Lecture 6 - Diabetes Student Version - 2024 PDF

WEEK 4: LECTURE 6 SEPT. 23 RD 2024 DIABETES HLSC 2825U: Nutrition and Health Jennifer Conium, MScFN, RD, CDE REQUIRED READINGS ◼ Textbook: Section 4.5 NORMAL PHYSIOLOGY  PHYSIOLOGY OF NOR...

WEEK 4: LECTURE 6 SEPT. 23 RD 2024 DIABETES HLSC 2825U: Nutrition and Health Jennifer Conium, MScFN, RD, CDE REQUIRED READINGS ◼ Textbook: Section 4.5 NORMAL PHYSIOLOGY  PHYSIOLOGY OF NORMAL GLUCOSE METABOLISM 1 ▪ Pancreatic beta cells regulate the storage and metabolism of glucose through the secretion of insulin ▪ Insulin is an anabolic (muscle building) hormone produced in response to higher blood glucose (BG) levels and suppressed by lower BG levels ▪ Meals cause a “biphasic” pattern of insulin secretion ◼ Phase 1: a large burst produced in the first 3 minutes after a meal ◼ Phase 2: the remaining over the next 1-2 hours 1.Building Competency In Diabetes Education: The Essentials  GLUCOSE HOMEOSTASIS2 2. Owens DR. Zinman B, Boll GB, Lancet. 2001: 368 (9823): 739-46.  HORMONES THAT REGULATE GLUCOSE: INSULIN 1,3 ◼ Secreted by pancreatic beta cells in response to rising blood glucose levels and allows BG to enter the body cells and be used as fuel ◼ Helps circulating free fatty acids (FFA) to be stored as triglycerides in fat cells ⭢lipid synthesis ◼ Helps convert glucose to glycerol, the basis for stored triglycerides in fat cells ◼ In muscle: ▪ Stimulates uptake of glucose for energy and storage of amino acids as protein in muscles ⭢ protein synthesis ▪ Stimulates storage of glucose as glycogen ▪ In the liver: ▪ Helps the liver and muscle tissue store glycogen for future use ▪ Stimulate storage of glucose as glycogen 1.Building Competency In Diabetes Education: The Essentials 3. Smolin, L. A., & Grosvenor, M. B. , Garfinkel D.(2020). Nutrition : Science & Applications (3rd Ed.). Wiley.  HORMONES THAT REGULATE GLUCOSE: GLUCAGON1,3 ◼ A hormone made in the pancreas that stimulates the breakdown of liver glycogen into glucose in response to low blood sugars ◼ Alpha cells in the pancreas secrete glucagon to signal the liver to break down glycogen into glucose ◼ During periods when carbohydrates have not been consumed (for a few hours), or during periods of “fasting” glucose levels begin to decrease. ◼ Stimulates Gluconeogenesis which is breakdown of glycogen into glucose 1.Building Competency In Diabetes Education: The Essentials 3. Smolin, L. A., & Grosvenor, M. B. , Garfinkel D.(2020). Nutrition : Science & Applications (3rd Ed.). Wiley.  GLUCOSE HOMEOSTASIS4 4. Röder PV, Wu B, Liu Y, Han W. Pancreatic regulation of glucose homeostasis. Exp Mol Med. 2016 Mar 11;48(3):e219. doi: 10.1038/emm.2016.6. PMID: 26964835; PMCID: PMC4892884. DIAGNOSING DIABETES  DIABETES3 ◼ “Diabetes mellitus is a heterogeneous metabolic disorder characterized by the presence of hyperglycemia due to impairment of insulin secretion, defective insulin action or both.” 3. Smolin, L. A., & Grosvenor, M. B. , Garfinkel D.(2020). Nutrition : Science & Applications (3rd Ed.). Wiley.  DIABETES IN CANADA5 5. Diabetes Canada: Diabetes Backgrounder. https://www.diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Backgrounder/2023_Backgrounder_Canada_English.pdf  TYPE 2 DIABETES AND INDIGENOUS PEOPLES6 ◼ Prevalence rates in Canada: ◼ 17.2% among First Nations individuals living on-reserve, 10.3% among First Nations individuals living off-reserve, and 7.3% among Métis people, compared to 5.0% in the general population ◼ Life-time risk around 80%, compared to 50% for non-First Nations ◼ First Nations populations are more likely to develop type 2 diabetes as children compared to Canadians in general ◼ Manitoba: 14% of the population is Indigenous, and a recent study found that 90% of children with type 2 diabetes identified as First Nations. 6. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42(Suppl  DEFINITION AND CLASSIFICATION1 Type 1 Diabetes Mellitus (T1DM): ▪ Primarily a result of pancreatic beta cell destruction with consequent insulin deficiency ▪ Can be due to an autoimmune process or unknown etiology of beta cell destruction ▪ Prone to diabetic ketoacidosis (DKA) 1.Building Competency In Diabetes Education: The Essentials  DEFINITION AND CLASSIFICATION1,3 Type 2 Diabetes Mellitus (T2DM): ◼ More common form and accounts for about 90% of all cases ◼ Insulin resistance + Beta cell dysfunction ◼ Decreases in cell’s sensitivity to insulin is known as insulin resistance ◼ Insulin Resistance: Tissues become less responsive to insulin and do not take up glucose as readily when glucose levels rise ◼ Constant stress on beta cells to secrete insulin may result in beta cells eventually not releasing sufficient insulin to maintain glucose homeostasis known as “beta cell dysfunction” ◼ May range from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance ▪ DKA not as common 1.Building Competency In Diabetes Education: The Essentials 3. Smolin, L. A., & Grosvenor, M. B. , Garfinkel D.(2020). Nutrition : Science & Applications (3rd Ed.). Wiley.  DEFINITION AND CLASSIFICATION1 Gestational Diabetes Mellitus (GDM): ▪ Glucose intolerance with onset or first recognition during pregnancy Latent Autoimmune Diabetes in Adults (LADA): ▪ Apparent T2DM who appear to have immune-mediated loss of pancreatic beta cells ▪ Clinically resembles T2DM but also clinically resembles T1DM ◼ Possible clinical features: ▪