SWEET BLOOD

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Cand.Med.Vet. Ezgi Salmanlı

SWEET BLOOD

» What are the symptoms of diabetes ?

» How insulin works and what are its roles in cellular metabolic pathways ?

» The effects of insulin deficiency / resistance on organism

» Cat , Sam

» 10 years old

» Owner is a veterinary medicine student

» Weakness and losing appetite

» Extreme thirst

» Diagnosed with DM type 2

http://tiho.casus.net/pmw2/app/cardtop2.html?docid=1402374147885

Diabetes Mellitus» Diabetes mellitus describes a group of diseases in

which the person has permanent high blood glucose (HYPERGLYCEMIA) , either because insulin production is inadequate , or because the cells do not respond properly insulin or both.

» is a chronic disorder of carbohydrate metabolism

» Diabete mellitus is the one of most common diagnosed endocrionopathies in cats and dogs

Insulin

http://www.daviddarling.info/images/insulin_secretion.jpg

Insulin» Action of insulin on Carbohydrate , protein and

fat metabolism

» Carbohydrate» Stimulates glucose uptake by muscle (GLUT-4)» Facilitates the conversion of glucose to glucogen

for storage in liver and muscle» Decreases the breakdown and release of

glucose from glycogen by the liver

» Protein

» Stimulates protein synthesis» Inhibits protein breakdown , diminishes

gluconeogenesis

» Fat

» Stimulates lipogenesis –the transport of triglicerides to adipose tissue

» Inhibits lipolysis- prevents excessive production of ketones or ketoacidosis

About Insulin» When our body functions normally

˃ Food converted to glucose˃ blood glucose levels rise ˃ Pancreas release Insulin into the blood˃ normal level of glucose in the blood

» Lack of insulin leads to increase in levels of glucose in the blood

» about 2/3 of the body’s cells use Insulin to absorbe glucose from blood to produce energy and other needed chemicals or for storage

http://www.pre-diabetes.com/prediabetes/how-is-insulin-resistance-diagnosed.html

http://tiho.casus.net/pmw2/app/cardtop2.html?docid=1402374136136

Diabetic metabolism

http://www.citisletstudy.org/images/edt.jpg

http://www.soylabs.com/img/diabetes_type2.jpg

Classification of DM » Type 1 DMIt is due to insulin deficiency and also known as

• insulin dependent Dm

» Type 2 DMIt is a combined insulin resistance and relative deficiency in insulin secretion is frequently known as

• noninsulin dependent Dm

Types of diabetes» Type 1 diabetes» Type 1 DM is characterized by an absolute deficiency of insulin due to immune- mediated destruction of the pancreatic b-cells» Autoimmun disease» Genetic and environmental factors are important» Treatment required insulin injection» Common type in Dogs

» Type-2 Diabetes

» Type 2 DM is characterized by the presence of both insulin resistance (tissue insensitivity) and some degree of insulin deficiency or b- cell dysfunction

» It is the most common type of feline diabetes

» Can be managed with dietary changes

Insulin resistance» Insulin resistance is the inability of cells to

respond adequately to normal levels of insulin.» The body produces insulin , but cells in the body

become resistant to insulin and are unable to use it as effectively.

» Beta cells increase their production of insulin , leads to hyperinsulinemia.

Symptoms of Type-2 DM

» Extreme thirst (polidipsia)

» Frequent urination (polyuria)

» Excessive hunger (poliphagia)

» Weight loss

» Increased ketone levels

Diabetic Ketogenesis» Insulin diminishes gluconeogenesis

During insulin resistance pyruvate and oxalacetate are utilized for the gluconeogenesis

» Insuline stimulates the uptake of glucose into adipocytes and the storage in form of triglyceridesDuring insulin resistance fatty acids are circulated in blood and broken down with Beta oxidation to produce energy meantime AcetylcoA is accumulated

» But since oxalacetate and pyruvate already are used for gluconeogenesis , citric acid cycle gets interrupted and Acetyl-CoA can not be removed

» High level of Acetyl coA results in the formation of ketone bodies

–Acetone–Beta hydroxybutyrate–acetoacetate

Symptoms of ketogenesis

» ketonemia

» Ketouria

» Ketoacidosis

» Sweet fruity breath

» Acidification of blood

Risk factors for diabeteso Overweight

o Genetic predisposition

o Age

o Gender

o Concurrent illness

o Drug intake

Diagnose in cats» Blood glucose test

» Urine Test (for ketones and glucose)

Therapy in cats» Blood glucose level should be measured in

regular basis» Insulin application» Dietary changes

˃ High protein – low carbohydrate diet

References» http://en.wikipedia.org/wiki/Insulin_resistance» http://emedicine.medscape.com» http://en.wikipedia.org/wiki/Gluconeogenesis» http://

en.wikipedia.org/wiki/Complications_of_diabetes_mellitus

» http://www.ncbi.nlm.nih.gov/pubmed/15855309/» http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2» http://en.wikipedia.org/wiki/Diabetes_in_cats» http://www.vet.cornell.edu/FHC/health_resources/

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