Diabetes

Table of Contents
Overview Introduction to Diabetes Mellitus Video Islets of Langerhans Pancreatic Islet Alpha Cell Stimulation Pancreatic Islet Beta Cell Stimulation Diabetes: Effects of Insulin Deficiency Diabetes mellitus Type I Treatment for Type 1 Diabetes: Overview Video Type II Treatment for Type 2 Diabetes: Overview Video Properties of Type I Diabetes Catabolic Disorder Possible Causes Autoimmune Mechanism Pancreatic Beta-Cell Destruction Prediabetic Stages Immune-Directed Pancreatic beta-cell destruction Overview of Clinical Presentation: Type I Diabetes Type 1 diabetes: Sam's story--patient perspective Onset Symptoms secondary to hyperglycemia Acute metabolic decompensation Causes of diabetic ketoacidosis Clinical manifestations of ketoacidosis Diagnosis of ketoacidosis Treatment of ketoacidosis Treatment response Outcome Properties of IDDM and NIDDM Late Complications of Diabetes Circulatory Abnormalities Retinopathy Nephropathy Treatment Foot Ulcers Autonomic Dysfunction Properties of Type II Diabetes Pathophysiological Phases Clinical Presentations Presenting Syndrome Syndrome properties Prognosis Treatment of Hyperosmolar States Type II Diabetes Treatment Overview Insulin Overview Insulin: Two Chains Secretion Proposed Mechanism Insulin Degradation Insulin Receptor Composition Activation Altered affinity Target Sites Glucose Transporters GLUT 4 Table Summary : Endocrine Effects of Insulin on Liver, Muscle, and Adipose Tissue Liver Hepatic Insulin Actions Mechanisms for insulin-hepatic actions "Fed" state repression of gluconeogenic enzymes Other hepatic effects Muscle Adipose Tissue Effect on free fatty acid	Insulin Preparations Four principle types Insulin modifications Subcutaneous insulin therapy Ultra-short acting Short-acting Clinical Use Intermediate- and long-acting insulin NPH insulin Insulin mixtures Insulin Species Beef and pork insulins Human insulins Human proinsulin Delivery systems Insulin Treatment: Overview Glycemic Control Complications of insulin treatment Hypoglycemia Autonomic hyperactivity Treatment Insulin: Immunopathology Oral hypoglycemics: Categories Sulfonylureas Table of Soulfonylureas Tolbutamide (Orinase) Chlorpropamide (Diabinese) Tolazamide (Tolinase) Acetohexamide Second Generation Sulfonylureas Glyburide (Micronase, DiaBeta) Glipizide Glucotrol) Glimepiride (Amaryl) Secondary Failure and Tachyphylaxis to Sulfonylureas Combination of sulfonylureas and insulin Biguanides Metformin (Glucophage) Proposed Mechanism of Action Clinical Use Toxic/Adverse Effects Contraindications Alpha-glucosidase Inhibitor Acarbose Adverse Effects Thiazolidinedion Derivatives Rosiglitazone (Avandia) Pioglitazone (Actos) Glucagon Overview Pharmacological Activity Consequences Cardiovascular Smooth Muscle Glucagon-clinical use Glucagon adverse effects

Islet Cells: Insulin and Glucagon Localizations

Left- anti-insulin stain, Right- anti-glucagon stain KUMC Pathology and the University of Kansas, used with permission; courtesy of Dr. James Fishback, Department of Pathology, University of Kansas Medical Center.

Pancreatic Islet Alpha Cell Stimulation

"Inputs to alpha cells and effects of glucagon, including negative feedback, which increases plasma glucose levels" courtesy of Robert H. Parsons, Ph.D., Rensselaer Polytechnic Institute, used with permission

Pancreatic Islet Beta Cell Stimulation

"Inputs to beta cells and effects of insulin, including negative feedback on glucose and amino-acids levels. " courtesy of Robert H. Parsons, Ph.D., Rensselaer Polytechnic Institute, used with permission