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A medical lecture on diabetes (mellitus)

by: A. Lorenzo Lucino Jr, MD-Ph.D Intern





diabetes is a disease of the endocrine system in which there is a partial, or total failure of the pancreatic b-cells (beta-cells) to create insulin, a hormone of the endocrine system. if the pancreatic beta cells are totally missing, there is a global loss of insulin, rendering that individual with diabetes mellitus type i (insulin dependent). if there is a gradual loss of insulin due to the break down of beta cells of the pancreas , typically seen in middle aged, obese individuals, this person will develop diabetes mellitus type ii.

acute manifestations of diabetes mellitus:
polydipsia, polyuria, polyphagia, weight loss, dka type 1 (diabetic ketoacidosis), hyperosmolar coma type 2, unopposed secretion of GH (growth hormone) and epinephrine (exacerbates hyperglycemia)

chronic manifestations of diabetes mellitus:
small vessel disease --> retinopathy, glaucoma, nephropathy
large vessel atherclerosis , cad (coronary artery disease), peripheral vascular occlusive disease and gangrene, cerebrovascular disease

osmotic dammages:
neuropathy (motor, sensory and autonomic degeneration)
cataracts (sorbitol accumulation

tests given to monitor patients:
fasting serum glucose, glucose tolerance test, hba1c






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TYPE 2-- ADULT ONSET (NON-INSULIN DEPENDENT DIABETES MELLITUS)




-there is an increased resistance to insulin by the receptors
-insulin therapy is not necessarily needed, if glucose levels are controlled (via oral hypoglycemics)
-patients are usually > 40 years of age
-there is a strong genetic predisposition
-there is no association with the HLA system
-there is mild to moderate glucose intolerance
-ketoacidosis is rare (so long as glucose levels are controlled)



treatment: oral hypoglycemics (glucophage, metformin, sulfonylureas), for uncontrolled diabetes give: ultralente, or direct insulin medication.




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Hello A Layman,

Thank you for sharing your wife's clinical situation with me. Diabetes and Parkinson's Disease are totally different disease states. Diabetes Mellitus is due to the oversaturation of the insulin-receptors in the Pancreas, leading to the pancreas' inability to secrete enough insulin. Insulin's natural ability is to reduce glucose in the blood (it has a hypoglycemic effect); now due to the fact that in Diabetes Mellitus Type II, the pancreas is unable to secrete enough insulin, the glucose levels in the blood remain high, this leads to Hyperglycemia. Because of the increased sugar content in the blood, this leads the blood to become very sticky and can become atherosclerotic. This is why diabetes has to be controlled via hypoglycemic medication (Glucophage, Metformin) or sometimes synthetic insulin (Ultralente etc). Because Diabetes leads to hyperglycemia and since that affects the blood's coagulability, there is also a link between diabetes and high blood pressure and cholesterol levels. All three , if uncontrolled, can lead to cardiovascular and cerebrovascular effects. It is important to make sure your wife is on hypoglycemic medication , and if she has hypertension, she should also control her hypertension. If she has high cholesterol, she should also control her cholesterol levels via statin and fibrates. All of which should be explained to your wife by the physicians at St. Lukes (by the way, is a very great medical system in the Philippines).

As for Parkinson's Disease, this problem is completely hormonal-related. There is an area of the brain called the Substantia Nigra, which is responsible for the production of Dopamine. Dopamine is a hormone that has multipotential effects; it is used for maintaining mood and also for maintaining catecholamine expression and motion. In Parkinson's Disease, the Substantia Nigra is destroyed or partially destroyed. Because it is destroyed, there is a pathological decrease in Dopamine expression. This decrease production of dopamine is responsible for the cogwheel motility found in Parkinson's Disease and related motion disturbances.

The mode of treatment for Parkinson's is to control the catecholamine expression, and to take synthetic dopamine. This disease can be maintained, however, it has a progressive course.

Both diseases, Diabetes Mellitus Type II and Parkinson's Disease are different diseases with different etiologies.

I hope that answered your question, A Layman. Please feel free to ask more should you need my assistance.

God Bless you and your wife. Persevere in the Lord, always.



Best,
Bran Lorenzo

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A Layman,

You are most welcome. Feel free to ask me any medical questions and I will gladly give you my professional counsel.

Please, you don't have to call me by titles. We are all Bolanons diri.

Call me Bran na lang.


God Bless and take care!

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