One in twelve US adults have diabetes. This amounts to approximately 25 million US adults, a number that is projected to increase starkly over the coming decades. This means that a majority of physicians, nurse practitioners and other health care professionals will deal with patients that have diabetes, either as the primary indication or as a co-morbidity in a patient that is admitted or referred for other indications. With between 400 and 500 students enrolled in NPB101, it is likely that some of you have diabetes, and many more of you will have relatives with diabetes.

 

Diabetes mellitus derives its name from the Latin phrases diabetes: 'to run through' and 'mellitus: 'of honey'.

 

3a) What 2 symptoms of patients with untreated diabetes gave rise to these terms.

 

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3b) Explain the physiology behind these symptoms. Are they related? If so, is there causality?

 

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3c) These days we diagnose diabetes with a glucometer that measures glucose levels in a small drop of blood, usually obtained by a finger stick. How would the ancient Greeks or Romans have diagnosed diabetes?

 

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3d) How many types of diabetes do you know?

 

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3e) The immediate cause of diabetes is a lack of insulin, but for different reasons. Explain the underlying causes for the lack of insulin in the two most common forms of diabetes.

 

Answer

 

3a) What 2 symptoms of patients with untreated diabetes gave rise to these terms.

1. Diabetes means  "passing though; a large discharge of urine": it is because patients with diabetes mellitus have very large amounts of urine and they also have an increased frequency of urination
2. Mellitus means "honey" and this is because there are increased amounts of glucose in urine and it makes it taste like honey

3b) Explain the physiology behind these symptoms. Are they related? If so, is there causality?

 Physiology of large amounts of urine: It occurs because of an increased osmolarity of tubular fluid. Remember that there are high levels of glucsoe in the blood. Normally, when glucose gets to the proximal tubule of the kidneys, they are COMPLETELY reabsorbed, however during diabetes mellitus, as there are very large amounts of glucose in the blood, then the proximal tubule won't be able to reabsorb them all and some of them will move forward the tubular system. As this occurs, glucose will increase the osmotic pressure in the tubular fluid (future urine) and it will drag water from the blood to the tubular fluid leading to large amounts of urine.

Physiology of glucose in urine is mentioned above, it means because of large amounts of glucose in the blood, all of them won't be able to be reabsorbed by the proximal tubule and this will lead to increased levels of glucose in urine.

3c) These days we diagnose diabetes with a glucometer that measures glucose levels in a small drop of blood, usually obtained by a finger stick. How would the ancient Greeks or Romans have diagnosed diabetes?

They diagnosed diabetes mellitus by tasting patient's urine. If urine tasted sweet, then they made the diagnosis of diabetes because sweet taste = high levels of glucose in urine.

3d) How many types of diabetes do you know?

I know three types:

1. Type 1 diabetes mellitus: autoimmune destruction of beta cells of the pancreas
2. Type 2 diabetes mellitus: due to peripheral insulin resistance
3. Gestational diabetes : it is a diabetes that appears for the first time during pregnancy and usually dissapears after it.

3e) The immediate cause of diabetes is a lack of insulin, but for different reasons. Explain the underlying causes for the lack of insulin in the two most common forms of diabetes.

The two most common forms of diabetes are:

1. Type 1 diabetes mellitus: It occurs due to autoimmune destruction of beta cells of the pancreas. These cells are normally involved of producing the hormone insulin so, as there is no insulin production, then glucose won't be able to get into cells with insulin-dependent glucose transporters like skeletal muscle and adipocytes.
2. Type 2 diabetes mellitus: in this condition, there are normal beta cells of the pancreas. The problem here is a chronic hyperglycemia due to increase in insulin resistance by peripheral tissues, it means the tissue won't respond to insulin as normal as they should and they will need an increase of production of insulin to respond normally. As a consequence, beta cells of pancreas will overwork in order to produce more insulin. As time passes, beta cells of pancreas will get "exhausted" and they will atrophy and they won't be able to produce more insulin and this will lead to diabetes mellitus.