PENYAKIT AKIBAT GANGGUAN

METABOLISME KARBOHIDRAT
 OVERVIEW DIABETES MELLITUS
INTRODUCTION
➢Diabetes mellitus (DM) → a group of metabolic disorders characterized by a chronic
hyperglycemic condition resulting from defects in insulin secretion, insulin action or
both.

➢DM is probably one of the oldest diseases known to man. It was first reported in
Egyptian manuscript about 3000 years ago.

➢ In 1936, the distinction between type 1 and type 2 DM was clearly made
 OVERVIEW DIABETES MELLITUS
EPIDEMIOLOGY

• The worldwide prevalence of diabetes has continued to increase dramatically. Globally, as of 2011, an estimated 366 million
people had DM, with type 2 making up about 90% of the cases.
• The number of people with type 2 DM is increasing in every country with 80% of people with DM living in low- and middle-income
countries
 OVERVIEW DIABETES MELLITUS

• A fundamental mechanism for the maintenance of glucose homeostasis is the rapid action of insulin to stimulate glucose
uptake and metabolism in peripheral tissues.
• Resistance to the actions of insulin in skeletal muscle is a major pathogenic factor in type 2 or type 1 diabetes mellitus
Insulin
Definitions and Concepts
Insulin → a peptide hormone secreted by the β
cells of the pancreatic islets of Langerhans and
maintains normal blood glucose levels by
facilitating cellular glucose uptake, regulating
carbohydrate, lipid and protein metabolism and
promoting cell division and growth.
 Biosynthesis of
Insulin
 Insulin is synthesized in the β cells of pancreas in the form of
preproinsulin → discharged into cisternal space of rough ER →
cleaved into proinsulin by proteolytic enzymes → Proinsulin with a
C-chain linking A & B chains then transported by microvesicles to
the Golgi apparatus → Proinsulin is released in vesicles →
maturing granules by prohormone converatse 2 & 3 and carboxy
peptidase → Insulin
Regulation and Mechanisms of Insulin Secretion at the Cellular Level

Synthesis and secretion of insulin is regulated by both nutrient and non-nutrient secretagogues

Nutrient secretagogues → Glucose → trigger insulin secretion from the β cell by increasing
intracellular ATP and closing of K+-ATP channels.

Non-nutrient secretagogues → Neural stimuli such as cholinergic and adrenergic pathways, or

through peptide hormones and cationic amino acids.
Insulin Secretion
 Insulin secretion
• Insulin release is not continuous
even after a meal but oscillates
with a period of 3-6 minutes:
spurts of insulin release.

• This oscillation is important to

consider when administering
insulin-stimulating medication as
oscillation is the target & not a
constant high concentration.
 ACTIONS OF INSULIN
WHAT IS THE OBJECTIVE OF INSULIN ? Insulin is an ANABOLIC hormone
↓ Insulin has important effects on:
It is to maintain blood glucose homeostasis! - CHO
INSULIN IS THE ONLY HORMONE CAPABLE OF - Fats
LOWERING THE BLOOD GLUCOSE LEVEL.
- Proteins
It LOWERS blood glucose levels of:
- Glucose
- fatty acids
- amino acids
It is a hormone associated with ENERGY ABUNDANCE
& the FED STATE.
 Most Cells  amino
 Protein synthesis acids
Insulin Muscle
Control  Glucose uptake
 Glycogen synthesis
Gastrointestinal
hormones
Adipose  triglycerides
 Glucose uptake
 Glycerol production
 Triglyceride breakdown
Amino
Pancreas  Insulin  Triglyceride synthesis
acids
Beta cells
Liver
Blood  Glucose uptake  glucose
glucose  Glycogen synthesis
 Fatty acid synthesis
 Glucose synthesis

Brain
No effect

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