The overall simplified action of insulin is to promote the uptake of nutrients in the feeding state and to promote the release of nutrients in the fasting state.
Feeding State
Insulin
Glucagon
Fasting State
Insulin
Glucagon
Effects on Liver
Increase in Glycogen synthesis
Increase Glucose use
Increase Glucose transport
Stop Glucose release from liver
Liver
Effects on Liver
Increase in Glycogen breakdown and release of Glucose to circulation
Activation of new Glucose synthesis and release
Effects on Fat Cells
Increase in Glucose uptake
Increase in Triglycerides uptake
Increase in fat synthesis
Fat Cells
Effect on Fat Cells
Increase in Fat Breakdown
Fatty Acids Oxidation
Effects on Muscles
Increase Glucose uptake
Increase Amnio Acids transport
Increase in Protein Synthesis
Muscle
Effects on Muscles
Stops Glucose uptake by Muscles
Increase in protein Breakdown
Simplified Classification of Diabetes Mellitus
Type I ( 5-10% )
Usually Young and Thin patient
The Beta cells in the Pancreas are destroyed by:
In Type I A: there is self destruction by auto-antibodies facilitated by genetic factors
In Type I B: No antibodies are found in the blood and the B cell destruction is caused by infection, drugs, neoplasm and chronic pancreas inflammation from any cause
There is Total loss of insulin production
Total Insulin Depletion
Type II ( 90-95% )
Usually Middle aged or older & overweight
There is slow decrease in the Pancreas ability to make and release Insulin associated with insulin action resistance made worse by obesity, muscle loss and inactivity
Decreased & Less effective Insulin
Organ
Chronic Changes
Acute Complications
Eye
Diabetic retinopathy is the leading cause for blindness
Its severity and progression depends on the duration and the level of sugar control, the presence of uncontrolled hypertension or hypercholestrolemia
It can cause:
A- Proliferative vascular changes in the vitrous
B- Non proliferative changes including micro aneurysm, bleeding and exudate
Intraocular hemorrhage
Retinal detachment
Vision loss
Nerves
Diabetic Neuropathy usually affects hands and feet
It causes pain, burning and tingling
If larger nerve are affected it may cause loss of position sensation, vibration and light touch
Autonomic Neuropathy can cause Gastrointestinal (Gatstroparesis or Diarrhea), urinary. (Bladder and Erectile dysfunction) heart symptoms (dizziness)
Intractable nerve pain
Dizziness and other autonomic nerve dysfunction symptoms
It can mask a heart attack
Heart
Diabetes is an independent risk factor for Coronary Heart disease
It increases the risk for atherosclerosis and narrowing of the coronary arteries
Chest pain can be atypical or masked by diseased nerves
Chest pain/Angina
Heart Attack
Kidney
Diabetic Nephropathy is the leading cause of end stage kidney disease
Uncontrolled hypertension is another important cause and works in harmony with Diabetes in damaging kidneys
Kidney failure and need for dialysis
Heart Attack
Vessels & Circulation
The Major burden of long standing uncontrolled Diabetes is the development of micro vascular disease leading to Eye, Kidney and Nerve disease.
In addition it affects the Coronary and Cerebral arteries
Any vital organ sudden decrease in circulation leading to major presentation like stroke or heart attack
It may cause legs poor circulation and Diabetic Foot Ulcer