The body has developed a complex system for feeding itself. Part of this system is designed to break down the starches and sugars which are within the foods we ingest, converting them in to our body's "basic food source", glucose.
Glucose is the basic fuel which is "burned" in the mitochondria of our cells, producing heat and charging ions which in turn helps producing cellular contraction and physical movement... (as when we move our fingers, hands, arms, or body).
Many organs are involved in this system. They include the Liver, Pancreas, muscle cells and fat cells, however one can not really separate any area of the body, since the entire body is affected by this process of energy use.
So, in diabetes mellitus, the pancreas doesn’t produce sufficient amounts of insulin, or body cells become resistant to its effects. In some cases, both abnormalities are present.
The hormone insulin enables the body’s cells to absorb the sugar glucose from the blood stream, which provides the cells with energy. Treatment aims to keep the amount of glucose in the blood within normal levels. This may be achieved through dietary measures, drug treatment or insulin injections, depending on the individual circumstances. Exercise and relaxation also help.
• What are the symptoms?
EXCESSIVE URINATION
THIRST AND DRY MOUTH
WEIGHT LOSS (especially in type 1)
BLURRED VISION
TIREDNESS
• Predisposition factors
- for type 1:
Exposure to viruses and environmental toxins (possibly)
Genetic tendency
- for type 2:
Being overweight or obese
Genetic tendency
Blood-sugar instability
Stress
Exposure to environmental toxins
DIABETES PHYSIOLOGY:
• Basics of physiology in diabetes
Glucose is the main fuel in the human body. Every cell uses glucose for energy, and some organs such as the brain rely exclusively on glucose for their metabolism. Circulation of the blood provides the transport of this important fuel. In healthy people the absorption, creation, uptake and utilization of glucose are under tight control so that the level of glucose in the blood varies only a small amount from minute to minute and from hour to hour. This ensures that every cell in the body has the amount of food it requires. Normal blood glucose is 80 milligrams per deciliter (mg/dL) or 5 millimolar (mM).
Glucose is a carbohydrate. There are three principal sources for the glucose in blood: alimentary glucose from the breakdown of dietary carbohydrates in the gut, glucose released from stores in the liver, and glucose made from protein in the liver. As shown in the diagrams below when you eat glucose is taken up in the gut and transported to the liver. The liver acts as a reservoir for glucose for maintaining the constant concentration of glucose in the blood. Excess glucose is taken up by the liver and stored as glycogen or converted to fat. Between meals the liver maintains the blood glucose concentration by breaking down the stored glycogen.
Insulin is the hormone that tells the liver when to take up glucose and when to release it into the blood. Regulating blood sugar is the primary effect of insulin, and it occurs quickly, on the order of minutes. Insulin also has growth promotion (or mitogenic) effects; these take hours to induce and last hours to days. As we will discuss below, insulin is produced in the pancreas by specialized cells that maintain stores of this protein for quick release after a meal.
Blood circulation also provides for the transport of insulin from the pancreas to the liver and on to the rest of the body. This is demonstrated on the diagram to the right, showing a simple scheme of general circulation. It is well known that blood is pumped twice by the heart, once to perfuse the lungs (for gas exchange) and once to perfuse the rest of the body. It is less well known that blood sometimes passes through two tissues in sequence before returning to the heart.
Called 'portal' circulation, the most important of these systems involves the liver. In the diagram note that the vascular bed labeled "intestinal circulation" (which includes the pancreas) drains to the liver. The portal vein is colored purple in the diagram. The liver in perfused by two sources: blood fresh from the heart through the hepatic artery and as well as blood rich with newly absorbed nutrients through the portal vein.
•The gut.
The gut absorbs food carbohydrate including glucose (and other nutrients). It is relatively quiescent when there is no food. At left are shown the principal components of the gastrointestinal tract. All blood from the gut is collected in blood vessels in mesenteries and goes first to the liver via the portal vein before going on to the blood pool. The liver is privileged to receive nutrient enriched blood before the rest of the body.
• The Liver.
For diabetes metabolism, the important points are:
• insulin passes first through the liver
• food nutrients pass first through the liver
(The Islet Sheet is designed to deliver insulin into the portal circulation. Any site in the abdomen can work. We think that suturing the sheet to a mesentery is promising. A large mesentery with the special name omentum, which wraps around the stomach (not shown in the diagram), is the most promising of all.)
The central actor in stabilizing blood sugar is the liver; it has been called the glucostat of the organism. After a normal carbohydrate-rich meal, it removes about 50% of the excess nutritional glucose to synthesize liver glycogen and to synthesize fat. Glycogen is a polymer of glucose that is readily mobilized from stores in the liver. It is very similar to muscle glycogen. During the short fast between meals or a longer fast for several days, as well as during exercise, the liver supplies over 90% of the glucose needed by the body cells via glycogenolysis (mobilization of glycogen) and gluconeogenesis (metabolic conversion of protein to glucose).
The short-term regulation of carbohydrate metabolism is the reversible shift from glycogen synthesis and glycolysis to glycogenolysis and gluconeogenesis. Three major factors are involved in the regulation of this balance: substrate concentrations, hormone levels, and activity of hepatic nerves. The longer-term, day-to-day control of carbohydrate metabolism is determined by whether the food carbohydrate supply falls short of or exceeds metabolic needs. In healthy metabolism excess fuel decreases appetite and increases metabolic rate. Put simply, excess fuel is burned. The major site of this activity is brown fat, a type of fat cell that uses "futile cycles" of metabolism to convert glucose into CO2 and heat.
The diagram at the left shows how the pancreas relates to the liver. 98% of the secreting cells in the pancreas make digestive enzymes that go to the intestines via the pancreatic duct. The remaining 2% of the cells, in the islet of Langerhans, make hormones that are secreted into the portal vein. (The endocrine system is the set of ductless glands that add hormones to blood; these include the adrenals and pituitary as well as the islets of Langerhans.)
• The Islets of Langerhans
The islets of Langerhans, found in the pancreas, have a special role in glucose control. They function as a glucose sensor, releasing insulin when blood glucose passes above 80 mg/dL and glucagon when glucose passes below 80 mg/dL. All insulin secreted by the islets passes through the liver where most is absorbed. Uniquely among peptide hormones, much of the absorbed insulin is returned to the blood after passing through liver cells. However, insulin has many effects on the liver as it passes through. It suppresses production of new glucose by glycogenolysis and gluconeogenesis and enhances uptake of glucose and its conversion to glycogen and fat. Furthermore insulin enhances th
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