Type I and Type II Diabetes Mellitus
ENDOCRINE PATHOLOGY: Note #1.
Figure 5 Clinical manifestations part I.
(2) Decreased glucose utilization
leads to decreased ATP production
The body is forced to use other metabolic sources of fuel
Lipolysis in the adipose tissue
o Breakdown of triglycerides into free fatty acids and
glycerol
Both can be used in the cellular pathway to make
energy
Proteolysis in the muscles
o Breakdown of proteins into amino acids
Can be used to make energy
↑ lipolysis and proteolysis lead to unexplained weight
loss
To replenish the calories
Called polyphagia
Figure 6 Clinical manifestations part II.
IV) DIAGNOSIS
(1) Blood work
Fasting glucose ≥ 126mg/dl
o If the patient hasn’t eaten in a certain amount of time,
the blood glucose is expected to be lower
Sign of diabetes especially if there are other
symptoms present
Random glucose ≥ 200 mg/dl
o Regardless of the patient eating or fasting
Alongside other symptoms is diagnostic of
diabetes
2-hour oral glucose tolerance test – glucose ≥ 200
mg/dl
o Glucose is given and is supposed to stimulate insulin
production
Insulin is supposed to push glucose into the cells
• Diabetics don’t have the insulin or are insulin
resistant → blood glucose levels remain high
o Need two tests to confirm diabetes
Hemoglobin A1c ≥ 6.5%
o Used for diagnosis and for monitoring glucose
control over three months
o High blood glucose levels make the glucose
conjugate to the hemoglobin
Produces glycated hemoglobin
o It is informative for the period of three months
This is the lifespan of the red blood cells
• Hemoglobin is located in them
(2) Antibodies
can also be taken into consideration
o Anti-islet cell antibodies
o Anti-glutamic acid antibodies
o Anti-insulin antibodies
Age and risk factors should be taken into
consideration
Figure 7 Diagnostic criteria for diabetes mellitus.
V) CHRONIC COMPLICATIONS
(A) NON-ENZYMATIC GLYCATION
(1) High blood glucose levels make
the glucose conjugate with different molecules
o Mainly proteins and lipids
No enzyme is used
o Called non-enzymatic glycation
Non-enzymatic glycation of lipids and proteins creates
very potent inflammatory molecules
o Can cause inflammation of the blood vessels
A lot of LDL deposit to that tissue
• Leads to atherosclerosis
o Some protein deposits can occur in the vessels and
around the basal membrane
Leads to hyaline arteriolosclerosis
(2) The combination of
these two effects leads to
o ↓ blood flow distal to these plaques and the
arterioles
o ↓ gas exchange across the tissues
Due to the thickened basal membrane
o Physical manifestations of particular types of diseases
are associated with non-enzymatic glycation
Figure 8 Non-enzymatic glycation.