General Summary of DM, with Medications (part I, Summary) 영양병원 내과 이준엽

Definition of Diabetes A chronic disorder of carbohydrate, fat, and protein metabolism Narrowly, Classically, 인슐린의 절대적 또는 상대적 결핍에 의해 혈액내에 당분(포도당)의 농도가 정상 이상으로 높아져서 소변으로 당이 배설되는 유전성 경향이 많은 만성적인 대사질환

anabolism Small Molecules 저분자 고분자 catabolism

Normal Insulin Physiology Homeostasis of glucose 1) liver – glucose production (glucogenesis/gluconeogenesis) 2) peripheral tissues – uptake & utilization of gulcose 3) insulin secretion - autocrine

Insulin: major anabolic hormone Transmembrane transport of glucose & amino acid Glycogen formation in liver & skeletal M. Glucose conversion to TG Nucleic acid synthesis Protein synthesis major function: increase the rate of glucose transport into certain cell

Glucose-Stimulated Secretion of Insulin * Secreted into portal venous system, degraded by the liver (~50%) phosphorylation of glucose causes a rise in the ATP:ADP ratio. This rise inactivates the potassium channel that depolarizes the membrane, causing the calcium channel to open up allowing calcium ions to flow inward. The ensuing rise in levels of calcium leads to the exocytotic release of insulin from their storage granule. Beta-cell receptor binding with glucose  closure of K+ channels  opening of Ca++ channels  increase in cellular [Ca++]  translocation of secretary granules to membrane surface  insulin release outside the cell Secreted into portal venous system, degraded by the liver (~50%) N Engl J Med 345:1772, December 13, 2001

Insulin-mediated glucose uptake (adipocyte/skeletal muscles) Insulin binding to the insulin receptor induces a signal transduction cascade which allows the glucose transporter (GLUT4) to transport glucose into the cell.

Fat cell and insulin sensitivity

Diabetes: Dual Impairment Insulin Resistance and Impaired b-Cell Function Normal -cell function Compensatory hyperinsulinemia Normoglycemia Relative insulin deficiency Hyperglycemia Type 2 diabetes Abnormal -cell function Insulin resistance

메트포민, 글리타존, 알파-글루코시다제 억제제 당뇨병 메트포민, 글리타존, 알파-글루코시다제 억제제 임상영양요법 인슐린분비촉진제 인슐린 식후혈당 혈당 (mg/dL) 공복혈당 126 mg/dl 인슐린 저항성 정상 기능 (%) 인슐린 농도 베타세포 기능부전 당뇨병 유병기간

Diagnosis of Diabetes Fasting Plasma Random Plasma Oral Glucose Test Glucose (FPG)* Glucose * Tolerance Test* (Preferred Test) Stage Diabetes FPG >126 mg/dl Random plasma Two-hour plasma glucose >200 mg/dl glucose (2hPG) (plus symptoms) >200 mg/dl Impaired Impaired Fasting Impaired Glucose Glucose Glucose (IFG)=FPG Tolerance (IGT) = Homeostasis >100 and <126 mg/dl 2hPG >140 and <200 mg/dl Normal FPG <100 mg/dl 2hPG <140 mg/dl Symptoms : polydipsia, polyuria, unexplained weight loss *In the absence of unequivocal hyperglycemia, these need to be repeated on the second day

혈당조절의 목표: 제2형 당뇨병

Pathogenesis of Diabetes

Symptoms of Diabetes 심한 갈증 때문에 물을 많이 마시게 됨 음식을 많이 먹게 되고 소변을 자주 봄, 빈번한 공복감, 피로, 전신권태 피부나 잇몸 염증이 잘 생기고 잘 낫지 않음 체중감소, 시야가 선명하지 않을 때가 자주 있음 발의 감각이 둔해지거나 쑤심