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Diabetic ketoacidosis

When glucose is high in the blood but unable to enter cells, the body starts using stores of fat for energy, which results in the production of acidic ketones as a by-product. If ketone levels rise unchecked a hyperglycaemic coma can result which may be fatal.

Hyperglycaemia

Raised blood glucose levels (more than 10mmol/l)

Blood vessels

The tubes through which blood is carried around the body eg arteries, veins and capillaries

Hypoglycaemic

This is the term used when the blood glucose level is too low (less than 4 mmol/l)

Mitochondria

Organelle(s) within cells that produce ATP, used as a store of chemical energy. Often called the cell's powerhouse

Respiration

The biochemical process by which the cells in the body releases energy

Capillary

Very small blood vessel with walls made of a single layer of epithelial cells. Exchange of materials, such as nutrients, oxygen and carbon dioxide, takes place between the blood and the cells of the body across the capillary walls.

Tissue

A group of cells in an organism that are specialised to work together to carry out a particular function.

Brain

The main organ of the central nervous system made up mainly of grey matter

Nerve

A bundle of neurones - it may be all sensory neurones, all motor neurones or a mixture of both

Adenosine triphosphate

Molecule which acts as the common energy currency in all cells, providing the energy needed to drive chemical reactions in cells.

Regulating blood glucose levels

Glucose is essential for all cells of the body. It provides the 'fuel' for respiration in mitochondria which generates ATP, the energy source for all cell processes. Without a sufficient supply of glucose, cells quickly start to 'shut down' processes. It is therefore important to regulate the supply of glucose in the blood. Brain cells are particularly sensitive to low glucose levels.

Blood glucose levels rise after a meal, as digested food is absorbed in the small intestine, and fall between meals as glucose is used by the cells of the body. The graph shows the fluctuations in glucose levels throughout the day in a person without type 2 diabetes and a person with type 2 diabetes.

Graph showing the changes in blood glucose levels throughout the day.

Unregulated blood glucose

If a person with diabetes does not regulate their blood glucose, they can fluctuate between excessively high levels (hyperglycaemia) and too little (hypoglycaemia) glucose. If this situation happens over several years, both can cause problems.

Hyperglycaemia

  • Blood glucose above normal
  • Damage to endothelial cells lining the blood vessels.
  • Damage to capillaries in retina (blindness), kidneys and elsewhere
  • Poor peripheral circulation leading to tissue damage.
  • Heart attacks and strokes.
  • Peripheral nerve damage.
  • Damage to insulin-producing beta cells in pancreas
  • Diabetic ketoacidosis (DKA) and hyperglycaemic coma.

Hypoglycaemia

  • Blood glucose below normal
  • Confusion and loss of consciousness as brain cells starved of glucose.
  • Hypoglycaemic coma and possible death if not treated promptly. Treatment is to administer glucose.

Diabetic complications: Incidence / year / 1,000 persons

Complication Type 1 diabetes Type 2 diabetes
Angina 8.8 38.4
Heart attack 8.6 21.9
Stroke 1.1 14.2
Lower-limb amputation 3.2 3.1
Peripheral vascular disease 5.5 13.6
Blindness 1.1 1.6
End stage renal disease 6.4 5
Deaths 14.6 50.0

More details of the complications caused by poorly controlled blood glucose levels

Insulin and glucagon

These two main hormones are involved in the regulation of blood glucose levels.

Insulin and glucagon regulate blood glucose levels



Question 2