Diabetes Mellitus and Hypoglycemia

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Inadequate secretion of insulin, or defects in the action of insulin, produce metabolic disturbances that are characteristic of diabetes mellitus. A person with type 1 diabetes requires injections of insulin; a person with type 2 diabetes can control this condition by other methods. In both types, hyperglycemia and glycosuria result from a deficiency and/or inadequate action of insulin. A person with reactive hypoglycemia, by contrast, secretes excessive amounts of insulin and thus experiences hypoglycemia in response to the stimulus of a carbohydrate meal.

Chronic high blood glucose, or hyperglycemia, is the hallmark of diabetes mellitus. The name of this disease is derived from the fact that glucose "spills over" into the urine

Table 19.6 Comparison of Type 1 and Type 2 Diabetes Mellitus

Feature

Type 1

Type 2

Usual age at onset

Under 20 years

Over 40 years

Development of symptoms

Rapid

Slow

Percentage of diabetic population

About 10%

About 90%

Development of ketoacidosis

Common

Rare

Association with

Rare

Common

obesity

Beta cells of islets (at onset of disease)

Destroyed

Not destroyed

Insulin secretion

Decreased

Normal or increased

Autoantibodies to islet cells

Present

Absent

Associated with

Yes

Unclear

particular MHC antigens*

Treatment

Insulin injections

Diet and exercise; oral stimulators of insulin sensitivity

*Discussed in chapter 15.

*Discussed in chapter 15.

when the blood glucose concentration is too high (mellitus is derived from a Latin word meaning "honeyed" or "sweet"). The general term diabetes comes from a Greek word meaning "siphon"; it refers to the frequent urination associated with this condition. The hyperglycemia of diabetes mellitus results from either the insufficient secretion of insulin by the beta cells of the islets of Langerhans or the inability of secreted insulin to stimulate the cellular uptake of glucose from the blood. Diabetes mellitus, in short, results from the inadequate secretion or action of insulin.

There are two major forms of diabetes mellitus. In type 1 (or insulin-dependent) diabetes, the beta cells are progressively destroyed and secrete little or no insulin; injections of exogenous insulin are thus required to sustain the person's life. This form of the disease accounts for only about 10% of the known cases of diabetes. About 90% of the people who have diabetes have type 2 (non-insulin-dependent) diabetes. Type 1 diabetes was once known as juvenile-onset diabetes because this condition is usually diagnosed in people under the age of 20. Type 2 diabetes has also been called maturity-onset diabetes, since it is usually diagnosed in people over the age of 40. Since the incidence of type 2 diabetes in children is rising (due to an increase in the frequency of obesity), however, these terms are no longer preferred. The two forms of diabetes mellitus are compared in table 19.6. (It should be noted that only the early stages of type 1 and type 2 diabetes mellitus are compared; some people with severe type 2 diabetes may also require insulin injections to control the hyperglycemia.)

Fox: Human Physiology, I 19. Regulation of I Text I I © The McGraw-Hill

Eighth Edition Metabolism Companies, 2003

616 Chapter Nineteen

Insulin deficiency (decreased secretion, resistance, or both)

Increased hepatic glycogenolysis

Increased hepatic gluconeogenesis

Decreased glucose utilization

Hyperglycemia

Osmotic diuresis (water, sodium, potassium, calcium, phosphate)

I_

Dehydration, volume depletion, hypotension

Increased hepatic ketogenesis

Metabolic acidosis

Decreased ketone utilization

Hyperketonemia

Increased lipolysis

■ Figure 19.11 The consequences of an uncorrected insulin deficiency in type I diabetes mellitus. In this sequence of events, an insulin deficiency may lead to coma and death.

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