Insulin, Glucagon and Diabetes

Vitamin Supplements - Human Digestion Chemistry

2013-07-16T09:59:00.000-04:00

Vitamin Supplements

Stomach acid is necessary for digestion in the stomach but not every thing is completely digested. Some medications are coated to protect the active ingredients. That is the case with many dietary supplements.

The concentration of free H+ ions in a solution determine acidity. In the mouth, the acidity is very low (more basic, chemically) ; the stomach is very acidic and the intestines are basic.

Starting from the mouth the basic nature of the food bolus is basic. When the bolus hits the stomach the basic food mixture triggers the stomach to prepare for its role in digestion by producing acid. The acid, when it reaches the intestines signals them to produce their products which are basic in nature. It is a signaling system!

If you take your medications or supplements on an empty stomach there is a good chance they will still be active when they reach the intestines where they can be absorbed into the blood stream. The stomach doesn't have a chance to produce enough acid from taking supplements. On a full stomach - there may be too much acid and medications may weaken or be destroyed.

There I go again into my teaching mode! Hope that helps you a bit.

Jim

Just what is Oxidative Phosphorylation?

2013-01-17T08:31:00.001-05:00

Oxidative Phosphorylation

Nutrients undergo a chemical process that consists of small changes to release ions that produce a stored chemical called ATP.

It is important to understand the term "oxidation." The small chemical changes actually are a series of oxidation and reduction reactions. When a substance is "oxidized" it gains an oxygen atom. When it loses the oxygen atom it is "reduced." This idea is known by most folks. The chemists call this a "Redox Reaction." It is part of a larger series of chemical reactions called aerobic respiration.

In the process of chemical energy release, in oxidative phosphorylation, the the highest ATP production occurs in the presence of atmospheric oxygen.This is referred to as "aerobic respiration." Respiration can occur in the absence of oxygen but the net production of ATP for celluar functions is far less. The chemists call this "anaerobic respiration."

Here is a list of atoms and ions (an atom with an overall electrical charge) used in aerobic respiration. In fact, oxidative phosphorylation is the last step in aerobic respiration that all your cells use for creating stored energy production in the form of ATP.

Oxygen
Hydrogen Atoms
Electrons

Here is the Redox Reactions in the form of Oxididation and Reduction

Oxidaion:                            Reduction:

Gain of Oxygen                  Loss of Oxygen
Loss of Hydrogen              Gain of Hydrogen
Loss of Electron                Gain of Electron

The substance that provides the oxygen is the oxidizing agent
The substance that accepts the oxygen is the reducing agent

Therefore, the oxidizing agent is reduced and the reducing agent is oxidized.

The substance that loses an hydrogen is the oxidizing agent
The substance that gains an hydrogen is the reducing agent

Therefore, the oxidizing agent is reduced and the reducing agent is oxidized.

The substance that loses an electron is the oxidizing agent
The substance that gains an electron is the reducing agent

These redox reaction pathways are very efficient in the formation of stored ATP that provides the energy, when needed, for each and every cell in your body to perform its duty.

The energy that is released in oxidative phosphorylation creates a high energy bond that is formed when ATP is formed.

The muscle cells need energy to contract and provide movement. ATP, with its stored energy released, makes it possible for the muscle cell to function.

Basically, this is oxidative phosphorylation!

High Fructose Corn Syrup - Metabolism of Fructose

2012-12-23T10:22:00.001-05:00

Metabolism of Fructose:

Sucrose, a disaccharide, is composed of equal amounts of fructose and glucose. High fructose corn syrup, as the name implies, is higher in fructose than glucose. Fructose and glucose are both monosaccharides.

Now the question is the ability of the human body cells to metabolize fructose in comparison to glucose. The name High fructose corn syrup that gives the impression that it contains a large amount of fructose. The content of fructose is only 55% versus 50% in sucrose. Sucrose is pure disaccharide of only glucose and fructose. The reason HFCS has more than 50% fructose is because the glucose extracted from corn starch is enzymatically treated ( Man is entering the picture) to convert some of the glucose to fructose. This treatment of the corn starch is done to make the sugar sweeter which is why it is so popular in the food industry. The enzymatically treatment is not done by the body but is artificially administered to increase the level of fructose. Any disorder and/or dysfunction attributed to the consumption of fructose can manifest whether one consumes cane sugar or beet sugar or HFCS. Plain old sucrose is the enemy.

Glucose metabolism is subject to a negative feedback system. When the hypothalamus metabolizes glucose a signaling pathway is initiated that results in the suppression of food intake and the ultimate release of glucose in the process of digestion. This feedback system prevents you from eating too much food. Changes in neuropeptide expression results in suppressed food intake while simultaneously increasing overall energy expenditure for the many very active cells that comprise muscle and neural tissue, for example. This is normal since an energy supply is necessary for active cells.

This is in contrast to fructose metabolism. The brain and the liver possess a unique set of transporters and enzymes that enable fructose to bypass a very important reaction that controls the rate limiting step in glycolysis that is critical in the regulation of ATP production and consumption. Glycogen is a stored sugar chemical in the liver that, when broken down, releases glucose into the bloodstream from the liver. If there is nothing ready to use the excess glucose it is converted to fat. You don't want that!

When the hypothalamus fructose metabolism bypasses the above regulatory step its metabolism rapidly depletes ATP in the hypothalamus. This leads to a series of chemical reactions that make the effects of glucose metabolism and fructose metabolism very different even though they utilize the same signaling pathway to control food intake. Keep this in mind. It is important to understand why fructose can lead to diabetes and obesity.

Fructose is highly correlated with the development of diabetes, obesity and a metabolic syndrome. Fructose metabolism differs from glucose metabolism in that fructose causes the formation of uric acid. A chemical is acted upon by uric acid that causes a very rapid depletion of ATP, the main source of chemical energy for body cells. When the body senses the loss of stored ATP it signals for food intake to manufacture the ATP it senses it, the body , needs. This chemical is not subject to feedback inhibition such as is the case for glucose metabolism. This results in a very large ATP depletion. This cycle repeats itself and more food is taken in and the breakdown product are stored as fat. You, in other words, get fatter and fatter. Since the liver is the source for the majority of fructose metabolism the depletion of ATP, in the liver, has a direct effect on other liver metabolic procedures. An increase in uric acid formation takes place after a series of chemical changes in the liver.

This increase in the level of serum uric acid is directly associated with the prediction for the development of obesity and hypertension. Gout is another disorder that is associated with the excess production of uric acid. Increased consumption of HFCS can lead to an increase in the symptoms of gout.

The metabolic syndrome results in laboratory test animals resulted in increases in obesity, visceral fat accumulation, fatty liver and elevated insulin levels. Changes in other chemicals after fructose consumption may account for increased food intake that could result in weight gain.

Keep in mind the consumption of any of the basic sources of sugar from sugar cane, sugar beets and corn starch all contain fructose. Abuse of sugar, any sugar, intake has serious effects on your health.

Jim

Symptoms of Diabetes show Partial Remission

2012-12-19T17:46:00.002-05:00

Diabetic patients, in a study in the Journal of the American Medical Association, reported that 11% of those patients who undertook an intensive diet and exercise program showed a partial disease remission at the end of one year. This compares with only 2% that didn't follow the intensive program.

Patients reported shorter symptoms of diabetes effects, a greater weight loss and better physical fitness gains form the intensive program. The above results saw improvements in blood glucose levels, the researchers said.

Please refer to other posts in this blog for follow up information related to exercise and diet in glucose level control in diabetics.

Enjoy the blessings associated with the birth of the Christ Child.

Merry Christmas and Happy New Year to all!

Jim

Insulin - Methods for Administering Insulin

2012-10-01T10:01:00.002-04:00

Different Methods for Taking Insulin

Needle and Syringe

With good blood glucose control a syringe and needle is the most common way to administer insulin. Knowing your normal dosage and the activities you plan to enjoy you can approximate your insulin amount to inject just under the skin.

Insulin Pens

The insulin Pen is similar to a regular writing pen with a cartridge. Insulin pen users screw a short, fine disposable needle on the tip of the pen before an injection. You dial in the amount of insulin you need, insert the needle under the skin and press the plunger on the end to deliver the insulin. The insulin pen is used more often in other countries than in the United States.

External Insulin Pumps

About the size and shape of an iPhone and weighs about three ounces or less. You can wear them on a belt or carry them in your pocket or purse. They use a disposable plastic cartilage as an insulin reservoir. A needle and plunger are temporarily attached to the cartridge to allow you to fill the cartridge with insulin from a vial. You then remove the needle and plunger and load the cartridge into the pump. Insulin pumps contain enough insulin for several days. An infusion set carries the insulin from the pump to the body through flexible plastic tubing and a soft tube or needle inserted under the skin.

Disposable infusion sets deliver insulin to a site on your body like the abdomen. Devices are available to assist you to insert a cannula beneath the skin. An infuse set consists of a cannula needle or a soft tube. The cannula needle or soft tube is held in place by an adhesive patch or dressing. You replace the infusion set every few days.

The insulin pumps supply insulin in a steady constant stream. The pump supplies a one-time larger dose of insulin at meal times and when faulty programming by you, sometimes, causes the blood glucose level to increase above what you planned. You must frequently monitor your blood glucose levels to determine the proper dose of insulin to deliver and program accordingly.

Injection Ports

The ports look similar to injection sets without the long plastic tubing. They do have a cannula that you insert into the tissue beneath the skin. An adhesive patch holds the port in place. You insert the insulin into the port with a syringe and needle or a pen. Reducing the number of skin punctures is the main advantage of an injection port.

Injection Aids

Spring loaded syringe holders make the injection under the skin quickly. Some of these devices have a button that activates a plunger to inject the insulin.

High Pressure Insulin Jet Injectors

These apply a fine spray of insulin, under high pressure, onto the skin that penetrates without a needle or cannula.

Exercise? Great for Diabetics

2012-09-27T08:37:00.005-04:00

Why Exercise?

Exercise is beneficial for diabetics by helping you manage blood glucose levels. Blood capillary beds are increased and that increases the efficiency of your body cells. This makes the cells use of insulin better.

Activity, through exercise, helps you "burn"' calories. This requires you to provide glucose that eventually creates products that muscles use for movement. It also lowers your blood glucose that aids in glucose management.

Exercise distributes your blood into the increased blood capillary beds. This lowers your blood pressure and reduces your chance of stroke.

Your heart is a wonderful muscle and, it too, increases its' capillary beds. This lessens the chance for heart related problems tied to oxygen deprivation. The effects of a heart attack are minimized and recovery is quicker,

On a chemical basis, exercise raises good cholesterol (HDL) and lowers bad cholesterol (LDL) and triglycerides. Keep in mind fat is necessary to provide insulation to myelinated nerves. Your body produces cholesterol naturally for this purpose. Too much fat in your diet is the problem. Anytime you can exercise is good for heart health.

Insulin need is reduced through exercise by reducing the amount of blood glucose. The pancreas produces less insulin because of exercise.

Weight control is better through exercise. Losing fat, a source of stored glucose in the form of glycogen, prevents the body from turning to this potential source of glucose. That, in turn, lowers blood glucose.

Exercise leads to quicker working energy by supplying glucose, needed for normal activities, faster. It also converts chemicals that make muscles "sore" faster. Your recovery time from good exercise is shorter.

Weight bearing exercise is excellent for other systems in your body. Blood flow back to the heart from lower extremities, like your legs, is enhanced by the "milking action" of muscles contracting in your lower legs and thighs. Bone health is enhanced by better blood circulation and repair of tissues in better and more efficient.

Swimming, a form of low-impact exercise, is very effective for increasing cardiovascular health without the risk of join damage associated with walking, jogging and running. The older you get the chance of damage or injury is greater with impact exercise.

Sleep, of course, is very important to your health. Exercise helps you achieve deep sleep which is necessary for psychological recovery.

Stress, anxiety and depression recovery are alleviated through exercise and proper sleep habits.

The local gym, personal coach and, especially good, a physician trained in exercise programs for diabetics is a great place to begin your exercise program.

Diabetes and Pregnancy

2012-09-25T09:41:00.000-04:00

Diabetes and Pregnancy

Several normal physiological changes occur in pregnancy. Increased hormonal secretions influence blood glucose levels. Remember, hormones are "global" since they are carried by the blood stream to all parts of your body.

One effect is a "glucose drain" from your system through the placenta to the fetus. The emptying of your stomach is slowed, an increased excretion of glucose by the kidneys occurs and there is a resistance of cells to insulin.

The risks to a developing fetus from a diabetic mother include:

Miscarriage
Growth restriction
Fetal obesity
Mild neurological deficits
Birth defects

Building on the above risks, mild neurological and cognitive deficits in offspring include increased symptoms of ADHD, impaired fine and gross motor skills and impaired explicit memory performance are linked to Diabetic Type 1 mothers. A mechanism for the above deficits may involve prenatal iron deficiency.

High blood sugar is harmful to both the mother and her fetus. If you plan on a pregnancy try and maintain the blood sugar level close to a normal range two to three months in advance of becoming pregnant.

Type II diabetics need insulin instead of oral diabetes medication. Type I diabetics need extra insulin during pregnancy. You need more frequent blood glucose checks to carefully manage your glucose levels in pregnancy.

Tips for diabetics before and during pregnancy.

Coordinate with your health care team to monitor and achieve blood glucose normal levels
See a physician experienced in diabetic pregnancies
Monitor your eyes and kidneys - pregnancy may increase damage to them
Stop smoking, drinking alcohol or the use of harmful drugs
Follow the dietary plan of an experienced dietician

If you are already pregnant consult a physician right away. It is not too late to bring blood glucose levels to a normal range so you and your fetus stay healthy during the rest of your pregnancy.

Screening for Glaucoma - Preventive Medicine

2012-09-18T08:10:00.000-04:00

Glaucoma

Glaucoma is silent and early detection is essential. Permanent loss of vision is the end result. Yearly examinations by a vision specialist, of your choice, will screen for the early onset of glaucoma.

Your body keeps you in balance without your knowledge. This is called homeostasis. In the eye a fluid keeps the shape of the eye perfect for you to see well. Fluid balance maintenance is very important.

In your eye, fluid enters the internal chamber from small blood vessels called capillaries. These capillaries are found at the arterial end of blood vessels that supply fluid to your body systems. These small tubes are only one cell layer thick. At the same time, fluid is reabsorbed back into the circulatory system through venous capillary beds that return blood to the heart.

This inflow and outflow of fluid from the chamber of the eye is perfectly balanced. Why is this important? Liquids are not compressible. This is why early detection is essential. If the rate of fluid formation, in the eye chamber, is greater than the rate of reabsorption internal pressure in the eye increases. This slowly increasing pressure destroys the optic nerve of the eye if it is allowed to continue undetected. Glaucoma is abnormal pressure buildup in the internal chamber of the eye.

This is not temporary. It results in permanent blindness. A vision specialist will prescribe a liquid medication that prevents the pressure buildup. You have to take the medication for the rest of your life.

There are non-profit groups that routinely test people with a machine called a tonometer. It measures internal eye pressure. They screen for values that may indicate you need to see a vision specialist for further tests.

Glaucoma may indicate a capillary condition that results from diabetes. Diabetes is controllable but there is not a cure for diabetes. If you are diabetic your chance of suffering from glaucoma is high.

A Different Way to Look at Oxidation and Reducton

2012-09-17T19:05:00.001-04:00

Oxidation and Reduction

Glucose is a simple sugar that provides, in small steps, a way to produce energy (ATP) . Cellular Oxidation or Cellular Respiration is: Oxygen + Glucose breaks down into Carbon Dioxide and Water and Energy. The reverse of this equation is Photosynthesis where the Energy is supplied by the Sun that raises an Electron to a Higher Energy Level.

Oxidation is a gain of Oxygen
Reduction is a loss of Oxygen

That explains Oxidation and Reduction. It also means, in an Equation, if something is Oxidized then something else is Reduced. There are Cycles in our cells that make this possible by rearranging atoms and molecules to make it all possible.

This means there is another way to state what happens to a atom or molecule in an Oxidation and Reduction reaction.

Here is a summary of the different ways to view Oxidation and Reduction.

Oxidation is:

A Gain of Oxygen
A Loss of Electrons
A Loss of Hydrogen

Reduction is:

A Loss of Oxygen
A Gain of Electrons
A Gain of Hydrogen

Household Cleaner, like Chlorine Bleach, is a good way to see Oxidation and Reduction in action. Chlorine, by itself, likes to steal electrons from whatever it touches. If it grabs an electron form something else, the Chlorine atom is reduced. The substance that losses its electron is oxidized. That why they say Chlorine Bleach is a great oxidizing agent used in cleaning.

To the Chemists, well, it is a little simple.

If you look at The Periodic Table that lists all the Elements you find an arrangement of particles found in each element. These particles make up the nucleus of each and every atom and contribute to a hazy electron cloud that surrounds each atom.

The nucleus is comprised of Protons (+) and Neutrons (No Charge) while the Cloud contains Electrons ( - ). In elemental form each atom of an element is neutral as far as a electrical charge.

Chlorine is placed in a group of elements that are very reactive. (They all like to steal electrons)
Why? In nature we all try to achieve an equilibrium of comfort. Thats life! Atoms have a different way to achieve comfort.

In an atom, when it is "neutral" as far as charge is concerned, the number of Protons (+) in the nucleus is the same as the number of Electrons ( -) zipping about in the electron Cloud. The overall charge is Zero on the Chlorine Atom. Why can't Chlorine just behave itself?

For an Element, like Chlorine, the Electrons whirl about the Chlorine Nucleus in several different rings or Energy Levels. To achieve stability, hence peace and quiet, an atom needs just 8 electrons in that outermost ring. Chlorine only has 7 electrons in its outermost ring. It is so reactive it steals another electron from some other element.

Keep in mind, the number of Protons in the Nucleus doesn't change. Forget the Neutrons for this discussion.

When Chlorine "steals" an Electron from some other Element it now has 8 Electrons in its outermost Energy Level. It now has achieved electronic stability. Now,the overall Charge on the Chlorine Atom, before stealing, was Zero. What is it now? Remember, originally the number of Protons and Electrons were the same. If you add one electron the overall charge on the Chlorine is a negative ( - ) 1. Due to stealing the electron the Chlorine Oxidizing Agent (used in disinfecting or cleaning) is Reduced (gained an electron) and become a negatively charged Ion! Therefore, all Elements or Molecules with an overall Charge are ions. Some simple and some Complex!

A Sodium Atom is the opposite of a Chlorine Atom. Sodium, using a line of reasoning like for Chlorine, needs to lose an Electron for stability. Guess where Chlorine got its Electron it needed. You are right! From Sodium. Sodium now has an overall Positive charge and become a positive charged Ion. When Table Salt is formed a Chlorine ion and a Sodium Ion unite in what is an Electrostatic Bond that forms a molecule of Sodium Chloride.

Isn't this fun! Since Chlorine was reduced by gaining an electron the Sodium is the Reducing Agent and Sodium was Oxidized (lost its electron) to Chlorine. Hence Chlorine is the Oxidizing Agent.

Whew! See how easy this was? I will leave the discussion now. The above is an Oxidation - Reduction Reaction. One of many that occur in the Oxidation of Glucose to eventually form ATP, a source of storable chemical energy.

Pre-diabetic - Several Screening Tests to Take

2012-09-13T13:20:00.001-04:00

Diabetes or Pre diabetes or Normal - Screening Tests

If you belong to a group of people that have a higher than normal risk for developing diabetes you need to consult with a Diabetologist for screening. African Americans, Latinos, Native Americans and Asian Americans are groups that are at risk.

As one ages you are susceptible for developing pre diabetes as the groups above.

All of these blood glucose tests, mentioned below,determine whether you are normal, pre diabetic or diabetic.

One test is the A1C. If your percent value is less than 5.7% you are normal. If your percent value is equal to or greater than 5.7% but less than 6.5% you are pre diabetic. If the percent value is equal to or above 6.5% you are diabetic.

The second test is the fasting plasma glucose test (FPG.) Less than 100 mg/dl is normal. If it is equal to or greater than 100 mg/dl but below 126 mg/dl you are pre diabetic. If it is equal to or greater than 126 mg/dl you are diabetic.

The third test is the oral glucose tolerant test ( OGTT. ) If your blood glucose is less than 140 mg/dl you are normal. If greater than 140 mg/dl but less than 200 mg/dl you are pre diabetic. If you are equal to or greater than 20 mg/dl you are diabetic.

A Diabetologist can interpret these results, from your specific test results and history, to determine whether you are normal, pre diabetic or diabetic.

Please check with the American Diabetes Association if a Diabetologist is not available in your area.

Step Out for Diabetes - Help Raise Funds for Diabetes Research

2012-08-27T15:18:00.000-04:00

Stepout for Diabetes

ADA

Register, Join, Check Locations in your State or Country and have a Great Time Raising Funds for Diabetes Research!

Click the Link Below!

Stepout

With you always in Diabetes Education and Fund Raising,

Jim

Diabetic Foot Problem - Charcot Joint Disease

2012-08-24T10:06:00.000-04:00

A Serious Diabetic Foot Problem

Charcot Joint Disease

Charcot Foot is the degeneration of a weight bearing joint in the foot. It is a process of bone destruction, bone resorption and eventual deformity.

If it is left unchecked it could lead to ulceration, superinfection, loss of function of the foot , possible amputation and death.

Diabetes mellitus neuropathy (the most common in the U.S. today, resulting in destruction of foot and ankle joints), with Charcot joints in 1/600-700 diabetics. The neuropathy is related to long-term poor glucose control.

One mechanism is the loss of peripheral sensations where you can't sense touching on the ankle surface. This can lead to minute further damage to the joint called microtrauma.

The damage to the ankle is unnoticed by a diabetic. This results in inflammatory resorption of traumatized bone that causes weakness in the effected weight-bearing joint that, in turn, makes the joint susceptible to further trauma. It is a vicious cycle.

It results, from the decline in fine motor control of the joint and unnatural pressure on some joints. This leads to more microtrauma. Desensitized nerves in the ankle joint cause an increase in the blood flow to the joint. This leads to hyperimia which leads to further resorption of bone tissue. The bone resorption along with mechanical stress will cause destruction of the ankle.

If untreated or unrecognized the final result may be amputation. In the serious states infection could set in and result in death.

Please continue to consult with a Diabetologist and ask questions if you suspect numbness in the foot and ankle could lead to complications.

Pituitary Gland and Diabetes Insipidus

2012-08-16T12:41:00.000-04:00

Diabetes Insipidus

When the Pituitary Gland is involved there are three types of diabetes insipidus:

Central Diabetes Insipidus a deficiency of the hormone ADH (Anti-Diuretic Hormone) in the Posterior Pituitary Gland. The urine is very dilute but without the sugar taste of the urine associated with diabetes mellitus.

Neurogenic Diabetes Insipidus is an insensitivity of the kidneys to ADH that controls excretion of body fluid. The urine is very diluted sense the inability of the hormone ADH to restrict water loss. Again, like in Central Diabetes Insipidus, no glucose is present in the urine.

Iatrogenic Diabetes Insipidus - an artifact of medical drug use that causes the kidneys to excrete large amounts of urine. There is no glucose in the urine.

Diabetes Insipidus is characterized by excessive thirst and the excretion of large amounts of severely diluted urine, that, with a reduction of fluid intake, that has no effect on the concentration of the urine. This means the patient needs to continually take fluids into their body to prevent dehydration from the fluid loss excreted from the body. You need reserve water if you are exposed to conditions where excess water is lost normally.

Diabetes Mellitus and Diabetes Insipidus are two entirely separate conditions with unrelated mechanisms. Both cause the production of large amounts of urine (Polyuria). Diabetes Mellitus causes polyuria by a process called osmotic diuresis due to high blood sugar leaking into the urine and carrying excess water with it.

Osmosis is the process where water moves through a selectively permeable membrane from an area of low solute concentration to an area of high solute concentration. When leakage of blood glucose from the blood capillaries into the tubular ducts takes place it increases the solute concentration in the tube above that in the blood capillaries. Water, therefore, flows into the tubule by osmosis. Since this causes diuresis excretion from the kidneys along with the sugar the taste of urine in diabetes mellitus is sweet to the taste.

Diabetic Retinopathy

2012-08-14T11:31:00.000-04:00

Diabetic Retinopathy

It is damage to the retina coat of the eye caused by complications from diabetes. It can lead to blindness. It affects approximately 80% of diabetics with a history of diabetes for at least ten years.

The necessity for an early eye examination schedule by an ophthalmologist is essential. The earlier the detection, in a diabetic patient, the possibility to reduce the effects of diabetic retinopathy increases.

The detection of diabetic retinopathy is difficult. A diabetic experiences no early warning signs. The presence of blood capillaries in the eye are especially sensitive to poor blood glucose control. High blood glucose damages the capillaries in the retina of the eye. This is the beginning of the non-proliferative diabetic retinopathy. Detection of this stage of the disease is one reason for the very early schedule of visits to an ophthalmologist. You can't detect the early changes. Early changes, that are reversible, and do not threaten central vision is called background retinopathy.

If you didn't see an ophthalmologist and schedule a series of examinations to detect the early start of the disease you may detect vision changes. Blurring vision makes driving and reading difficult. Blurred vision is minor the first time you experience it. The blood capillaries, in the retina, begin to leak. This is called ocular hemorrhage and blurs vision. Proliferative diabetic retinopathy is the proliferation of new blood capillaries at the back of the eye that leak. A second, more severe leaking of blood from the capillaries, begins soon after. The onset may occur in several days to several weeks later.

Your eye has the ability to reabsorb the few red blood cells that leak the first time from the capillaries. The next phase a much greater amount of blood leaks. The reabsorption of the blood may take from only a few days to as much as years to clear. These hemorrhages usually take place at night during sleep. The blurring of the vision deepens. Your activities that require clear vision decline.

The elevation of blood glucose that causes the blood capillaries to leak also cause a swelling of the crystalline lens of your eyes. Edema, or swelling, is the result of sugar alcohol accumulating in the lens. You experience the thickening of the lens as blurred distance vision. Your near vision is not affected or the changes are slight.

Hyperglycemia causes the death and thickening of the basement membranes of the capillary cells. The capillary begins to leak. Holes begin to open that allow the contents of the capillary spill into the chamber of the eye that contains the retina. Some diabetics develop macular edema. When fluid from the capillary moves into the macula your vision blurs even more. The macular portion of the retina is responsible for the detailed portion of our vision.

As the proliferative diabetic retinopathy progresses severe non-proliferative diabetic retinopathy enters an advanced, or proliferative stage when blood vessels grow. Without treatment these new capillaries can bleed, cloud vision and destroy the retina.

Glaucoma can result as the capillaries grow and prevent the proper reabsorption of the fluid in the eye. The build up of pressure can damage the optic nerve. The blindness is now permanent.

Islets of Langerhans Transplantation

2012-08-09T15:29:00.001-04:00

Goal of Transplantation

When you agree to have a transplantation, from a donor of their Islets of Langerhans from the Pancreas, the goal is to infuse enough islets to control your blood glucose level thus removing the need for insulin injections.

A successful transplant can slow or prevent the progression of complications like nerve, blood vessel and eye changes associated with diabetes. It should help with good control of blood glucose levels.

Unless you are receiving a transplant from an identical twin that contains cells with exactly the same DNA your immune system will think the transplanted cells are foreign bodies and produce anti-bodies to kill them.

This requires the administration of drugs that supress your immune system. You must continue to use some of the drugs for the rest of your life.

For different diabetes events these mugs are great participant gifts.

Procedure

Transplanted islets come from the pancreas of a deceased donor. The pancreas is subjected to a mixture of purified enzymes called collagenases that isolate islets from the other pancreatic tissue. The researchers inject the enzyme solution into the pancreatic duct that runs the length of the pancreas. This causes the pancreas to swell. The donor pancreas is then cut up into little chunks, transferred to a Ricordi's Chamber where digestion takes place until the islets are separated out from the exocrine gland tissue.

The pancreas has both endocrine products and exocrine products.

For our sake, we are interested in the endocrine products, insulin and glucagon. They are hormones that are secreted into the blood circulatory system directly when called upon to control blood glucose levels. They are found in the islets.

The products that digest our food in the small intestine are enzymes. They enter the small intestine through ducts. When tissue does that the products are referred to as exocrine. (Pass into a duct system - not the circulatory system)

The islets are separated from the exocrine debris in a purification process. During the transplant procedure a catheter (tube) is carefully guided through the upper portion of your abdomen and into the hepatic portal vein of the liver. This provides the way the islets are placed into the body where they can begin to function.

It takes a little time for the islets to attach to the new blood capillaries and to produce insulin. As the new islets ramp up for production of insulin the physician may order many tests to check blood glucose levels after the transplant. You may need to continue injections of insulin to help you bridge the gap until the new cells take over.

Immune System Depression

Like everything else there is no free lunch. If you have to suppress the immune system, to prevent the immune system from destroying the islet cell from an unrelated donor, you leave your body more susceptible to other diseases that may enter you body. Your physician can inform you of those possibilities.

Three drugs currently used to suppress the immune system are Daclizumab (Zenapax), Sirolimus (Rapamune) and Tacrolimus (Prograf). Two of the drugs, Sirolimus and Tacrolimus, you must take for life. In conclusion, immune system suppressant drugs are not a cure. They provide a comfort level to allow a transplant to do its thing. The alternative is the destruction of the transplanted cells.

Mis--diagnosis of Type II Diabetes

2012-08-07T08:44:00.002-04:00

Type II Diagnosis and Type I Diagnosis - Cause for Concern?

The population in the U.S. is bordering on obesity. Obesity and lack of exercise are contributing factors in the onset of Adult Onset Type II diabetes.

Physicians routinely see patients with high blood glucose that are obese and inactive. They make a diagnosis of Type II diabetes that results in a program of treatment that doesn't make the patient feel better.

The reason the patients don't feel better is, in many cases, because they suffer from Type I diabetes. The protocol for treating Type I diabetes is different from Type II diabetes.

When the correct diagnosis is finally made the patient begins to feel much better.

Here is a link to an excellent article, published in todays Wall Street Journal, that is well written that addresses the problem that exists today.

Damage to Blood Capillaries in Diabetes

2012-08-04T15:39:00.001-04:00

Capillary Problems and Blood Glucose

When a capillary narrows the flow decreases dramatically. If you halve the radius of a blood capillary the blood flow through the capillary decreases to one-sixteenth of its normal rate.

This will cause an increase in blood pressure (think hypertension) which can lead to ruptured blood vessels. In the brain region, a stroke is possible. Heart attacks can occur with lessened blood flow to the arteries that supply the heart muscle.

Blood vessels capillary networks in diabetics are unable to relax well. Researchers believe altered proteins involved in relaxation are affected by a glucose-derived molecule. The net result is possible hypertension, chance of strokes and increased obesity.

When insulin is not present in the circulatory system the level of glucose remains high in our circulatory system. It begins to decrease the level of nitric oxide, a chemical that increases the diameter of blood vessels. The continual exposure to high blood glucose levels leads to the eventual narrowing of the blood vessel system.

I have not read this book. If you do read the book tell others the pros and cons.

Unfortunately, in diabetes, when a person has their diabetes under control, a small percentage of the glucose is converted to a sugar type that can modify the proteins.

In your blood vessels this modified glucose competes with a mechanism called phosphorylation that modifies an enzyme that makes possible the formation of nitric oxide. Its name tells you what it does. Its called a nitric oxide synthase. It catalyzes the formation of nitric oxide, a blood vessel dialator. The modified-glucose wins out in the competition with phosphorylation and negates the formation of nitric oxide. Net result is constricted blood vessels that increase a diabetics chance for developing high blood pressure, strokes and heart attacks.

Researchers are focusing on blocking the mechanism that prevents the formation of the modified-glucose molecule. If that is successful the effect on nitric oxide production will cease and become normal and the danger from hypertension, stroke and heart attacks will diminish.

Interesting point to remember about nitric oxide is the nitro glycerine tablet a person takes to dilate their heart blood vessels in a heart attack.

Glucose - Enzymes - Food for Thought

2012-08-01T11:05:00.003-04:00

Glucose and Enzymes

All chemical reactions require enzymes to catalyze the reactions. How are enzymes produced?

In cells the nucleus, an organelle, contains DNA that contains our genome. The genome contains all the information that constitutes you. It is unique.

All of us basically share a likeness (physical, chemical, psychological, etc.) to all that we are. Very small differences make us unique.

When a cell receives a message, from somewhere in our body ,that glucose is on its way to supply a basic ingredient for energy production our cells prepare to receive the glucose.

It seems simple. Glucose appears outside the cell, enters the cell, and produces energy that is immediately used or is stored for future use. There are two ways glucose can enter the cell. Both work when a person doesn't have diabetes.

Type I Diabetes occurs early in life and the cause is lack of insulin.

Type II Diabetes occurs later in life and insulin production is available. The factor that transports insulin into the cell is missing.

The cell needs a factor present for glucose to enter the cell. In the nucleus of a cell there are two important molecules. DNA and RNA. Like a blueprint, the DNA has a code for the manufacture of the enzyme. It replicates the code for RNA. RNA receives the information and forms a complementary code. It begins the manufacture of a faulty trigger that doesn't insulin to enter the cell interior.

All this takes place in the nucleus and inner cell machinery. Here is where trouble can begin for a Type II diabetic. What if the DNA message has changed? What caused the message to change? How does the body compensate for the inability of insulin to function? Lots of questions.

If the cell manufactures a faulty factor, from information received from the nucleus, it won't catalyze the reaction that makes it possible for glucose to enter the cell. The result is the loss or ability to activate the factor that facilitates the cell membrane to ferry the glucose into the cell interior.

It doesn't matter if the levels of insulin are normal. Glucose that doesn't enter a cell means the glucose in the blood begins to rise. There is a solution from the kidneys. The second way glucose can enter a cell, and out of the bloodstream, is based on the sodium/potassium pump. The Sodium+/Potassium+ active transport Pump allows glucose, that is reabsorbed from the kidneys, to piggy-back with the Sodium with its transporter. The Sodium Transporter helps glucose enter the cell. Even though normal amounts of insulin are available but can't function to lower blood glucose the secondary active transport system is available.

To make the removal of glucose easier diet plays a role in the Type II diabetic. That helps control blood glucose and allows normal levels of glucose in the bloodstream.

With you always in understanding the confusing relationship of glucose, insulin and secondary active transport systems in the kidneys.

Enzymes - Necessity?

2012-07-31T11:19:00.000-04:00

Enzymes

They increase the rate of chemical reactions in living systems. Molecules at the beginning of a chemical reaction, called substrates, converted into different molecules called products.

All living cells need specific enzymes to occur at rates sufficient for life and at low temperatures (body heat) than inorganic catalyst temperatures(very high temperatures).

Enzymes determine the metabolic pathways that take place in a living cell.

Enzymes are not consumed by the reaction. They are used to catalyze the same reaction over and over until they are replaced from wearing out. The enzymes are highly specific for their substrate they catalyze.

Enzymes are affected by other molecules. Inhibitors are molecules that decrease enzyme activity. Activators increase their activity. They are, of course, part of negative feedback systems we discussed earlier, and help maintain homeostasis.

Remember the perfect environment for living cells? Drugs and poisons are enzyme inhibitors. Temperature, pressure, chemical environments, like pH and concentration of substrate molecules, affect enzymes.

Continue to focus on how slight changes in any of the above factors can results in a change in the enzyme. Once changed the enzyme no longer catalyzes their specific chemical reaction.

Life is very fragile.

This is a "reminder" post about the significance of enzymes and how they play a very crucial role in human homeostasis.

Food Pecking Order and Storage - Danger?

2012-07-29T11:45:00.002-04:00

Carbohydrates, Fat and Proteins - Pecking Order

In Diabetes the emphasis is the breakdown product of polysaccharides to disaccharides to glucose, a monosaccharide.

What if, for a variety of reasons, glucose stays lower than normal. If you went to a diabetic camp, where your time exercising is high, you know what happens.

First line of supply is the storage of Glycogen in the liver. It is broken down to release glucose until the hypoglycemia returns to normal values of glucose.

If you are unable to ingest carbohydrates your body begins to call upon other sources to use as fuel.

The second line of defense is your fat storage centers. In the production of energy fat enters the energy cycle and is a great source of energy. Danger exists if you continue to use fat because carbohydrates are unavailable. The body has many uses for fat other than providing a source of energy.

Starvation is near. The final source of energy is protein. The major source of protein that comprises your muscle tissue. In severe loss of protein a very important organ can deteriorate. Your heart. Several important singers (Karen Carpenter for one) died from heart failure when the heart "muscle" was used as a food source.

Again, the glucose energy pathway has an entrance point for proteins to enter.

The body has to protect a means to seek food. The muscular system is of paramount importance. When muscle tissue is depleted to severe levels you can't move about to find food.

It is wise, in diabetes education to consider the pathways our bodies work to protect essential organs like the heart and brain.

Diabetes and Glaucoma

2012-07-27T09:33:00.000-04:00

Diabetes, Glaucoma and Homeostasis

Remember, the main function of our body systems provides a perfect environment for a cell to live.

Acidity, concentrations of electrolytes, removing wastes, 98.6 degrees F, food (glucose) , a perfect place to live forever.

Diabetics have trouble maintaining that environment. Insulin regulation and diet are important. The problem is the blood capillaries. The capillaries continue to gradually decline in their ability to maintain essential solute molecules to retrain blood volume. Regulating insulin doesn't stop the breakdown of capillaries.

Its like a movie in slow motion. How can a person with diabetes stop this slow degradation of the capillary single cell thick membrane? Research will continue to probe and test. Right now there isn't a cure.

Since the capillaries reach everywhere in our body where living cells reside there are numerous exchange points for providing fluid (water) that disappears from the blood only to return a short time later. How does this work in the eye?

A capillary bed is an exchange point for maintaining a function for an organ, part of an organ, tissues, spaces inside a structure - anywhere fluid provides products the body uses and fluids.

A capillary has an arterial end (think high pressure) and a venous end (think lower pressure). In the eye what does a capillary bed provide that makes our vision operate well?

It provides water.(think incompressible) The water maintains the shape of the eye so the mechanics of vision can function. Its like a stream flowing along , at the same rate, year after year.

In glaucoma, one end of the capillary bed is not functioning well. Blood pressure supplies the water to the interior of the eye and the venous end of the capillary bed is supposed to reabsorb exactly the same amount of water that enters the eye chamber from the arterial end of the capillary bed.

In a person suffering from glaucoma the above does not take place. There is an imbalance. More water is formed than water reabsorbed. Keep in mind this difference is very slow in developing.

What is the reason why there may be a connection between a history of glaucoma and diabetes? The deterioration of the capillary membrane from, possibly (don't know for sure), diabetes.

When the larger solute molecules leave the blood capillaries at the arterial end of the capillary bed the venous end has lost its ability to reabsorb all the water that was formed by osmosis.

Since water is incompressible it will put increased pressure on the optic nerve over time. The sensitive retinal layer, in the rear of the eyeball, begins to fail from the increase of pressure. You will develop blindness if the buildup in pressure continues without detection. Total destruction of the retinal layer will render you blind.

See an Ophthalmologist for an eye examination if you are diabetic or, if not diabetic, were screened and found to have intraocular pressure readings from a Tonometer exceeding 20.

The treatment is easy and painless. One drop of a fluid to each eye each day will keep the buildup from happening.

What if a Concentration Gradient Doesn't Exist?

2012-07-26T18:29:00.000-04:00

Active Transport and Concentration Gradients - Energy

In the nervous system and muscle system small particles with electrical charges use active transport carriers to recover the functioning capability of each body system.

Remember what the purpose of glucose is to a living cell? It provides a large molecule, glucose, that is broken up and acted upon in a cycle that produces usable chemical energy.

The energy produced is stored by the cells as ATP. It is in the form of a high energy bond associated with ATP. When a cell needs energy for one or more functions the ATP provides that energy.

There are two types on active transport mechanisms. One is associated with small particles like Sodium Ions (+), Chloride Ions (-), Potassium Ions (+), Hydrogen Ions (+) Calcium Ions (+) and a few more complex ions like NH4 (+), HCO3 (-) and Phosphate Ions (-). The other with larger protein molecules that I will post on tomorrow.

Example of a small particle active transport:

When a nerve is ready to receive an impulse that eventually reaches the brain for interpretation, it prepares by fixing its cell membrane to carry an electrical charge.

A nerve cell membrane has a large concentration of Sodium Ions (+) on the outside of the membrane and a large concentration of Potassium ions (+) on the inside of the cell membrane.

The cell, when it has a larger concentration of positive ions on one side (outer membrane surface) and a lower concentration of positive ions on the inside of the membrane (both positive) the cell membrane is polarized (ready to create a electrical charge by depolarizing.}

Think of a nerve as a railroad track. On the track is a single railroad car. Wherever the railroad car is a depolarization is taking place. All the Sodium Ions are rushing into the cell through the selectively permeable membrane and all the Potassium Ions rush out of the same membrane.

After the railroad car has passed over a section of track it begins the process of depolarization. The nerve cell calls upon its supply of ATP to provide energy to push the Sodium ions back out of the nerve cell against its concentration gradient. There are many more Sodium Ions out there even after a depolarization.

A small carrier molecule picks up a Sodium Ion, carries it to the external membrane surface and releases it.

Instead of wasting its return trip to pick up another Sodium Ion the carrier molecule picks up a Potassium Ion and returns (against its concentration gradient) it to the cell interior by active transport. Its like a two way pump that re-establishes the polarity across the nerve cell membrane.

All this activity needs energy to function. Once the nerve cell is depolarized it is ready to receive a new nerve impulse.

In review, active transport uses energy to push a particle (ion) through a selectively permeable membrane against its concentration gradient.

The Importance of Large Molecules in Blood Vessels

2012-07-25T16:08:00.005-04:00

Fluid Balance and the Role of Large Molecules

Water is a critical fluid in maintaining life. How does the circulatory system maintain its volume? What role does osmosis play in the circulatory retention of water?

First, just what is a solute particle? In the blood capillary the two major solute particles that are to large to pass through the selectively permeable membrane are albumins and globulins. They are found in the blood plasma. Problems begin when the number of albumins and globulins escape from the blood capillary.

Normally they are always present in the capillary and provide the high concentration of solute molecules that cause water, a solvent, to enter the blood capillary via osmosis.

This is very important. The circulatory system is the transportation system of our body. The volume of the circulatory system is critical for maintaining blood pressure and the prevention of circulatory collapse.

Therefore, again, osmosis is the movement of water from an area of low solute concentration to an area of high solute concentration through a selectively permeable membrane.

In this example, the importance of retaining the albumins and globulins in the blood capillaries is paramount. In the kidneys the functional unit is the glomerulus. It is here the blood, under pressure, loses (filters out ) almost everything that is considered a solute except for albumins, globulins and red blood cells.

In diabetes the capillaries become inflamed (an "itis," attached to a medical term, is used to convey an inflammation of something) For instance, glomerulitis means an inflammation of the capillaries of the glomerulus.

When glomerular capillaries are inflamed spaces appear between the capillary cells that are now large enough for albumins, globulins and red blood cells to pass through into the interstitial fluid. Now we really have problems.

The capillaries of the circulatory system are unable to reconstitute the circulatory system with water that was lost during the initial filtration by the kidneys.

When the inflammation is treated the capillaries are again able to retain water by osmosis. This damage is the very serious for the diabetic. It occurs, even though a person has their insulin under control.

If you ever attended a "Walk for the Cure" event for Diabetes they have T- Shirts for participants. This is a little different.

I use this example to point in the direction of other solute particles, like ions and smaller molecules, that are selectively moved to create osmotic effects for water transport.

Above all else the integrity of the cells that make up a capillary must be maintained without leakage of the albumins, globulins and red blood cells for our body to function. This is a challenge for physicians treating diabetics.

The Traveling Man - Glucose

2012-07-25T09:54:00.002-04:00

Glucose - A Molecule in Motion with a Purpose

Lets begin with its breakdown. It starts with a polysaccharide to a disaccharide to a monosaccharide (glucose). All of this begins in the mouth. Glucose is so important to you it gives excessive time to digest all the basic sugar components of nutrition you provide.

Keep in mind, the pancreas is both an endocrine organ ( insulin and glucagon) and an exocrine organ (digestive enzymes for disaccharides, dipeptides and fats). Hormones are secreted directly into the circulatory system and are global( Reaches all cells supplied by blood capillaries). Enzymes work locally and enter their workplace through a tube into the small intestine.

One very important principal is the concept of surface area. There is a direct correlation between an increase in the rate and quantity of absorption of digestion products and the increase in the surface area exposed to the end product glucose.

Surface area is one of the factors that scientists use to differentiate lower animals from higher animals like us. The increased surface area in our intestines (especially the small intestine) allows us to meet our energy demands efficiently and quickly. This is a big improvement over lesser creatures.

Once in its final stage of breakdown (the monosaccharide glucose) it is absorbed in the small worm-like villae that cover the inside of the small intestine. They really increase the surface area used for absorption.

Remember, it passes through the mosaic membrane of the cells (intracellular fluid compartment) that are in direct contact with the glucose in the small intestine. It now exits that membrane cell on the other side of the cell membrane into a fluid matrix called the interstitial fluid compartment of the extracellular fluid compartment. It travels through that compartment where it enters the intracellular fluid compartment of a cell layer that makes up blood capillary.

It leaves the cell that lines the blood capillary. In review, it goes from an intracellular compartment into the blood capillary fluid that makes up the other compartment of the extracellular fluid.

The blood, with the dissolved glucose in it is transported to all the cells that use glucose for energy.

Excess glucose that isn't used enters the kidneys where it is excreted into the urine. It is similar to water flowing over a dam. This occurs when something is amiss. Maybe insulin is not produced adequately and this excess is in addition to the glucose transported to the liver for storage as glycogen. It may be called back as glucose in emergencies.

The glucose that is still present in the blood, in very high amounts, even after flowing over the dam in the kidneys, is Diabetes. (The result of not facilitating the uptake of glucose that we described above)

This trip we just took is a one way trip. There is some glucose that is converted to a more complex molecule and stored in the liver. This more complex stored molecule breaks down in the liver, when called upon, to provide glucose when your blood sugar is low due to a number of factors.

I don't know about you but my feet are a little sore from walking with the glucose molecule on its trip. You should begin to realize now how complex your body has developed to accomplish all this without you really knowing that it is happening.

Negative and Positive Feedback Systems - Homeostasis

2012-07-24T08:33:00.002-04:00

Concentration Gradients and Homeostasis

Time to backup and talk about feedback systems that keep the concentration of things your body needs to function normally.

Homeostasis is a state reached when your chemicals necessary for life are within their normal concentration range.

Wide swings in concentrations is not good. You don't feel good when "wide swings" occur. Do you feel good with high concentrations of glucose in your blood that persist? No.

A "Negative Feedback System" , when operating normally, prevents "wide swings" in the concentration of substances that are important to your body systems. One of these chemicals is a by-product of digestion.

If the body produces glucose for the metabolism necessary for life in all our living cells there is a feedback system ( this link is a series of excellent diagrams of negative and positive feed back systems) for glucose that turns off the production of glucose when it is no longer needed. It does this to prevent the concentration of glucose to reach levels in the blood that are dangerous. The swing upward (wide swing) of glucose is too great if the feedback system isn't working.

Lets look at a muscle cell. If its contracting it needs food (glucose) to manufacture energy for contraction to occur. When the period of contraction ends the need for glucose ends. To conserve glucose for another time a process takes place to remove the excess glucose from the blood and store it. The normal level of glucose is maintained. Insulin does this normally.

Think of a small stone thrown into a quiet pond. Little waves are produced. This is very similar to the small up and down swings in your glucose concentration if the feedback system is working well. This is homeostasis.

The process is called a "Negative Feedback System." It prevents "wide swings" in the concentration of necessary chemicals, like glucose, from occurring. It starts a system up to provide the necessary chemical (glucose) and shuts down the process when the need for (glucose) temporarily disappears. The body likes to save essential chemicals for a later time.

For a diabetic, the pancreas is not producing enough insulin to bring the concentration of glucose back to normal levels after the need for the glucose ends. (like a muscle contracting.)

The Negative Feedback System for glucose homeostasis is not functioning. The excess glucose is not returning for the storage process after the "need event." This, in very simple terms, is Diabetes.

Let me digress a bit, before I get one of my headaches when I start to think to much! :):)

A Positive Feedback System is Blood Clotting. You want blood clotting to occur and keep occurring at the site of a good, bleeding scratch or cut to form a scab to prevent further fluids and electrolytes from leaving the body too quickly and not under body control. Since there is not a need to lose body fluids and electrolytes in uncontrolled events (like a severe cut) this system works only one - a positive action to make a clot and scab formation possible.