Preproinsulin -> Proinsulin -> insulin and C-peptide.
Secretory granules in the β-cells fuse with the plasma membrane and are stored until such time that it is demanded (Wilcox, 2005).
Secretion is mediated by the level of glucose and requires energy (Okamoto et al., 2017).
Acts by receptors present on the target organs which are α and β present on liver, skeletal muscles and adipose tissue.
Development of chronic insulin resistance
Fat is built up in cells of the system like in liver, skeletal muscles and even pancreatic cells
Compensatory mechanism- increased insulin production which reduces over time and result in β cell dysfunction (Okamoto et al., 2017).
Neuropathy – poorly controlled diabetes
Due to metabolic imbalance signal conduction is affected
The repair and healing is delayed is associated with diabetes and can be associated with neuropathy (Vinik et al., 2018).
It can lead to loss of a single toe, feet or even a limb.
Factors contributing to diabetes can lead to formation of atherosclerotic plaque formation.
The plaque due to flow of blood can get detached from and get lodged in the artery to heart causing myocardial infarction (Pradhan & Sethi, 2018).
Also, in diabetes there is incidence of autonomic neuropathy which is a contributing factor for myocardial infarction (Pradhan & Sethi, 2018).
Phillip is given metformin – drug of choice in case of type II diabetes mellitus.
Oral antihyperglycemic drug
Improves glucose tolerance and lowers basal and post-prandial blood glucose levels.
In type II diabetics, there is increase in glucose production and underutilization of it.
Metformin decreases glucose production in liver, its uptake from gastrointestinal tract and increase in insulin sensitivity by increased uptake in periphery (Rena et al., 2017).
Less chance of hypoglycemia.
Phillip is overweight which is a risk factor for development of type II diabetes mellitus.
Increase of fat in belly increases deposition of fat in the cells of liver and pancreas (Okamoto et al., 2017).
In liver the sensitivity of insulin is decreased due to fat deposition.
Due to increase in the sensitivity the pancreas try to compensate but over time the production reduces (Okamoto et al., 2017).
Measure of control
Labpedia.net (2020). HbA1c (Glycosylated Hemoglobin), Glycohemoglobin (G-Hb), Glycated Hemoglobin, Diabetic control index. Retrieved from: labpedia.net/hba1c-glycosylated-hemoglobin-glycohemoglobin-g-hb-glycated-hemoglobin-diabetic-control-index.
Okamoto, H., Takasawa, S., & Yamamoto, Y. (2017). From insulin synthesis to secretion: Alternative splicing of type 2 ryanodine receptor gene is essential for insulin secretion in pancreatic β cells. The International Journal of Biochemistry & Cell Biology, 91, 176-183.
Pradhan, A., & Sethi, R. (2018). Diabetes and myocardial infarction: revisiting the conundrum. Journal of Diabetes Metabolism Disorder and control Control, 5(5), 174-175.
Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60(9), 1577-1585.
Vinik, A. I., Casellini, C., Parson, H. K., Colberg, S. R., & Nevoret, M. L. (2018). Cardiac autonomic neuropathy in diabetes: a predictor of cardiometabolic events. Frontiers in Neuroscience, 12, 591.
Wilcox, G. (2005). Insulin and insulin resistance. Clinical Biochemist Reviews, 26(2), 19.
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