Health

Disease of the exocrine pancreas (e.g., pancreatectomy, pancreatitis) can result in the development of diabetes. What are the characteristics of this type of diabetes?  Both beta and alpha cells are affected, resulting in both insulin and glucagon deficiency. These patients require insulin and are at greater risk for hypoglycemia as a result of glucagon deficiency. …

Features of diabetes resulting from exocrine pancreas disease Read More »

therapeutic options available for the treatment of type 1 diabetes Patients with type 1 diabetes have deficiency of both insulin and amylin. Without insulin these patients develop hyperglycemia and ketosis (i.e., diabetic ketoacidosis). These patients typically require long-acting insulin (glargine, detemir, neutral protamine Hagedorn [NPH]) to cover basal needs and short acting insulin (i.e., lispro, …

How is type 1 diabetes treated Read More »

What are the screening recommendations and criteria for the diagnosis of diabetes?  Universal screening is recommended at age 45 years. Younger individuals should be screened if they have risk factors for type 2 diabetes (i.e., obesity, family history of diabetes, hypertension, and hyperlipidemia). Prediabetes identifies individuals at high risk for developing diabetes. American Diabetes Association …

Criteria for the diagnosis of diabetes Read More »

Role of incretins in glucose homeostasis and diabetes Oral intake of food stimulates the intestine to produce incretins (i.e., glucagon-like peptide 1 [GLP-1] and gastric inhibitory peptide). These peptides enhance insulin release, reduce glucagon secretion, and delay gastric emptying. GLP-1 has a short half-life and is degraded within minutes by the enzyme dipeptidyl peptidase 4 …

Role of incretins in glucose homeostasis and diabetes Read More »

Role of pancreatic hormones in the development of diabetes Autoimmune destruction of pancreatic beta cells results in type 1 diabetes. These patients are deficient in both insulin and amylin. Peripheral insulin resistance (i.e., reduced insulin sensitivity) followed by beta cell failure is the predominate pathologic finding in type 2 diabetes. These patients have relative deficiency …

Role of pancreatic hormones in the development of diabetes Read More »

Role of the pancreas and pancreatic hormones in glucose homeostasis Pancreatic islets (i.e., alpha and beta cells) are scattered throughout the pancreas. Beta cells secrete both insulin and amylin. Alpha cells produce glucagon. Amylin functions synergistically with insulin. It reduces plasma glucose by increasing satiety, delaying gastric emptying, and inhibiting glucagon.

General principles of glucose homeostasis Glucose is derived from dietary carbohydrates, glycogenolysis (breakdown of glycogen, which is a storage form of glucose), and gluconeogenesis (formation of glucose by the liver). Insulin, glucagon, and other hormones maintain normal plasma glucose levels.  High glucose stimulates insulin production. Insulin enhances glucose uptake, use, and storage. As a result, …

Glucose homeostasis Read More »