PPP Diabetes

CHO, fat and protein

Type 1a- immune mediated 90%, type 1b- idiopathic no autoimmune 10%, type2 diabetes, gestational diabetes, maturity onset diabetes of the young, steroid induced diabetes from glucocorticoids, genetic higher incidence in prader willi and down's syndrome

Fasting plasma glucose 7.0mmol/l or more or 2 hours after ingestion og 75g oral glucose load 11.1mmol/l or more HBA1C 6.5% or more in USA. UK 48/49

A fasting blood glucose of less than 7mmol/L AND a blood glucose of 7.8 mmol/L or more but less than 11.1mmol/L after a 2 hour oral GTT

A pre diabetic state; blood sugars are raised but not as high as a diabetic, but have same CV risk. If lose wt /cut risk factors may delay onset of diabetes. Give same advice as for diabetics

Tail part

Apha cells - glucagon, beta cells insulin, delta cells - somatostatin - inhibits insulin and glucagon as needed to keep insulin in homeostatuc balance

A c peptide chain at the top and underneath that an A chain and under that a B chain; the A and B are hold together by disulphide bonds

You can measure it in type 1 diabetics to see if they are still able to produce their own insulin

Using GLUT transporters, in beta cells GLUT 2 transporter

Glucose transported into beta cell via GLUT2 transporter, glycolysis produce ATP and ADP. Elevation closes the ATP sensitive potassium channel which causes depolarisation of cell. Calcium channel opens; influx calcium into beta cells trigger release of insulin out of beta cell into bloodstream

They enable glucose uptake in the muscles and adipose tissue. once insulin attaches to insulin receptor on cell membrane, GLUT4 t5ransporters are trabslocated up to the cell membrane and can transport glucose from outside cell to inside cell

Glucose can get into cells without firing insuln. Exercise triggers cyclic AMP activated kinase which causes translocation of GLUT4 to the cell membrane.

When renal threshold exceeds 10mmol

T cell mediated autoimmune destruction of the islets B cells