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RICHARD F. DODS, PhD, D.ABCC, has studied, taught, and written about diabetes mellitus for many years, beginning as a research associate at New York University Medical School. As Director of Clinical Chemistry at the Louis A. Weiss Memorial Hospital, Dr. Dods published pioneering papers on the use of HbA1c as a test for monitoring diabetes mellitus. Later, he established his own company, Clinical Laboratory Consultants, which advised hospital and commercial laboratories on the implementation and interpretation of assays and the use of instruments for the diagnosis and monitoring of disease, including diabetes.
Preface
1 A Pandemic in the Making
Diabetes Prevalence and Cost in the United States
A dire prediction based on alarming data
The increase of diabetes in youths
The cost
Diabetes Prevalence and Cost Worldwide
A worldwide epidemic
Numbers of cases of diabetes
Cost
Obesity and Overweight: Another Epidemic in the United States
A parallel epidemic
Definitions of overweight and obesity
Overweight and obesity among adults in the U.S.
Obesity and overweight among children and adolescents in the U.S.
Overweight and Obesity Worldwide
Overweight and obesity globally for adults
The Relationship between Obesity and Diabetes
Bibliography
Projects and Questions
2 Early History of Diabetes Mellitus
The Ebers Papyrus
Neandertals
Hippocrates, Aretaeus and Demetrius
Galen
Sushruta
Ibn Sina (Avicenna)
The Yellow Emperor
Japanese Medicine
Paracelsus (Philippus Aureolus Theophrastus Bombastus von Hohenheim)
Thomas Willis
John Conrad Brunner
Matthew Dobson
John Rollo and William Cruickshane
Thomas Cawley
Michel Eugene Chevreul
Claude Bernard
Paul Langerhans (Edouard Laguesse and Eugene L. Opie)
Oscar Minkowski and Joseph von Mering Advances in Sugar (Glucose) Determinations
Earliest Approaches- Taste and Fermentation
Evaporation of urine to yield sugar crystals
Moore’s test
Trommer’s test
Barreswil and Fehling’s Solutions
Frederick Pavy
Benedict’s Solution
Folin-Wu Determination of Blood Glucose
Banting, Best and MacLeod
Leonard Thompson
John Jacob Abel
Frederick Sanger
Pedro Cuatrecasas
Bibliography
Questions and Crossword Puzzle
3 A Glucose Metabolism Primer
Prologue to Chapter 3
The Carbohydrates and Their function
Digestion and Absorption of Carbohydrates
Salivary and Pancreatic Amylase
Disaccharidases
Absorption
Overview of Glucose Metabolism
Adenosine 5’-Triphosphate (ATP)
Glucose Metabolism
Glucose transport into cells
Phosphorylation of Glucose
Introduction to Glycogen synthesis and Hydrolysis
Beautiful Concepts
Glycogen Synthesis
Uridine Bisphosphate Glucose (UBP-Glucose)
Glycogen Synthase
Branching Enzyme
Glycogenolysis
Glycogen Phosphorylase
Phosphoglucomutase
Glucose 6-phosphatase
ɑ (14) - Glucosidase
Synchronization of Glycogenesis and Glycogenolysis (A Beautiful Pathway)
Dephosphorylation
Effectors
Glycolysis (Glycolytic Pathway)
Phosphoglucose Isomerase
Phosphofructokinase
Aldolase
Triose Phosphate Isomerase
Glyceraldehyde 3-Phosphate Dehydrogenase
Erythrocyte Bisphosphoglyceromutase and Bisphosphoglycerate Phosphatase
3-Phosphoglycerate Kinase
Phosphoglyceromutase
Pyruvate Kinase
Lactate Dehydrogenase
Tricarboxylic acid cycle
The Coenzymes: Nicotinamide Adenine Dinucleotide (NAD) and Flavin Adenine Dinucleotide (FADH)
Steps in the Tricarboxylic Acid Cycle
Pyruvate Dehydrogenase: Acetyl CoA
Pyruvate decarboxylase
Dihydrolipoyl transacetylase
Dihydrolipoyl dehydrogenase
Citrate Synthase
Aconitase
Isocitrate Dehydrogenase
ɑ-Ketoglutarate Dehydrogenase
Succinate Dehydrogenase
L-Malate Dehydrogenase
Pyruvate Carboxylase
Summary
The Electron Transport System and Oxidative Phosphorylation
Steps in the electron transport system
Oxidative Phosphorylation (ATP Synthase)
Shuttles
Glycerol 3-phosphate shuttle
Malate-aspartate shuttle
Moles ATP produced by oxidative phosphorylation from one mole of glucose
The Phosphogluconate Oxidative Cycle
Steps in the Phosphogluconate Oxidative Cycle
Glucose 6-Phosphate Dehydrogenase: Lactonase
6-Phosphogluconate Dehydrogenase; Ribose and Xylulose
Transaldolase
Transketolase
The Fate of Glyceraldehyde 3-phosphate
Uronic Pathway
Hexosamine biosynthesis pathway
The Steps of Gluconeogenesis
Conclusions
Questions
4 Regulation of Glucose Metabolism
Insulin
Structure
Transport and Secretion of Insulin
Insulin Signaling Pathways
Akt pathway
GLUT4 Translocation
Pathway 1
Pathway 2
Insulin Stimulated Glycogenesis
Insulin stimulated inhibition of gluconeogenesis
Insulin stimulated protein synthesis
Insulin stimulated lipogenesis (fatty acid synthesis)
Insulin inhibited lipolysis (fatty acid hydrolysis)
Scaffold Proteins
The Incretin Hormones (Incretins)
Amylin
Glucagon, Epinephrine, Somatotropin (Growth Hormone), Somatostatin, Cortisol, ACTH, Thyroid Hormone, and Insulin-like Growth Factors
Glucagon
Epinephrine
Somatotropin (Growth Hormone)
Somatostatin
Cortisol
Adrenocorticotropin (ACTH)
Thyroid Hormones
Insulin-like growth factor (IGF)
Fibroblast growth factor 19 (FGF19)
Adenosine 5’-monophosphate-activated protein kinase (AMPK)
Bibliography
5 Glucose Metabolism Gone Wrong
Pancreatic β-cell mass
Glucose Transport and Hexokinase
Glycogen synthesis and breakdown
Glycogen cycling
Gluconeogenesis and Glycogenolysis
Glycolysis, glucose oxidation (tricarboxylic acid pathway) and pyruvate dehydrogenase
Mitochondrial defects
Tricarboxylic acid pathway and oxidative phosphorylation
UCPsSirt3
Lipids (Free Fatty Acids)
Hexosamine biosynthesis pathway
Techniques Used in the Above Investigations
Hyperinsulinemic-euglycemic clamp
In animals
In humans
Vastus lateralis muscle biopsy
Bibliography
6 Classification System for Diabetes Mellitus
T1D
Latent autoimmune diabetes (LADA) or Type 1.5
T2D
Hybrid
Idiopathic diabetes (T1b)
Secondary
Genetic defects of β-islet function
MODY
Other genetic defects of the β-cell
Genetic defects in insulin action
Diseases of the exocrine pancreas
Endocrinopathies
Drug or chemically caused diabetes
Infections
Uncommon forms of immune-mediated diseases
Other genetic syndromes sometimes associated with diabetes
Prediabetes
Gestational diabetes (GDM)
Statistical Risk Classes
Metabolic syndrome
Bibliography
7 Diagnosis of Diabetes Mellitus
Part 1: Establishing a Normal Range
The Concept of Normal and Abnormal Populations
The Probability Factor in Diagnosing Disease
Probability of Disease and Prevalence
The Normal Range
Assay Sensitivity and Specificity
Relationships among Sensitivity, Specificity, Prevalence, Predictability and Normal Range
How does one choose a normal range?
Truthfulness (Efficiency)
The Effect of Reproducibility on Sensitivity and Specificity
Severity of Disease and Assay Results
Parallel and Series Multiparameter Testing
Bibliography
Part 2: Modern Techniques for the Quantification of Glucose
Methods of Historical Interest
Modern-Day Methods of Measuring Glucose
Glucose oxidase/Peroxidase/Chromogen
Hexokinase/NADP
Glycated Hemoglobin
Specimen Collection
The Gold Standard
Instrumentation
Bibliography
Part 3: Symptoms and Tools for the Diagnosis of Diabetes Mellitus
The Symptoms of Diabetes Mellitus
Individuals who should be tested for diabetes
Tools for the Diagnosis of Diabetes
Urinary glucose
Fasting blood glucose (FBG)
Oral glucose tolerance test (OGTT)
HbA1c
Cut points for the diagnosis of diabetes
Diagnosis of Diabetes using FBG, 2-h PG or HbA1c
Diagnosis of Gestational Diabetes Mellitus (GDM)
Autoimmune antibodies as predictors for T1D and LADA
Bibliography
8 Complications of Diabetes Mellitus and Their Pathophysiology
The Complications of Diabetes Mellitus
Retinopathy and other eye conditions
Neuropathy and related conditions
Gastric Emptying (Gastroparesis)
Sexual Complications
Urologic Complications
Nephropathy, Diabetic Kidney Disease (DKD) and End-Stage Renal Disease
Cardiovascular Disease, Hypertension, Coronary Heart Disease or Coronary Artery Disease (CHD), Cerebrovascular Accident (CVA), Pathophysiology of CVD: Endothelial Dysfunction
Cardiovascular Disease (DVD)
Hypertension (Athersclerosis)
CHD
CVA
The Pathophysiology of CVD: Endothelium Dysfunction
Shear Stress
Diabetic Ketoacidosis (DKA)
Hyperglycemic Hyperosmolar non-Ketotic Syndrome
Hypoglycemia
Infections
Alzheimer’s Disease or Alzheimer Disease (AD)
Diabetes and Cancer
Pathophysiology of Diabetic Complications
Glycation
Sorbitol Accumulation
Reactive Oxygen Species (ROS) in Diabetes
Bibliography
9 Hereditary Transmission of Diabetes Mellitus
Inheritance of T1D in Monozygotic (MZ) and Dizygotic (DZ) Twins
Pairwise and Probandwise Concordance in T1D
Pairwise and Probandwise Concordance in T2D
Diabetes in offspring of one or two diabetic conjugal (biological) parents
Diabetes in siblings of diabetics
Summary
The Genetic Component of Diabetes Mellitus
The Major Histocompatibility Complex Proteins (MHC) or Human Lymphocyte Antigens (HLA) and Disease
Online Mendelian Inheritance in Man (OMIM)
HLA Nomenclature
HLAs and Diabetes Mellitus
T1D and Class II Genes
T1D and Class I Genes
Non-HLA T1D Promoting Alleles
Genetics of T2D
T1D and Environment
Enteroviruses (Coxsackie B Virus)
Rubella Virus (German measles)
Mumps Virus
Cytomegalovirus (CMV)
Retrovirus
Reovirus and Rotavirus
Epstein - Barr virus
Viruses that produce T1D in animals but so far no evidence in humans
Other Environmental Factors
Early Exposure to cow’s milk as opposed to breast milk
Vitamin D
Summary
Genes and Obesity
The FTO Gene
The KLF14 Gene
Bibliography
Projects
10 Treatment
Part 1: Medicinal Treatment
Insulin (Early Treatment)
It is not your father’s insulin any more
Modern-Day Human Insulin
Genetically Engineered Insulin Derivatives
Other modes of delivering insulin: Tablets or capsules, inhalable insulin and nasal spray insulin
Closed-Loop Insulin Delivery (Artificial Pancreas)
Islet Transplantation and stem cell therapy
Antidiabetic Oral Drugs
Sulfonylureas
Biguanides
Thiazolidinediones
Incretin-based inhibitors
Exenatide
Liraglutide
Albiglutide and Taspoglutide (Long-Acting Release)
Sitagliptin, Vildagliptin and Saxagliptin
Amylin derivatives (Pramlintide)
Glucokinase Activators (GKA): Potential Anti Diabetic Compounds
ɑ-Glucosidase Inhibitors
Other new strategies that are in the clinical trials phase
SGLT2 Inhibitors
11β-Hydroxysteroid Dehydrogenase Type 1 inhibitors
Bibliography
Part 2: Prevention, Delay and Management
Prevention and Delay
Exercise
Evidence
Diet
Biochemistry of the beneficial effects of exercise
Gastric Bypass Surgery (A Cure for T2D)
Bibliography
Epilogue
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