Diabetes

Chapter 29:  Diabetes

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Physiology

Overview

 

Left- anti-insulin, Right- anti-glucagon

KUMC Pathology and the University of Kansas, used with permission; courtesy of Dr. James Fishback, Department of Pathology, University of Kansas Medical Center.

 

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

"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

 

 

 

Properties of IDDM* and NIDDM**

Characteristic

IDDM

NIDDM

Genetic locus

Chromosome 6

unknown

Typical age of onset

Usually < 40 years of age

> 40 years of age

Plasma insulin

Low to absent

Normal to high

Plasma glucagon

High, suppressible

High, resistant

Acute complication

Ketoacidosis

Hyperosmolar coma

Insulin therapy

Responsive

Responsive to resistant

Response to sulfonylurea drugs

Unresponsive

Responsive

* Insulin-dependent diabetes mellitus

**Non-insulin dependent diabetes mellitus

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Type II diabetes:

 

Insulin

Overview:

 

 

"Structure of the insulin receptor, a heterotetramer consisting of two extracellular insulin-binding subunits linked by a disulfide bonds to tow transmembrane beta subunits. The beta subunits contain an intrinsic tyrosine kinase activity that is activated upon insulin binding to the alpha subunit. "

courtesy of Robert H. Parsons, Ph.D., Rensselaer Polytechnic Institute, used with permission

Insulin preparations: Overview

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Table: Sulfonylureas

Tolbutamide (Orinase)

tolazamide (Tolinase)

acetohexamide

chlorpropamide (Diabinese)

glyburide (Micronase, DiaBeta)

glipizide (Glucotrol)

glimepiride (Amaryl)

 

Biguanides

Alpha-glucosidase Inhibitor

Thiazolidinedione Derivatives

 

Glucagon

Karam, J. H., Pancreatic Hormones and Antidiabetic Drugs, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 684-703

Foster, D. W., Diabetes Mellitus, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 2060-2080

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