1. Introduction to Human Physiology
(Know how your body works so you can treat your
diabetes effectively)
Lecture 3
by Eric Holzman

2. A Diabetic’s Guide to
Managing Diabetes
Knowledge of human physiology is
important in the management of diabetes
• Learning to control your blood glucose level is like
learning to maintain your own car.
– Auto-mechanics understand how cars work.
• Doctors are human body “mechanics”.
– A doctor understands how the human body works.
– A doctor uses his knowledge and experience to diagnose
and treat medical problems.
• We need to understand how the body regulates its blood
glucose level.
• Your blood glucose level is affected by the activity of a
number of organs and glands.
– pancreas and adrenal glands
– Stomach and intestines
– Liver
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3. A Diabetic’s Guide to
Managing Diabetes
Diabetes prevents our body from
producing the energy we need to live
• The human body is an engine that “burns” fuel to make energy.
• Our fuel comes from the food we eat and the air we breath.
• We need energy to live.
– Muscle action: digestion, blood circulation, breathing,…
• Cells are the body’s energy producers.
– Cells extract energy from foods that react with the oxygen we breathe.
• Metabolism: the energy-producing chemical reactions in the body’s cells.
• Diabetes inhibits the body’s metabolic processes.
– It prevents glucose from crossing the cellular barrier.
– No glucose in cells means no energy for the body.
glucose
diabetes cell energy
blood
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4. A Diabetic’s Guide to
Managing Diabetes
The main purpose of the food we eat is
to provide the energy we need to live
• The food we eat can be divided into macronutrients and micronutrients.
• Macronutrients, carbohydrates, protein, and fat, are consumed in
large quantities to provide energy.
• Energy in – Energy expended = weight change
Macronutrient Energy content Other Purpose Source, Smil, pp. 93-94.
(Kcal/gram)
Total Usable
Carbohydrate 4.2 4.1 Fiber for digestion
Fat (lipid) 9.4 9.1 Builds cell membranes,
hormone release
Protein 5.5 4.1 Builds body tissue
Alcohol (ethanol) 7.0 7.0 intoxication
• On most nutrition labels, the word “calorie” is used in place of “kilocalorie”.
• 28 grams = 1 ounce
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5. A Diabetic’s Guide to
Managing Diabetes
Micronutrients--essential for normal
body metabolism
• Micronutrients, vitamins and minerals, are needed in small quantities
to sustain the body’s metabolic reactions.
• Vitamins are organic compounds.
• Minerals are basic atomic elements.
Vitamin Needed for Mineral Needed for
A cell growth, prevent “night Sodium (Na) Transport across cellular
blindness” membrane
B1 (Thiamine) nervous system metabolism Potassium (K)
B2 (Riboflavin) cell energy production Chlorine (Cl)
Niacin cell energy production Calcium (Ca) Bones
C (Ascorbic acid) growth of tissue, cartilage, Phosphorus (P) Metabolism, bones
bone and teeth Iron (Fe) Oxygen transport, cellular
D Calcium absorption oxidation
E normal growth Iodine (I) Cellular metabolism
K blood clotting Magnesium (Mg) Carbohydrate metabolism
Folic acid normal growth Cobalt (Co)
B12 growth, blood cell formation Copper (Cu)
B6 (Pyridoxine) protein metabolism Manganese Bone formation,
Pantothenic acid carbohydrate, fat metabolism (Mn) carbohydrate metabolism
Source, Guyton and Hall, p. 809-813.
Zinc (Zn) Metabolism, protein
digestion
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6. A Diabetic’s Guide to
Managing Diabetes
Carbohydrate--our body’s preferred
source of energy
• Carbohydrate (CHO): chain of sugars, carbon-hydrogen-oxygen
• Sources: plants, particularly grains (wheat, barely,…), rice, potatoes
– Animal meat contains very little or no carbohydrate.
• Carbohydrate is preferred over fat and protein as an energy source.
– The body will use carbohydrates first, then switch to fat and lastly, protein.
• Excess carbohydrate is stored in fat and liver cells with aid of insulin.
• Glucose: a sugar that is the building block of most carbohydrates.
• Carbohydrate is converted to glucose by the digestive track and liver
before reaching our cells.
• Decrease in blood glucose causes feeling of hunger.
Bernstein, pp. 365, 366, 368.
Guyton & Hall, pp. 19, 786, 806.
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7. A Diabetic’s Guide to
Managing Diabetes
Fat--Not All Bad
• Lipids or Fat: Used for energy, muscle activity, hormone release, formation of
cell membranes.
• Sources are both animal and plant—CHO is also converted to and stored as
fat (triglycerides) by the liver.
• Major source of energy after CHO.
– 9 cal/gram—provides as much energy as CHO.
• Energy storage: fat stored in the liver and in fat cells (adipose tissue).
• Cholesterol—promotes digestion of fats, forms cell membranes, skin
– LDL (low density lipoprotein) is bad: causes Atherosclerosis (clogged arteries).
– HDL (high density lipoprotein) is good: reduces risk of Atherosclerosis.
• Dietary fat—good or bad?
– Saturated fat raises cholesterol level in blood
– Unsaturated fat decreases cholesterol level
– Too much fat may lead to weight gain Guyton & Hall, pp. 19, 781-789.
Bernstein, pp. 112-116
Smil, p.94
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8. A Diabetic’s Guide to
Managing Diabetes
Protein
• Protein: essential for normal human growth and formation of most body
tissue, immunity (globulin), blood clotting (fibrinogen)
• ¾ of body solids are proteins: primary constituents are 20 amino acids
– 10 amino acids synthesized in human body
– 10 essential amino acids most come from our diet
• Sources are animal and plant (beans, cereals and nuts) foods
– Complete protein, has all essential amino acids, in animal foods & mushrooms.
– Minimum of 20-30 grams required per day—60-75 grams recommended.
• Used by body only after CHO & fat sources are emptied—4 cal/gram
– Starvation
– Untreated type 1 diabetes
• Liver can convert protein to energy, store as fat or glycogen (glucose).
Guyton & Hall, pp. 791-796.
Source, Smil, p. 94.
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9. A Diabetic’s Guide to
Managing Diabetes
The Human Body Continually
Switches from Carbohydrate to Fat for Energy
• We switch between metabolizing carbohydrate and fat for energy.
• Shortly after we eat most food that is metabolized is carbohydrate.
• Fasting: 8-10 hours after a meal, readily available carbohydrate stores
are empty, and nearly all energy is derived from fat.
• Exercise burns carbohydrate or fat depending on its timing.
– before eating, fat is metabolized
– shortly after eating, carbohydrate is metabolized
• Between meal snacking on carb-dense foods suppresses fat
metabolism.
• Untreated diabetes: without insulin, carbohydrate cannot be
metabolized no matter how much food is consumed.
fat CHO fat CHO fat CHO fat
Breakfast Lunch Dinner Breakfast
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10. A Diabetic’s Guide to
Managing Diabetes
Gastrointestinal Fundamentals—What
Happens to the Food We Eat?
• The digestive system, or alimentary tract,
provides the body with important products:
– Water
– Electrolytes: sodium, potassium, chloride
– Nutrients (CHO, Protein, Fat, Vitamins & Minerals)
• The body processes the food we eat by:
– moving the food through the tract
– Secreting digestive juices and digesting the food
– Absorbing digestive products
– Circulating blood through the tract to carry away
the absorbed substances
– Controlling all these functions with the nervous and
hormonal systems
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11. A Diabetic’s Guide to
Managing Diabetes
Gastrointestinal Fundamentals—
How Food is Processed by Your Body
• Chewing—aids in digestion of food, particularly
raw fruits and vegetables.
• Swallowing—movement of food from mouth to
the stomach via the esophagus.
• The stomach has several functions
– stores food before intestinal digestion.
– Mixes food with digestive juices to make chyme.
– Empties chyme into small intestine at a rate
controlled by small intestine.
• Small intestine mixes & conveys chyme for
several hours.
• Colon absorbs water & electrolytes; forms,
stores & expels feces.
• The more one eats at a meal, the longer the
digestive process will last.
• Fats and proteins take the longest to digest.
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12. A Diabetic’s Guide to
Managing Diabetes
Gastrointestinal Fundamentals—
The Role of Glands
• Throughout the alimentary tract, a variety of
glands aid in digestion by secreting
hormones, enzymes and mucus.
• Pancreas secretes digestive juices through a
duct into intestine when chyme is present.
– Enzymes for digesting all three
macronutrients.
– Sodium bicarbonate for neutralizing the acidic
chyme.
• Liver aids in fat digestion by secreting bile
(primarily water & cholesterol-based salts).
Guyton & Hall, pp. 738, 746-751.
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13. A Diabetic’s Guide to
Managing Diabetes
Digestion--the break down of
macronutrients into molecules that can be absorbed
• The macronutrients we eat cannot be absorbed by the body without digestion.
• Hydrolysis is the basic digestive process: water plus enzymes break down the
macronutrient molecules into smaller molecules.
• The small intestine absorbs nearly all the body’s nutrients.
– CHO (100s of grams), fat (100+ grams), protein (50-100 grams), water (7-8 liters).
• Most dietary carbohydrate comes from one of three major sources.
– Sucrose (cane sugar), Lactose (from milk), Starches (from plant-based food)
– Cellulose (fiber) cannot be hydrolyzed by humans.
• 80% of digestible carbohydrate is converted to glucose.
– Sucrose fructose; lactose galactose are then converted to glucose by the liver.
– Glycemic index: measure of how fast CHO are digested & absorbed.
• More than 99% of ingested protein is broken down into individual amino acids.
• Animal fats are primarily in the form of triglycerides.
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14. A Diabetic’s Guide to
Managing Diabetes
Metabolism of Carbohydrates
• Cells oxidize macronutrients and produce large A fire oxidizes fuel to make heat
amounts of energy.
– For mechanical motion by muscles, glandular
secretion,…
– Calories are units of energy liberated from a
substance. Your body oxidizes nutrients to
make energy
• Circulating blood carries CHO as glucose to
tissue cells.
• A glucose molecule cannot be used by a tissue
cell until it crosses the cell membrane. It is too
large to do this on its own.
• Without insulin, the amount of glucose that
passes across most cell membranes is far too
little for normal metabolism.
– Exceptions are brain & liver cells
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15. A Diabetic’s Guide to
Managing Diabetes
Cells store glucose in the form of glycogen
• Glucose can be used by cells for energy immediately or stored as glycogen.
– Initiated by insulin, the “fat storing” hormone.
• All cells can store glycogen, but liver and muscle cells can store the most.
• Glycogenesis—storage of glucose as glycogen
• Glycogenolysis—breakdown of glycogen into glucose for energy.
– Initiated by hormones epinephrine (adrenal gland) & glucagon (pancreas α cells).
• In stressful situations, epinephrine release stimulates the release of stored
glucose to muscles for action (“fight or flight”).
– In diabetics, this glucose release can lead to an unexpected rise in blood glucose.
Viewing a scary or suspenseful movie can cause a release of epinephrine.
• Gluconeogenesis: formation of glucose from fat & protein; occurs when
cellular glucose and blood glucose are low.
glycogenesis glycogenolysis
glucose glycogen glucose
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16. A Diabetic’s Guide to
Managing Diabetes
Fat (Lipid) Metabolism
• Dietary fat (triglycerides) is absorbed from the intestines.
• Triglycerides are used mainly to provide energy.
– Cholesterol is used to form cell membranes.
• Most fat is removed from the blood and stored as it passes through the
fat tissue and/or liver.
– Liver can synthesize triglycerides from excess carbohydrate and protein.
– 150 times as much energy is stored in fat as carbohydrate.
• Fat is transported by the blood to other tissues for metabolism.
• Almost all the normal energy requirements of the body can be provided
by fat without using any carbohydrate or protein.
– Almost all cells can use fat interchangeably with glucose for energy.
– Occurs during starvation and in un-treated type 1 diabetics.
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17. A Diabetic’s Guide to
Managing Diabetes
High-Fat Diets and Ketosis
• A bi-product of normal liver breakdown of fat is a minute amount of
acetone.
• Ketosis: condition of high concentration of acetone (a ketone body) in the
blood.
– occurs in starvation, un-treated type 1 diabetes & sometimes in high-fat diets
• Lack of available CHO causes body to use stored fat.
– Used by tissues cells for energy
– Converted to ketone bodies by liver
– Some acetone is exhaled—acetone breath is an indicator of ketosis.
• One can slowly convert from CHO to a fat diet without ketosis occurring.
– Traditional Inuit (Eskimos) diet almost entirely of fat.
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18. A Diabetic’s Guide to
Managing Diabetes
The Facts About Cholesterol
• Cholesterol is a dietary fat, but most is formed in the body.
• Cholesterol makes the skin highly impenetrable to a variety of substances and
resistant to water evaporation.
• LDL (low density lipoprotein) cholesterol increases risk of atherosclerosis
(clogged arteries).
• HDL (high density lipoprotein) cholesterol reduces risk.
• Ingesting more cholesterol increases the
blood concentration (up to 15%), but inhibits
body’s production of cholesterol.
• A highly saturated (animal) fat diet increases
blood cholesterol more (15% to 25%).
• Ingesting unsaturated fat (olive, nuts,
avocado,…) decreases blood cholesterol up
to a moderate amount.
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19. A Diabetic’s Guide to
Managing Diabetes
Protein Metabolism
• The body needs 20-30 grams of protein per day.
• The molecules of all amino acids (proteins) are
too large to pass through cell membranes
unaided.
– Exact transport mechanisms are not well
understood.
– Cells combine amino acids and store them as
larger protein molecules.
• Insulin accelerates transport of some amino
acids into cells.
– Total lack of insulin suppresses cellular protein
storage. www.happycow.net/humor_images
• Once cell storage of protein reaches its limit,
added protein is stored as fat or used as energy.
– Carbohydrate and fat normally are used before
protein.
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20. A Diabetic’s Guide to
Managing Diabetes
Endocrinology–coordination of
body functions by chemical messengers
• Endocrine system involves glands or specialized cells that
release chemicals (hormones) into the blood to influence
function of cells at another location.
• Pancreas hormones
– insulin (β cells): promotes glucose entry in many cells,
controls glucose metabolism
– glucagon (α cells): increases synthesis and release of
glucose from liver into the body fluids
• Adrenal gland: helps body cope with stress
– cortisol: influences metabolism of macronutrients, increases
rate of liver formation of glucose by 6-10 times. Stresses
– Epinephrine: “fight or flight” hormone • Trauma
• Infection
• Increases activity of the heart, can increase the metabolic rate of
• Intense heat or cold
the entire body up to 100% above normal.
• Surgery
• Increases glycogenolysis in liver, glucose release into blood. • Debilitating disease
Guyton & Hall, pp. 703-704, 836-838, 875, 876.
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21. A Diabetic’s Guide to
Managing Diabetes
The Pancreas, Insulin and Glucagon
• The islets of Langerhans secrete insulin &
glucagon directly into the blood.
– 1-2 million islets, about 0.3 mm in diameter
– Organized around small blood vessels
(capillaries)
– Beta cells: secrete insulin, 60% of all cells
– Alpha cells: secrete glucagon, 25% of all cells
• Insulin secretion
– increases in presence of energy-giving foods in the diet.
– inhibits glucagon secretion
– causes excess carbohydrate storage as glycogen in liver and muscles.
– causes fat storage in fat tissue, conversion of excess carbohydrates to fat.
– promotes protein uptake by cells and inhibits breakdown of proteins.
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22. A Diabetic’s Guide to
Managing Diabetes
Insulin’s Affect on Carbohydrate Metabolism
• For much of the day, muscle tissue uses fat not glucose for energy.
– Resting muscle cell membranes are only slightly permeable to glucose.
– Between meals, insulin is secreted at a low level.
• Muscles use large amounts of glucose under two conditions:
– During moderate or heavy exercise, contracting muscles use glucose
without extra insulin secretion.
– For a few hours after eating, insulin secretion is high, and muscles use
glucose.
• Glucose is stored in muscles or used depending on activity level.
• Within seconds after insulin binds with the receptors on a cell, the
transport of glucose into the cell increases greatly.
– Especially true for muscle and fat cells.
– Cells also become more permeable to amino acids, potassium, phosphate.
Guyton & Hall, p. 886.
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23. A Diabetic’s Guide to
Managing Diabetes
The liver keeps the body supplied with
glucose during fasting periods
• At meal time, the pancreas secretes insulin in large quantities.
– Up to about 100 grams (4 ounces) of the glucose absorbed after eating is
stored in the liver as glycogen.
– Bolus insulin secretion is the large amount of insulin that must be secreted
at meal time to maintain a normal blood glucose concentration.
• Fasting: after digestion of the last meal is complete
– the blood glucose concentration falls,
– causes the pancreas to decrease insulin secretion.
• Lack of insulin in the blood during fasting or diabetes causes
– liver storage of glucose to cease
– liver glycogen to be converted back to glucose and released into blood to
maintain body metabolic processes.
– A basal level of insulin must be secreted for uptake of the glucose.
– A poorly treated diabetic produces too little insulin to keep his liver from
causing a steady rise in blood glucose level during fasting periods.
Guyton & Hall, p. 887.
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24. A Diabetic’s Guide to
Managing Diabetes
The brain needs glucose, but it
does not need insulin
• Brain cells can use glucose without the
assistance of insulin.
• Brain cells normally use only glucose for
energy.
– They can use fat only with difficulty
• Hypoglycemic (low blood glucose)
symptoms arise when the blood glucose
level is too low.
– 20 to 50 mg/dL
– Light headedness,
irritability fainting seizures coma. • Many of the symptoms of
low blood glucose affect
our mental state.
• Diabetics need to learn
to recognize them.
Guyton & Hall, p. 887.
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25. A Diabetic’s Guide to
Managing Diabetes
Insulin also affects fat and protein metabolism
• Insulin promotes synthesis and storage of fat.
• When insulin is not available, storage of large amounts of fat (weight
gain) is not possible.
– Lowering carbohydrate intake will lower insulin secretion and fat storage.
• In untreated type 1 diabetics, a symptom of lack of insulin is weight loss.
• Insulin is required for protein synthesis and storage also.
– Both insulin and growth hormone are essential for growth.
– Lack of insulin eventually causes the body’s protein to be consumed.
• When I was diagnosed with type 1 diabetes, my insulin production was
so low that I had lost 10% of my body weight.
Guyton & Hall, p. 888.
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26. A Diabetic’s Guide to
Managing Diabetes
Glucagon increases the blood glucose
concentration
• Glucagon is a hormone secreted by the Pancreas alpha cells.
• Affects glucose metabolism by causing
– glycogenolysis: breakdown of liver glycogen into glucose
– gluconeogenesis: formation in liver of glucose from fat & protein
• Injection of a fraction of a gram can easily double blood glucose
concentration within minutes.
• As blood glucose concentration increases,
– glucagon secretion decreases, and
– insulin secretion increases.
I keep a glucagon syringe for low blood
glucose emergencies. Injection of its
contents into my body will release all my
liver’s stored glucose.
Guyton & Hall, p. 891-892.
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27. A Diabetic’s Guide to
Managing Diabetes
Your blood glucose concentration is
continuously varying
• The healthy human circulatory system
contains about 1 teaspoon of glucose at all
times.
• In a normal person, blood glucose is tightly
controlled, usually 80-90 mg/dL of blood
during fasting periods, and rarely much
higher after eating.
Exercise Insulin Insulin
pancreas
injected
muscles
Blood Glucose Concentration
digestion
glucagon
adrenal
liver
Stress Hypoglycemia Eating Fasting
Bernstein, pp. 41-43
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28. A Diabetic’s Guide to
Managing Diabetes
What is a Normal Blood Glucose Level?
• To care for ourselves, we diabetics need to know what is normal.
• The body is in a state of fasting when all food has been absorbed.
– The size of your last meal determines when fasting starts
– Typically, it is 3-4 hours
• A normal person has a fasting blood glucose level of 90 mg/dL.
• A normal person will rarely have a blood glucose level outside the
range 80 to 100 mg/dL.
• Some literature defines “normal” to be a wider range, up to 140 mg/dL
within an hour after a meal. Don’t be deceived! That’s rarely normal.
– Dr. Bernstein has “seen ‘nondiabetics’ with sustained blood sugars
averaging 120 mg/dL develop diabetic complications.”
• Hypoglycemia: below normal blood glucose
• Hyperglycemia: above normal blood glucose
Bernstein, pp. 41-43
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29. A Diabetic’s Guide to
Managing Diabetes
Type 1 diabetes has nothing to do with obesity
• Lack of insulin causes impaired carbohydrate, fat & protein metabolism.
• Type 1 is an autoimmune disease: the immune system destroys the beta
cells of the pancreas.
– Symptoms: increased blood glucose, thirst,
loss of weight (fat and protein)
– Body mass is low to normal.
– Insulin sensitivity can be normal.
– In teenage juveniles, onset can be abrupt
(days or weeks).
– In adults, it can take years for symptoms to
become apparent (“honeymoon” period).
– Confirmed by a “positive” blood test for anti
GAD antibodies.
• Type 1 diabetics don’t produce insulin, so
the proper treatment is externally
administered (exogenous) insulin.
Bernstein, pp. 34-41.
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30. A Diabetic’s Guide to
Managing Diabetes
Type 2 diabetes and obesity are closely linked
• Type 2 diabetes is caused by insulin resistance, the degraded
sensitivity of body tissues to the effects of insulin.
• Insulin resistance can force the pancreas to produce more than the
normal amount of insulin—pancreas burnout may eventually result.
• Even a normal person experiences variation in resistance to insulin
throughout the day.
• 80% of Type 2 diabetics are obese.
• Insulin resistance increases with age.
• Treatment involves
– weight loss normal insulin sensitivity
– exercise to reduce insulin resistance,
– medication to counter insulin resistance,
– exogenous insulin to assist pancreas.
Bernstein, pp. 43-45.
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31. A Diabetic’s Guide to
Managing Diabetes
Alcoholic beverages do
not raise blood glucose, but…
• Unsweetened alcoholic drinks such as beer, wine and hard liquor do
not raise your blood glucose level.
• The liver metabolizes alcohol.
• Alcohol (ethanol) can indirectly lower the blood sugar of Type 1
diabetics if consumed at meal-time.
– Can prevent liver from converting the protein in a meal into glucose.
– Most likely to occur for people on low carb diets.
• Symptoms of hypoglycemia are similar to alcohol intoxication.
• Too much alcohol consumption is not good--a healthy liver is essential
for tight blood glucose control, whether you are diabetic or not.
Bernstein, pp. 118-120.
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32. A Diabetic’s Guide to
Managing Diabetes
The female menstrual cycle complicates
blood glucose control
+
• The hormones estrogen and progesterone are secreted at varying
rates during the course of the female menstrual cycle.
– Increased levels of progesterone may cause increased insulin
resistance hyperglycemia (high blood glucose).
– Increased levels of estrogen may cause increased insulin
sensitivity hypoglycemia (low blood glucose).
• In one study, 2/3 of diabetic women reported elevated blood glucose
levels during the week prior to the beginning of their menstrual period.
– More prevalent among women with premenstrual symptoms.
• Women with diabetes are more likely to experience irregular menstrual
cycles than non-diabetics.
• During menopause, decreasing production of hormones can cause
changes in insulin sensitivity.
Guyton & Hall, pp. 929-936. www.insulin-pumpers.org/howto/menses3-1.html
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33. A Diabetic’s Guide to
Managing Diabetes
How do you know if you have diabetes?
• Diabetes: fasting blood glucose level tests above 126 mg/dL on two occasions.
• Pre-diabetes—fasting blood glucose level between 100 and 126 mg/dl.
– You have type 1, and the autoimmune attack on your beta cells is underway
– You are at risk for type 2
• A random, non-fasting blood test above 200 mg/dL indicates you may be diabetic.
– accompanied by the classic symptoms: increased thirst, urination, and fatigue.
– This test must be confirmed with a fasting blood glucose test.
• Oral glucose tolerance test: diabetes is diagnosed if glucose level is higher than
200 mg/dL after 2 hours
– This test is used mostly for type 2 diabetes.
• For pre-diabetes, it is still important that blood glucose control be near normal.
– Your doctor may tell you are ok. You need to decide for yourself.
– Your impairment could develop into diabetes.
– Consistent post-prandial (after eating) readings of greater than 120 mg/dL are cause for
concern.
– Take an HbA1c test every 6 months to monitor your condition.
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34. A Diabetic’s Guide to
Managing Diabetes
Why is there a Type 2 diabetes epidemic
among the world’s well-off?
• The wealthier people of the world exercise less and eat more.
– Drive cars instead of walk.
– Buy food from a market rather than grow it themselves.
– Hold sedentary rather than physically intensive jobs.
• They tend to be overweight.
– About 2/3 of US adults are overweight—1/3 are obese.
• The obese tend to be insulin-resistant
– An obese person produces two to three times more insulin then a
slender non-diabetic.
• Because a type 2 diabetic produces insulin, complications may
arise gradually without his/her knowledge.
• There is no easy solution to losing weight.
– People are addicted to food--life-time dieting requires will-power
– Daily exercise
Bernstein, pp. 45-47. http://www.obesityfocused.com/index.php
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35. A Diabetic’s Guide to
Managing Diabetes
What should you know about
Physiology to manage your diabetes?
• Macronutrients, carbohydrates, protein, and fat, provide energy.
• Immediately after we eat, nearly all the food that we metabolize is carbohydrate.
• The more one eats at a meal, the longer the digestive process will last.
• insulin: promotes glucose entry in many cells, controls glucose metabolism.
• Without insulin, the amount of glucose that passes across most cell
membranes is far too little for normal metabolism.
• During exercise, contracting muscles use glucose without extra insulin secretion.
• In stressful situations, epinephrine release stimulates the release of stored
glucose to muscles for action (“fight or flight”).
• A normal person will have a blood glucose level in the range 80 to 100 mg/dL.
• Type 1 diabetics don’t produce insulin, so the proper treatment is externally
administered (exogenous) insulin.
• Type 2 diabetes is caused by insulin resistance, the degraded sensitivity of
body tissues to the effects of insulin.
• A poorly treated diabetic produces too little insulin to keep his liver from causing
a steady rise in blood glucose level during fasting periods.
• Unsweetened alcoholic drinks do not raise your blood glucose level.
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36. A Diabetic’s Guide to
Managing Diabetes
Metric Units
• 28 grams (g) = 1 ounce
• 454 grams (g) = 1 pound
• 1 gram (g) = 1000 milligrams (mg)
• 1 liter (L) = 34 ounces
• 1 liter (L) = 10 deciliters (dL)
• Normal blood glucose level: 90 mg/dL
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37. A Diabetic’s Guide to
Managing Diabetes
References
1. V. Smil, Energies: An Illustrated Guide to the Biosphere and Civilization, MIT
Press, 1999.
2. R. Bernstein, Dr. Bernstein’s Diabetes Solution, Little, Brown and Company,
1997.
3. A. C. Guyton and J. E. Hall, Textbook of Medical Physiology, 10th edition, W. B.
Saunders Company, 2000, Chapters 62-71, 74, 77, 78.
4. Cawood, Bancroft and Steel, “Perimenstral symptoms in women with diabetes
mellitus and the relationship to diabetic control,” Diabet. Med, vol. 10, June
1993, pp. 444-448.
5. Kjaer, Hagen, Sand and Eshj, “Epidemiology of menarche and menstrual
disturbances in an unselected group of women with insulin-dependent diabetes
mellitus compared to controls,” J. Clin. Endorinol. Metab., vol. 75, Aug 1992, pp.
524-529.
6. Brown, Derby and Ng, “Cylcical disturbance of diabetic control in girls before the
menarche,” Arch. Dis. Child, vol. 66, Nov 1991, pp. 1279-1281.
7. M. J. Franz, “Protein: New Research/New Recommendations,” Diabetes Self-
Management, November/December 2001, pp. 85-87.
8. Images from Google™ Image Search at http://images.google.com
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