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what is the honey moon period?
the period of time between the first acute event that triggered an acidosis state and the time point where insulin secretion goes below the critical threshold (in type 1 DM)
what is happening in phase I of a patient developing type 2 diabetes mellitus?
insulin resistance, increase in insulin release, maintain normal blood glucose levels
what is happening in phase II of a patient developing type 2 diabetes mellitus?
beta-cell degradation, insulin secretion is lowered, glucose levels begin to rise
what is happening in phase III of a patient developing type 2 diabetes mellitus?
severe beta-cell exhaustion, severe increase in blood glucose levels
what processes does insulin resistance increase the activity of?
- breakdown of tissue proteins
- liver glycogenolysis
- liver output of glucose
- FFA in plasma
- hepatic VLDL production
what processes does insulin resistance inhibit/slow down?
- glucose uptake by tissues
- VLDL clearance by LPL
what are the incretins?
GIP and GLP-1
what is the function of GIP?
amplifies glucose stimulated release of insulin (does not affect insulin secretion when glucose levels are not elevated)
what is the function of GLP-1 (glucagon-like peptide 1)?
- increases levels of insulin in response to a meal (secreted from L-cells of intestine, released within minutes of eating)
- patients with type 2 DM have low levels of GLP-1
how does GLP-1 (and GIP) lower blood glucose levels (6 ways)?
- 1. inhibits beta-cell apoptosis
- 2. promotes beta-cell growth
- 3. increased insulin
- 4. decreased glucagon
- 5. inhibits appetite
- 6. delays gastric emptying