COURSE WEB ADDRESS

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COURSE WEB ADDRESS

• http//foodsci.rutgers.edu/fs104/

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Diabetes

• Lecture 18
• March 31, 2008
• Dr. Quadro

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Cell Theory

• 1) Every organism is composed of one or more
  cells.
• 2) A cell is smallest unit having the properties
  of life.
• 3) Continuity of life arises from growth and
  division of single cells.

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Cell

• Smallest unit of life.
• Can survive on its own or has potential to do so.
• Is highly organized for metabolism.
• Senses and responds to environment.
• Has potential to reproduce.

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What does a cell do?
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Structure of Cells

• Plasma membrane
• Cytoplasm
• Nucleus (compartment where DNA is stored)

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Structure of Cells

• Plasma membrane
• Cytoplasm
• Nucleus (compartment where DNA is stored)

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Structure of Cells

• Plasma membrane
• Cytoplasm
• Nucleus (compartment where DNA is stored)

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Plasma Membrane
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Diabetes is

• an individual cannot regulate blood glucose
• levels due to lack or ineffectiveness of insulin
• abnormally high levels of glucose in blood
• the true cause continues to be a mystery,
  although both genetics and environmental factors
  such as obesity and lack of exercise play roles

American Diabetes Association www.diabetes.org
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Diabetes Symptoms

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

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Pancreas

• Produces hormones
• insulin glucagon - help regulate many aspects
  of our metabolism
• Insulin is a hormone that is needed to convert
  sugar, starches and other food into energy needed
  for daily life.

Behind your stomach
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Maintaining the Blood Glucose Level

• Insulin a hormone secreted by the pancreas in
  response to high blood glucose levels it assists
  cells in drawing glucose from the blood.
• Glucagon a hormone released by the pancreas that
  signals the liver to release glucose into the
  bloodstream.
• Glycemic effect the effect of food on a persons
  blood glucose and insulin responsehow fast and
  how high the blood glucose rises and how quickly
  the body responds by bringing it back to normal.

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Blood glucose regulation
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Blood glucose regulation
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Relative Blood Levels Glucose, Insulin, and
Glucagon
After a meal ingestion of carbohydrates,
including sugar blood sugar rises
Insulin is released when blood glucose levels
rise Enables body to use and store the glucose
Glucagon released when stores are low and liver
breaks down stored glycogen
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Insulin Synthesis

• Produced by beta cells in pancreatic islets
• Produced as a single polypeptide that is cleaved
• BOTH mature insulin and connecting peptide (C
  peptide) have biological activity
• C peptide stimulates nitric oxide production by
  endothelial cells
• Insulin binds surface receptors on responsive
  cells for biological effects

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Extracellular space
Intracellular space
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Insulin-Insulin Receptor and GLUT4

• GLUT4 is a facilitative transporter for glucose
  uptake from the circulation, carrying it
  primarily into adipose tissue and skeletal muscle
• Translocation of GLUT4-containing vesicles is a
  key insulin-mediated event essential to glucose
  homeostasis
• GLUT4-containing vesicles translocate from the
  cytosol to the plasma membrane in response to
  insulin via the action of a number of
  docking/fusion proteins
• When plasma glucose levels fall, GLUT4
  transporters are removed from the plasma membrane
  by endocytosis and recycled back to their
  sequestered intracellular locations

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Insulin Resistance and Diabetes

• Normal Condition Insulin signaling results in
  glucose transporter
• (GLUT4) translocation from intracellular storage
  sites to the
• cell membrane (muscle, adipose tissues).
• Type I diabetes insulin-dependent. Lack of
  insulin due to the
• destruction of the pancreatic ?-cells.
• Insulin resistance the inability of maximal
  concentration of
• insulin to appropriately stimulate muscle glucose
  transport and
• other physiological responses.
• Type II diabetes insulin-independent. A global
  disorder of
• insulin signal transduction that ultimately
  dysregulates cell
• function in a wide range of tissues.

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Type I vs. Type II Diabetes
Type 1 Insulin Dependent
Type 2 Non- Insulin Dependent
Incidence

• 5-10 of cases
• Pancreas unable to make insulin to meet needs
• Genetic predisposition environmental factors
• Insulin injections
• Dietary Intervention
• Reduce the amount of simple sugars
• Eat foods w/ dietary fiber
• Person will lose weight

• 90-95 of cases
• Maybe insufficient insulin or cells maybe
  unresponsive to insulin
• Genetic predisposition obesity
• Dietary intervention
• Weight loss intervention
• Person is always hungry
• Increase in obesity

Insulin
Risk factor
Treatment
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Magnitude of Diabetes

• Americans with diabetes
• 18.2 million or 6.3 of the population

Those who know ? 13 million who have been
diagnosed (2/3rd)
Those who dont know ? 5.2 million people
(1/3rd) who are unaware
UN- AWARE
AWARE
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MORE Magnitude of Diabetes

• one in every 400 to 500 children and adolescents
  has type 1 diabetes
• 210,000 people under 20 (0.26 of population)
• 60 years or older 8.6 million
• 18.3 of all people in this age group have
  diabetes
• type 2 diabetes is becoming more common among
  Native American/American Indian, African
  American, and Hispanic and Latino children and
  adolescents

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Why is Type II an Epidemic?

• 130 billion dollars of health care costs
• 5th leading cause of death in the US
• Number of new cases rising
• 1990 ? 4 2001 ? 7.9
• of the children born in the year 2000,
• 1 out of 3 will suffer from diabetes at some
  point
• Within a couple of decades, predicted to affect
  at least half a billion people

http//www.ncbi.nlm.nih.gov/books/bv.fcgi?riddiab
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http//www.ncbi.nlm.nih.gov/books/bv.fcgi?riddiab
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http//www.ncbi.nlm.nih.gov/books/bv.fcgi?riddiab
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http//www.ncbi.nlm.nih.gov/books/bv.fcgi?riddiab
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http//www.ncbi.nlm.nih.gov/books/bv.fcgi?riddiab
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http//www.ncbi.nlm.nih.gov/books/bv.fcgi?riddiab
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Diabetes in New Jersey

• Behavioral Risk Factors Surveillance System
  (BRFSS) data for 2003-2005 estimate that over
  473,000 adults 18 years and older (7.2) have
  been diagnosed with diabetes and an additional
  190,000 residents have the disease but are still
  unaware of it. In New Jersey, diabetes is common,
  costly and significant in its impact on health.
• http//www.state.nj.us/health/fhs/diabetes/nj.shtm
  l

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Obesity and Type II Diabetes

• In both obesity and diabetes, target tissues such
  as muscle and liver fail to adjust glucose
  metabolism appropriately in response to insulin.

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Obesity and Type II Diabetes

• The onset of this insulin-resistant condition
  is intimately associated with weight gain,
  suggesting that the increased fatty adipose
  tissue generates a signal(s) that interfere with
  the action of insulin.

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Adipocytes Fat Cells

• Store triglycerides
• The distribution is to some extent sex-dependent
• Female Male
• ? lower body ? intra-abdominal
• ? back side and thighs ? around waist and
  shoulders
• ? around mammary glands
• It produces peptides that modulate glucose
  homeostasis

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Is adipose tissue an endocrine organ?

• In 1995, leptin was first discovered.
• This is a fat-derived hormone that controls body
  weight by regulating both feeding behavior and
  energy expenditure.
• Other adipose-derived molecules (adiponectin,
  FFA, resistin, TNF-?) signal changes in the mass
  of adipose tissues and energy status to other
  organ that controls fuels usage.

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Molecular link between obesity and diabetes
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Acute Complications
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Long term complications of diabetes

• At the cellular level
• -conversion of glucose to sugar alcohols,
  causing toxicity and cell distension
• -distended cells in the eyes (lens) cause blurry
  vision
• -production of glycoproteins

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Long term complications of diabetes

• Structure of blood vessels and nerves becomes
  damaged
• -loss of circulation and nerve function
• -infections (high glucose favors microbial
  growth)

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Long term complications of diabetes

• Diseases of large blood vessels atherosclerosis,
  heart attacks
• Diseases of small blood vessels loss of kidney
  function and retina degeneration
• Diseases of the nerves loss of sensation in
  hands and feet. Unnoticed injuries-infections-deat
  h of tissues (gangrene, amputation)

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Recommendations For Diabetes

• Recommendations for type 1 diabetes
• Adjust insulin doses and schedule of
  administration to accommodate meals, physical
  activity and health status. Coordinate diet,
  physical activity and insulin.
• Recommendations for type 2 diabetes
• Weight loss and control diet