793
iabetes mellitus is an abnormality in blood glucose
regulation and nutrient storage related to an abso-
lute or relative deficiency of insulin and/or resistance to
the actions of insulin. In the United States alone, dia-
betes mellitus affects 25.8 million people, or approxi-
mately 8.3% of the population.
1
Type 1 diabetes, which
is caused by an absolute deficiency of insulin, accounts
for 1 million of these people with the remainder hav-
ing type 2 diabetes. In addition, another 79 million
people have been categorized as having “prediabetes.”
Globally, the prevalence of prediabetes and type 2 dia-
betes is increasing at an alarming rate.
Hormonal Control of Nutrient
Metabolism and Storage
Nutrient intake and storage in the form of adipose
tissue, along with the action of insulin and other hor-
mones, play an important role in the development of
insulin resistance, the metabolic syndrome, and type 2
diabetes. This section provides a brief overview of nutri-
ent (glucose, fat, protein) metabolism and storage and
the hormones, including insulin, that are involved in the
process. Overweight and obesity, as well as adipose tis-
sue and its function in energy storage and as an endo-
crine organ, are discussed in Chapter 10.
Nutrient Metabolism and Storage
The body uses glucose, fatty acids, and other substrates
as fuel to satisfy its energy needs. Although the respira-
tory and circulatory systems combine efforts to furnish
the body with the oxygen needed for metabolic pur-
poses, it is the liver, in concert with insulin and other
hormones, that controls the storage and mobilization of
the body’s fuel supply.
D
Diabetes
Mellitus and
the Metabolic
Syndrome
33
C h a p t e r
Hormonal Control of Nutrient Metabolism and
Storage
Nutrient Metabolism and Storage
Glucose Metabolism and Storage
Fat Metabolism and Storage
Protein Metabolism and Storage
Glucose-Regulating Hormones
Insulin
Glucagon
Amylin, Somatostatin, and Gut-Derived
Hormones
Counterregulatory Hormones
Diabetes Mellitus
Classification and Etiology
Categories of Risk for Diabetes
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus and the Metabolic
Syndrome
Other Specific Types of Diabetes
Gestational Diabetes
Clinical Manifestations of Diabetes
Diagnostic Tests
Blood Tests
Urine Tests
Diabetes Management
Dietary Management
Exercise
Oral and Injectable Antidiabetic Agents
Insulin
Pancreas or Islet Cell Transplantation
Management of Diabetes in Children
Acute Complications
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar State
Hypoglycemia
The Somogyi Effect and Dawn Phenomenon
Chronic Complications
Theories of Pathogenesis
Diabetic Neuropathies
Diabetic Nephropathies
Diabetic Retinopathies
Macrovascular Complications
Diabetic Foot Ulcers
Infections
