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Diabetes Mellitus & and Management
Diabetes Mellitus & and Management
Diabetes Mellitus & and Management
and Management
Presented by Dr Phanavarine.
Advisor: Bun Se. Leang,MD
bloodstream.
-
+
- -
+
+ Insulin
Ca2+
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Basal insulin secretion
Pacemaker
Ca2+ channel closed and no insulin
ß cells
secretion. Pacemaker beta cells
stimulate every 10 minutes the voltage
gated Ca2+ channel => open => insulin
is released ~ 20 units daily (50% of daily
need).
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The Bi-phasic Insulin Response
1st phase, rapid burst first few min.
Usually responds to G, aa,
sulfonylurea, glucagon and
gastrointestinal (GI) hormones.
Insulin
GLUT4 vesicle mobilization
to plasma membrane
GLUT4 vesicle
integration into
plasma membrane
Glucose entry into cell
GLUT4=Glucose Transporter 4 Glucose
via GLUT4 vesicle
Type 2
30% 50% 50% diabetes
Impaired
70% 150% 10%
glucose
metabolism
100% 100% Normal glucose
metabolism
Intermediate (minutes):
• Stimulation of protein synthesis
• Inhibition of protein degradation
• Activation of glycogen synthase and increased glycogenesis
• Inhibition of phosphorylase and gluconeogenic enzymes
(decreased gluconeogenesis)
• Carbohydrate Metabolism
• Protein Metabolism
• Lipid Metabolism
ß cell Destruction
Type I DM
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Pathogenesis of Type II DM
ß cell defect Environment
Genetic Obesity
Normal glucose
100% 100% Metabolism
(≥ 2x)
≥ 100 ≥100 ≥ 99
and <126 and < 126
< 140 ≥ 140 and or ≥ 144
(≥ 2x)
< 200
• The reaction is slow and irreversible, the rate is proportional to the glycemia levels
over the 120 days life of RBC. Non-diabetes have HbA1C ~ 3-6.5%.
• Thus, its value reflects chronic glycemic control over the past 3-4 months.
• Any condition that alters erythrocyte turnover lowers HbA1c levels (i.e., bleeding,
pregnancy or splenectomy).
• On the other hand, uremia, fetal Hb, aspirin or high levels of ethanol may falsely
elevate levels of HbA1c.
• These interfering substances do not affect HbA1c levels measured by more specific
methods such as affinity chromatography.
strike diet/exercise
-fine out of injection, IHD, …
Jul 9, 2022
29-Apr-06 Sihanouk HospilalCenter
Sihanouk Hospital CenterofOf Hope
HOPE 60 53
Sulfonylureas
• Sulfonylureas stimulate the beta cells of the
pancreas to release more insulin.
• This drugs have been in use since the 1950s.
– Actions- increased insulin secretion
– Phamacokinetic- metabolized by liver and excreted by
kidney.
– Side effects- increased risk of hypoglycemia, weight
gain.