Okay, now, here's a question for you.
What do you think are the 2 main
effects on the metabolism of glucose
when insulin usage isn't effective?
So just so that makes sense, what do you
think happens to the metabolism of glucose
when a human body can't utilize
insulin to get glucose into the cell?
So here's the results.
You have an increase in glucose production.
These people already have elevated blood sugar,
but because it can't be utilized,
it increases its production
and you can't utilize the blood sugar that's there
or the additional blood sugar that's coming out.
Can you say "Train wreck?"
So when you have insulin resistance and you're
not able to utilize the glucose that you have,
you are at an extreme high risk
of the complications of diabetes.
So, there's the magic red box that Lecturio
always uses with the exclamation point
to tell you this is why insulin
resistance is a problem.
If the patient can't use the glucose
that's in their blood stream,
they're robbing their body of energy, they're
going to increase their glucose production,
and their blood sugar's going
to remain consistently high.
Now, we're risking all the nasty
complications of diabetes.
So, I know there's a lot of complications here.
And we usually just don't throw them all up on the
screen, but I wanted you to get the effect --
Here it is.
There's a ton of these complications, but I
have a solution; strict blood glucose control.
If you will help your patient
learn what it takes to control
the blood sugar in their body
through activity, through diet,
and through proper medication management,
you're going to minimize the risk of them
developing all those horrible complications.
So, now, let's go back and look
at them at a reasonable pace,
but I wanted you to get the
idea, we have the answer.
Whether they're type 1 or type 2,
if we can work alongside
with the patient without judgment
or making them feel bad,
we can help them find the most effective
strategies to be more active,
their cells to be more
receptive to taking up insulin
if they increase their physical activity,
to monitoring their diet to a reasonable level.
And following their medication
we can minimize the risk of
developing these complications.
So, diabetic patients are at
an increased risk for stroke.
So, automatically, if I have diabetes, I know
that my chance to get a stroke is higher.
The poorer the control of my blood
sugar, the higher my risk for stroke.
Patients with diabetes can lose
their vision from retinopathy
caused from elevated blood sugar.
They're not only at risk for stroke,
they're also at risk for cardiovascular
disease and hypertension.
And hypertension puts you at an increased
risk for cardiovascular disease and stroke.
So it's kind of like, "Wow.
It all comes together in one, doesn't it?"
Now, you have the macrovascular damage.
That is when you are damaging the
smallest vessels in your body,
which makes it really hard for us to get
good blood flow to your extremities,
which is why diabetics who
have very high blood sugars
for a long period of time have horrible
circulation in their extremities.
They also often end up with an infection
in their toe or in their foot.
It's very difficult to get an antibiotic
down there to that infection,
and it is not unusual for these types of diabetic
clients to have toes, feet, or legs amputated.
You know, that's really unnecessary if we can help
them understand how they can manage lifestyle
and medications and avoid
those types of complications.
Also, we want to teach them
to always look at their feet,
so we can catch a wound early and intervene.
Now, anyone with high blood
pressure risks nephropathy,
or problems with your kidneys, but
diabetics are double whammy, man.
They have the macrovascular damage and they
have the issues with nephropathy, renal damage.
So, eyes, kidneys, heart, brain.
Those are some pretty important organs
that take a hit from the complications
of elevated blood sugar with diabetes.
The other one's kind of personal,
but it's a huge deal, obviously,
that diabetes can cause erectile dysfunctions.
Also, they don't heal well, okay?
They have high lipids, high glucose,
and it's almost like the have this --
this influx, it suppresses inflammation.
So, when they get a regular cut, or they
have to have surgery or they have a wound,
it just doesn't heal as well as
someone who didn't have diabetes.
And last, we talked about that foot
damage, but I want to bring it up again.
Remember that poor circulation, they are very
prone to the risk of losing toes, feet, or legs,
and it just doesn't happen to the
majority of patients that it does.
If we can partner with them, and help them
make the changes to keep them the safest,
and live their best quality of life.
So let's wrap up this section.
Glucose is taken in through
We talked about some awesome pizza.
Then it's absorbed into the cells of skeletal
muscle, and also stored in the liver.
Those are the 2 main areas of storage.
Insulin is secreted by the pancreas
when the blood glucose levels rise.
So when you eat that pizza, your blood glucose
levels go up, the pancreas secretes the insulin.
Remember what the insulin does,
it binds to that receptor,
opens the doorway to the glucose to go
from the bloodstream into the cell.
That's what insulin does.
It's the facilitator, the helper to
glucose, to get it into the cell.
Type 1 diabetic patients have damaged
beta cells in their pancreas.
They can't secrete insulin.
That's why they have to have insulin replacement.
There are some oral medications that
we can use for type 2 diabetics
that stimulate the pancreas
to put out more insulin.
That's not going to be appropriate
for a type 1 diabetic client
because their pancreas just can't do it.
Those cells have been damaged and
are not able to secrete insulin.
That's why most of the oral medications,
oral anti-diabetic medications,
will not work for that type 1 diabetic,
but watch for the one that's showing some
promise for type 1 diabetics around insulin
and we can add this oral medication
to make that even more effective.
But even so, there's no replacement
for insulin at this point.
Type 2 diabetics are patients
that often are insulin resistant.
"Resistance is futile." Yeah, it is futile
because if you can't get that under control,
they're going to have a lot of complications.
So, a type 2 diabetic might
be able to make insulin,
but they just can't use it effectively to get that
glucose into their cell to use it for energy.
So all that does is wreak havoc
on the rest of their body.
Now, type 2 diabetes can be
treated with oral anti-diabetics.
Now, it may progress to the need
to have insulin replacement,
but initially, if we catch it early enough,
we can do oral anti-diabetics
and some lifestyle changes,
and hopefully, get that under control and
slow the progression of the disease.
Now, several cardio risk factors
are associated with diabetes,
and there's potential for their eyes, kidneys,
and their microvascular
circulation to be damaged, okay?
So, you're thinking eyes, kidneys, remember?
Even your brain with a stroke, and then
your circulation is definitely affected.
So, the more controlled and
consistent you can help keep
their blood sugar closer to a normal
blood sugar, and keep that sustained,
the lower the risk factor of these
extensive complications from diabetes
that your patient will experience.
So don't rush over that.
You need to have a clear understanding
of type 1 diabetes and type 2 diabetes,
and also understand the
difficulties in lifestyle changes.
You need to be someone who's also
making healthy choices in your diet
and in your level of physical activity,
so you can understand how
difficult it is for your patient.
Thank you for watching our
video on diabetic medications.