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Clinical Gems

Our clinical gems come from the top selling medical books, and text books because knowledge is everything when it comes to diabetes.

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #28: Insulin Gene Expression and Biosynthesis Part 4 of 6

Insulin biosynthesis: the previous section outlines that insulin gene transcription is a highly controlled process. The product of this process, pre-proinsulin mRNA, is unusually stable in pancreatic beta cells and it is further stabilized as glucose concentrations increase. As such, there is normally an abundant source of preproinsulin mRNA in the beta-cell cytosol available for translation.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #27: Insulin Gene Expression and Biosynthesis Part 3 of 6

Dysregulation of the insulin gene: There is convincing evidence that abnormalities in insulin gene sequence or function play a role in pancreatic beta-cell dysfunction in type 2 diabetes. Abnormalities in the insulin gene structure consist of rare control region mutations, while insulin gene expression appears to be reduced by metabolic conditions associated with the diabetic state.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #24: Pancreatic Morphology in Normal and Diabetic States Part 4 of 4

Chronically elevated glucose and/or free fatty acids: type 2 diabetes is characterized by increased circulating nutrients including glucose and free fatty acids (FFA).The literature clearly shows that chronic exposure of beta cells to elevated glucose results in impaired beta-cell function, but the data regarding cellular toxicity in response to this nutrient are more mixed.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #23: Pancreatic Morphology in Normal and Diabetic States Part 3 of 4

Disturbances in pancreas/islet morphology in diabetes: Type 1 diabetes (T1DM) is classically associated with autoimmune destruction of beta cells. However, the pancreas is more broadly affected, with overall pancreas size being decreased in individuals with this form of diabetes, and loss of exocrine tissue occurring close to areas of immune infiltration.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #22: Pancreatic Morphology in Normal and Diabetic States Part 2 of 4

Islet vasculature: The islet is richly vascularized; while islets comprise only ∼2% of pancreas volume, they receive approximately 15% of the blood flow. Arterioles enter the islet and branch into tortuous capillaries, which have been suggested to contact almost every endocrine cell in the islet. These then converge on collecting venules outside the islet.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #20: Development and Maintenance of the Islet Beta Cell Part 4 of 4

For many years it was speculated that beta cells, much like neurons, were postmitotic and that their turnover in the mammal was minimal or zero. Over the last two decades, studies in mice have suggested a more dynamic picture, wherein beta-cell mass can change in response to physiologic states such as growth, pregnancy, and obesity.

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