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Pathophysiology of Type 1 and Type 2 Diabetes Mellitus

1. (a). Insulin release regulates the blood glucose. It has direct impact on beta cells of pancreas, that means when plasma glucose increases then it will increase the insulin secretion and vice-versa. Insulin cause improved intake of glucose from blood to the liver and thereby increase the activity of glucokinase and glycogen synthase. Glucose is released from the liver into the blood between the meals. This will lead to decrease the insulin secretion and thereby activates phosphorylase enzyme and glucose phosphatase. Blood glucose levels are controlled in normal person within narrow range. In morning, the level of blood glucose is low, about 70-110mg/dL. Whereas, during first initial hours of meal intake it rises to 100-140 mg/dL. Different hormones are responsible for blood glucose regulation, among which insulin helps to minimize the blood glucose levels, due to which it is also known as anti-diabetogenic hormone.

(b). Insulin binding will lead to autophosphorylation on multiple areas and phosphorylation of cellular substrates. Insulin arouses extrahepatic uptake glucose present in the blood and inhibit glycogenolysis in the cells and thereby regulates glycogen synthesis. When glucose enter the hepatocytes, it gets bind with them and inhibit the phosphorylase activity of glycogen. The binding of free glucose will eventually regulate the de-phosphorylation of phosphorylase and deactivate it. When there are low levels of blood glucose in the body, then liver is unable to compete with other tissues for the requirement of glucose and thereby extra-hepatic uptake of glucose is regulated for insulin. On the other hand, if level of blood glucose is high in the body, then liver uptake the glucose to convert into glycogen for further requirements.

In majority of case, diabetes mellitus developed due to deficiency of insulin. It is a metabolic disorder that occurs due to high level of blood glucose. When insulin receptors fail to respond insulin, then this condition leads to insulin resistance which cause type II diabetes mellitus (Kelkar et al., 2019).

  1. The most common form of diabetes is type-II diabetes, which include both environmental and genetic factors that affects the functioning of beta-cells and tissues. Pathophysiology of type-2 diabetes mellitus is explained by multiple factors, such as peripheral insulin resistance, improper regulation and production of hepatic glucose, beta-cells declining, and ultimately beta-cells failure. When body is not able to produce sufficient insulin, then there is increased demand of insulin and the pancreas will eventually lose its ability to produce insulin. When glucose forms into blood in spite of the cells, then it may cause health issues, such as nerves or kidney damage, and heart disease. Type II diabetes can be prevented by healthy lifestyle changes, like health diet, more physical activities, and healthy weight.

In comparison with this, type I diabetes develops when the immune system diminishes the pancreatic beta cells which produces insulin to regulate the blood glucose. It is affected by only 5% of people as compare to type-II diabetes (Zaccardi et al., 2015).

(a). In the case of Stevenson, it is important to control the level of blood glucose, because she is suffering from type-II diabetes. Moreover, she is overweighted and do less exercises which might leads to more complications if not treated. To manage type-II diabetes conditions, it is required for patient to do regular exercises, maintain body weight, intake healthy nutritious diet, use diabetic medications like metformin and insulin, regular monitoring of blood sugar, and insulin therapy.

(b). Metformin is an important drug suggested for management of type II diabetes mellitus. It works as an initial therapy for asymptomatic patients of type-2 diabetes. It is recommended to give 500mg dose of metformin in evening meals, and if needed than one more same dose by morning breakfast meals. This dosage can be increased thoroughly as needed and can be given as maximum of 2000mg each day. It is preferable drug due to its tolerability, cost efficiency, glycemic efficacy, and lack of weight gain and hypoglycemia conditions. Metformin decrease the production of hepatic glucose by inhibiting mitochondrial respiratory chain complex 1. It also decreases the glucose absorption by intestine. In type-2 diabetes, it works by reducing the glucose content that liver releases to blood, and makes the body more responsive for insulin (Wexler, 2020).

  1. If type-II diabetes are not controlled timely, then it may lead to long-term poorly controlled hyperglycemia conditions like nephropathy and hypertension.

Nephropathy- Diabetic nephropathy is generally kidney disease that results from diabetes. Diabetes cause high blood glucose levels which diminishes the filters of kidneys that are used to filter the blood. These filters will cause leakage and eventually leads to protein comes out by urine. However, only some people diabetic nephropathy can lead to kidney failures or associated disease.

Hypertension- High blood pressure is another term for hypertension, which often happens due to diabetes mellitus type 1 & 2 as well as gestational diabetes. Type-2 diabetes and hypertension are metabolic syndromes that consists of cardiovascular disorders and obesity. An individual with type-2 diabetes not have sufficient insulin to process glucose from food products to use it as energy. This will result in accumulation of insulin in the blood, which cause high glucose levels and can damage the kidneys and blood vessels. The experience of this damage will lead to increase the blood pressure and cause hypertension (Cosmo et al., 2016).

References for Physiology of Insulin

Cosmo, S. D., Viazzi, F., Piscitelli, P., Giorda, C., Ceriello, A., Genovese, S., . . . Pontremoli, R. (2016). Blood pressure status and the incidence of diabetic kidney disease in patients with hypertension and type 2 diabetes. Journal of Hypertension,34(10), 2090-2098. doi:10.1097/hjh.0000000000001045

Kelkar, S., Muley, S., & Ambardekar, P. (2019). Physiology of insulin. Towards Optimal Management of Diabetes in Surgery, 253-273. doi:10.1007/978-981-13-7705-1_10

Wexler, D. J. (2020). Retrieved October 05, 2020, from https://www.uptodate.com/contents/initial-management-of-blood-glucose-in-adults-with-type-2-diabetes-mellitus/print?search=oral+hypoglycemics+adult

Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2015). Pathophysiology of type 1 and type 2 diabetes mellitus: A 90-year perspective. Postgraduate Medical Journal,92(1084), 63-69. doi:10.1136/postgradmedj-2015-133281

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