1. Diabetes and Obesity • Type I is simple—no insulin • Type II is complicated—”resistance” to insulin • Factors are multiple • Lifestyle and culture important • On the rise, especially in “developed” or “first world” settings • The Pima Indian case study

2. “Traditional” and “Modern” Diets

3. Glucose Regulation • What is diabetes? • Cells need sugar—ATP and the Krebs Cycle • What comes in through the gut—basic nutrition • Role of liver in processing nutrients, storing glucose • Absorptive Pathways and role of insulin from pancreas • Post-absorptive Pathways • Understanding Diabetes

4. Diabetes mellitus—”starvation amidst plenty” • Type I • Juvenile onset • Pancreas beta cells die, no insulin produced • Type II • Adult onset • Complicated set of factors, some insulin production • Goal—understand why we need insulin

5. Cells and Glucose • All cells of body need constant glucose supply, especially nervous tissue • Most other nutrients can be converted into glucose or derivatives for making ATP • ATP is celluar “gasoline”

6. Why not eat just sugar?

7. What factors affect diabetes and obesity? • Weight • Activity level • Genetics • Cultural-social-economic (class?) • Educational • Can these be controlled?

8. Pima Indian Study • Pima Indians and Diabetes • Pima Indians and Breastfeeding • Pima study to justify low carb diet?

9. “How Stuff Works” Diabetes: http://www.howstuffworks.com/diabetes1.htm

10. Glucose metabolism • Liver receives blood from intestines (don’t forget hepatic portal system • After meal, in response to insulin from pancreas, glucose stored as complex carbohydrate--glycogen--in liver • Between meals, in response to glucagon from pancreas, glucose is released • Pancreas releases insulin when sugar levels in blood go up • Inadequate or zero insulin production results in hyperglycemia or high blood sugar • Overproduction or over-dosing of insulin results in hypoglycemia or low blood sugar--insulin shock • Diabetes is insufficient production of insulin • Type I--juvenile onset with elimination of Islets of langerhans and zero insulin production • Type II--adult onset with gradual loss of insulin production