the pores of the cell membrane and the increase osmotic pressure in the extracellular fluids causes osmotic transfer of water out of the cells. And also due to excess of glucose in blood, it leads to lose of glucose in the urine. Therefore even the presence of glucose in the renal tubules greatly decreases the tubular readsorption of fluid.
So overall there is excessive loss of fluid in urine causing frequent urination and dehydration which eventually increases the thirst also.
Polyphagia: Due to the failure of glucose utilization, the body starts to increase the utilization of protein and fats for energy. Therefore rapid weight loss and increase in apatite leads to polyphagia.
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