Homeostasis and Diabetes L3

1. Homeostasis and Diabetes L3

2. What is Homeostasis? The maintenance of a constant internal environment, despite external changes is called Homeostasis

3. What is Homeostasis? • Body cells work best if they have the correct • Temperature • Water levels • Glucose concentration • Your body has mechanisms to keep the cells in a constant environment.

4. Where is the pancreas?

5. Pancreatic endocrine functions •  cells: make insulin (stores glucose) = ¾ of the cells; secrete Insulin •  cells: make glucagon to (mobilize glucose) ¼ of the cells; secrete Glucagon • The pancreas also secretes enzymes needed in digestion

6. Insulin and the 3-”G’s” • Insulin: (anabolic). Initiates buildup of glucose to store as glycogen. • 1. Glucagon: (catabolic). Breaks down stored glycogen into glucose. • 2. Glycogen is stored form of glucose. • 3. Glucose: usable form of sugar present in blood.

7. Controlling Glucose levels • Your cells (muscles, brain, etc) need an exact level of glucose in the blood. (normal serum level 65 – 105 mg) • Excess glucose gets turned into glycogen in the liver and muscles • Blood glucose levels are regulated by 2 hormones (chemical messengers) from the pancreas called: Insulin Glucagon

8. Normal Maintenance of Blood Glucose Levels • Eat a meal: • Pancreas detects increased glucose levels in blood and secretes INSULIN • This results in uptake of GLUCOSE by: • Cells that need it for energy (including brain) • Liver and muscle cells to be stored as glycogen • Pancreas stops release of Insulin • Glucose levels return to normal (80-120)

9. Glucose levels rise after a meal. Insulin is produced and glucose levels fall to normal again. Glucose Concentration Normal Time Meal eaten

10. Normal maintenance, cont. • Insulin secretion regulated by Negative Feedbackof blood glucose levels • High blood glucose stimulates insulin secretion • Low blood glucose inhibits insulin secretion

11. Glycogen If there is too much glucose in the blood, Insulin tells the liver to convert some of it to glycogen Insulin Glucose in the blood

12. Normal Maintenance of Blood Glucose Levels, cont. • Blood glucose drops due to NOT eating • Pancreas detects and releases glucagon • stimulates the release of glycogen (broken down to glucose) • Glucose is released into the blood and levels return to normal.

13. Glycogen If there is not enough glucose in the blood, Glucagon tells the liver to convert glycogen into glucose. Glucagon Glucose in the blood

14. Normal Maintenance, cont. • Release of Glucagon also regulated by Negative Feedback mechanism sensitive to glucose levels in blood. • Low blood sugar stimulates glucagon secretion • High blood sugar inhibits glucagon secretion

15. Diabetes • Some people do not produce enough insulin. • When they eat food, the glucose levels in their blood cannot be reduced. • This condition is known as DIABETES. • Diabetics sometimes have to inject insulin into their blood. They have to be careful of their diet.

16. Glucose levels rise after a meal. Glucose Concentration Diabetic Insulin is not produced so glucose levels stay high Time Meal eaten

17. The glucose in the blood increases, Glycogen but there is no insulin to tell the liver to convert it into glycogen. Insulin Glucose concentration rises to dangerous levels. Glucose in the blood

18. Hyperglycemia= high blood glucose levels • Drowsy • Flushed • Thirsty

19. Hypoglycemia= LOW blood sugar • Glucagon: causes release of glucose from liver • breakdown of glycogen to glucose

20. Hypoglycemia • Weak, sweaty • Confused/irritable/ disoriented

21. Diabetes MellitusComplications • Major health problem US/worldwide • Complications [Poor blood vessels/circulation (PVD] • Blindness (L3: retinal proliferation, macular degeneration) • Renal failure • Amputations • Cardiovascular disease (heart attack) • Cerebrovascular disease (strokes) • [OB/neonatal complications] • Diabetic neuropathy • Erectile dysfunction

22. Diabetes Mellitus The good news: • Blood glucose control reduces complications of Diabetes!

23. What is going on? • Absence (or ineffectiveness of ) insulin • Cellular resistance • Cells can’t use glucose for energy • Starvation mode • Compensatory breakdown of body fat/protein (ketone breath: smells like alcohol)

24. Side Effects • HYPERGLYCEMIA: fluid/electrolyte imbalance. • Sodium, chloride, potassium excreted (frequent urination) • Dehydration (thirsty all the time) • cells are starving, so person feels hungry despite eating huge amounts of food. Starvation state remains until insulin is available. (eats too much)

25. Type I Diabetes • MUST HAVE INSULIN WHICH IS INJECTED!!! Can also have oral medications too to help. • Cause: autoimmune-happens at birth or by teen years. (AKA:juvenile diabetes) • Beta cell destruction in genetically susceptible person • Some viral infections: can destroy beta cells

27. Type II Diabetes • Can have insulin but usually given oral meds. • Cause/Who gets it- usually adult onset but a problem on the rise in children • Reduction in ability of most cells to respond to insulin • Poor control of liver glucose output • Decreased beta-cell function (eventual failure)

28. Risk Factors for Type II • Major risk factors • Family history • Obesity • Origin (Afro-American, Hispanic, Native American, Asian-American) • Age (older than 45) • History of gestational diabetes • High cholesterol • Hypertension

29. Preventions • Prevention of effects: combination approach • Increased exercise • Decreases need for insulin • Reduce calorie intake • Improves insulin sensitivity • Weight reduction • Improves insulin action

30. Triad of Treatment • Diet • Medication • Oral hypoglycemics • Insulins • Exercise

31. Oral medications • Stimulate pancreas to secrete insulin • Glyburide • Many others • May need to add insulin in times of stress

32. Insulin • Moves glucose into cells (thus acts like growth hormone in a way) • Needs to be injected

33. Insulin preparations • Rapid acting • Short acting (regular) • Intermediate acting (NPH) • Long acting

34. Some things to know…L3 • Dawn Phenomenon and Somogi’s effect • Dawn phenomenon • Blood sugar rises in early morning • Somogi’s (rebound) effect • Blood sugar rise in morning as reaction to hypoglycemic time during the night

35. Some things to know…L2/L3 • Diabetic foot care • Dry, cracked skin + poor circulation could = loss of a limb • For the most part nurses don’t trim nails of diabetic clients. Refer to Podiatrist.

36. Typical diabetic foot ulcer

37. Quick Quiz: • 1. Give name of the very important anabolic hormone that builds up glucose and stores it as glycogen. 2. What is the usable form of sugar in the blood called? • 3. What are the cells associated with insulin production called? • 4. What is the main problem (physiologically) that exists in people that are diabetic?

38. Quick Quiz, cont. • 5. In a normal person without diabetes, __________ ____________will result thus allowing high blood _________ to stimulate Insulin secretion. 6. Low blood sugar will stimulate what to be released? 7. Describe how someone would look/act if they were hyperglycemic

39. Quick Quiz, cont. • 8. Describe someone who is hypoglycemic 9. List 3 treatments/preventions for diabetes and label if they are for Type 1, 2 or both 10. What is the good news for diabetes?