CRIrmo AL CARE Na Ekstvo QUARTIRIY/APRn-JUNE 2004
ent from the glycerol produced in fat break-
down. Glucose production by the liver is one
take and
acid
rage by
s and
amino acid uptake by
Insulin defi
the most important processes resulting in
ciency then results in a reversal of these pro-
he hyperglycemia of diabetes, whether from
cesses and in essence creates a state equiva-
lent to starvation
nsulin deficiency or from insulin resistance
nsulin is produced by the B ce
lets of Langerhans of the pancreas under the
nfluence of the blood glucose level
Insulin TYPE 1 DIABETES MELLITUS
is a protein hormone secreted by the B cell
deposited into the intracellular space
and is TIDM is a genetic disease of the immun
It then passes into the bloodstream and pro
system and the genes responsible for this dis
ceeds through the circulation to the cells of
ease are carried on the DQ band da designa-
body. At the cellular level. insulin inter-
tiot
of a specific band in the genetic mark-
ers) of the short arm of the chromosome
surface called
acts wi
a protein on the ce
an insulin receptor. This interaction stimu.
Genes in this area are known as the Major
lates a cascade of intracellular reactions, each
istocompatibility system and control the im-
catalyzed by a different enzyme, which ulti-
mune system. These are the genes that are
mately results in the production of another
matched for organ
transp
When some
in, called a glucose transporter (GLUT4
of these genes malfunction or are abnormal
scle cells). GLUTi passes or migrates
they can impair
the immune system's abil
to the cell surface facilitating the entrance
it
to recognize itself. Autoimmune diseases
of larger molecular nutrients such as glucose
such as TIDM nd others, eg, rheuma
and protein. One of the key enzymes in this
toid arthritis,
are the result. A few genes
PPAR-y operoxisome proliferat
discovered so far
for TIDM are called
activated receptor y) This is an enzyme
in LA-DQA 0301. HLA-DQAI*O302, HLA-DQ
the cell nucleus that has many functions but
1 0002, and HLA-DQwi.2. Some genes ap
here it causes the production of messenger
pear to protect against diabetes. Genetics is
acid) that then forms t
not the wh
RNA (ribonucleic
story, however, since not ev
glucose transporter protein, (GLUT 1-5). It is
eryone with these genes develops the disease.
this enzyme that is activated by the oral agents
Only about 50% of iden
twins get the
glitazone and pioglitazone. PPAR-y has
disease. There must therefore l
ros
vironmental factors involved that trigger the
be involved in protect
also been shown
ing vascular tissue from the damage caused by
high blood glucose levels. This effect unre
cells of
nmune system
the pancreas and destroy them, causing in
lated to its effect on blood glucose control
n deficiency and diabetes. The environ
mental factors that trigger the destruction
on insulin resistance.
yet fully identified. Cer
Insulin has a number of functions in differ
of f cells are n
ent cells. It facilitate not only the uptake of
viruses, such as coxsackie viruses, have
tain food components into the cel
but also their
been identified in some patients. Cow's milk
storage. Insulin stimulates the enzymes that
as also been suspected but data so far are
make glycogen and fat and suppresses the en-
incomplete. There are probably other
enri.
zymes that break down glycogen and fat. This
ronmental precipitating factors yet to be iden-
breakdown of storage
substances is a normal
tified and
dies are going on for this pur
process and is vital to the metabolic process.
pose. Many of these studies are being done
the absence of insulin the process is too in Europe especially in Scandinavia where the
rapid. The system cannot utilize the metabo- prevalence of TIDM is the highest
The
lites produced and a catabolic state is created.
There are at least 3 forms of TIDM, The liver can also produce new glucose (gl
commonest form of the disease is that which
co neogenesis) from protein and to a lesser ex-
occurs most during the preadolescenu growth