Matinum

Taking Charge of Your Health


– [Voiceover] Since type
one diabetes is caused by autoimmune destruction of the pancreas, that results in an absolute
deficiency of insulin, it makes sense that the
treatment of type one diabetes is to give insulin. Now, this is true, but unfortunately it’s not quite that simple. So let’s talk about
treating type one diabetes. And before we get into the
specifics of the treatment, let’s first briefly review
some of the metabolic states in the human body. And there are two general states. You have the absorptive state in which the body takes
energy and stores it and you have the post-absorptive state, in which the body takes this stored energy from the absorptive state and utilizes it. Now this absorptive state here is driven by the hormone insulin. Whereas the post-absorptive
state is driven by the hormone glucagon. Now throughout the day, the human body will typically fluctuate
back and forth between this absorptive state and this
post-absorptive state. So to get a better
understanding of how this looks, let’s draw what I’ll call
a physiologic timeline. And let’s just bring in a graph here to help describe this timeline. Now down here on this x-axis
we’ll have the time of the day. And right here in the
middle we’ll have noon, six in the morning, six at night, midnight, and then maybe we’ll put three AM, nine AM, three PM, and nine PM. Now as I mentioned before, the body will fluctuate
back and forth between this absorptive state and
post-absorptive state. So let’s see that here. And if you look closely, this fluxuation back and forth makes sense here, and around six AM when you go from this post-absorptive state
while you’re sleeping, and then you eat breakfast, and then you’ll go into an absorptive state because you need to absorb the nutrients from the food in breakfast and then as your morning goes you go back into this post-absorptive state
and so on and so forth. Now these changes back and forth between these metabolic states are driven by these hormones insulin and glucagon. So on the y-axis here, let’s
put in these hormone levels. So in purple here we’ll put in insulin, and then in green we’ll do glucagon. And what you can see from this is that it’s really insulin here
that’s driving these changes between the post-absorptive state and the absorptive state. and glucagon also plays a role, but its level doesn’t vary nearly as much as insulin’s level throughout the day. Now since in type one diabetes the body doesn’t produce enough of this insulin, it makes sense that the goal of treatment when we’re treating type one diabetes, is to give insulin that will try and mimic the body’s normal production of insulin. However, when we’re
treating type one diabetes, just giving insulin maybe
once or twice a day, as is done with most medication, doesn’t really work because the levels are changing so frequently. So then how exactly do we
manage type one diabetes? To get a better understanding of this, let’s erase some of our work. Now fortunately, physicians
and pharmacologists have created a very
elegant method for treating type one diabetes. And this method is known as
the Basal-Bolus Strategy. And in order to understand this
concept a little bit better, let’s first talk briefly about insulin. Now, insulin is a peptide hormone. And as such, that means when we give it as a medication, it can’t
be taken in a pill form, because the stomach and digestive system would break down the
peptides or the protein of insulin into its component parts before it could be absorbed. And therefor insulin must
be given as an injection. And there are many
different types of insulin that are available for use
in the treatment of diabetes and they are classified based on how quickly they take effect, which is know as the onset of action and how long they work for, which is known as the duration of action. So to get a better understanding of this, let’s create another
graph similar to this one that we’ll call the
pharmacologic timeline. And on the x-axis here we’ll
put that duration of action. And this will be an hour,
so we’ll have maybe three, six, nine, 12, 15, 18 hours here. So one of the three
main groups of insulins that can be given when
treating type one diabetes are known as the rapid-acting insulins. And their pharmacologic time
looks something like this. And these rapid-acting
insulins usually take somewhere about 15 minutes to 30 minutes
before the start working and their duration of action
will last, you can see here, somewhere around four to six hours. Now the next major group
of insulins are known as intermediate-acting insulins. And these intermediate-acting insulins, you can see by the graph,
take a little bit longer before they have an onset of action, about 30 minutes to an hour, and then they last a little bit longer than the rapid-acting insulins, for somewhere between
maybe eight to 12 hours, as you can see on the graph here. Now the last major category of insulin are known as the long-acting insulins. And as you can see on this graph, the long-acting insulins take even longer to take action, somewhere in the order of maybe one to four hours, and their peek action
is not quite as intense as this rapid or
intermediate-acting insulins, and their duration of
action is much longer. Depending on the type
of long-acting insulin, it can be somewhere
between 12 and 24 hours. So now that we have a little bit better understanding of the
different types of insulin and why it needs to be injected instead of taken as a pill, let’s go back to this
physiologic timeline here. And let’s specifically
look at this insulin level Now you notice that the insulin level never goes all the way down to zero. There’s always this baseline level here. And we’ll call this the basal level. And then intermediately
there are these peaks, which we’ll call boluses. And these boluses occur after we eat and they’re what drive
the transition from that post-absorptive state
to the absorptive state, about three times a day,
depending on how often you eat. Now hopefully what you
can see by this is that if we transpose a couple of these graphs from the pharmacologic timeline onto the physiologic timeline, we
can use injectable insulin to mimic this physiologic timeline in order to treat type one diabetes. So for these boluses,
these kind of rapid peaks, you’ll notice that they look somewhat like the rapid-acting insulin here. So let’s put that on there. And then this basal level
here, this constant level, you can create with a long-acting insulin. So we’ll put that on the graph. Now hopefully what you can see by this, and it’s starting to get
a little crowded here so I’ll highlight it, is that by using this Basal-Bolus Strategy someone with type one diabetes can kind of mimic the
natural levels of insulin that the pancreas should be producing. And this is why this Basal-Bolus Strategy of treating type one
diabetes is very efficient. Because it mimics what the body would do if the pancreas was working properly. So an overview of the Basal-Bolus Strategy is that usually once or twice a day, depending on the type
of long-acting insulin, say in the morning and
then again at night, someone with type one diabetes will take a dose of insulin, of
this long acting insulin that will serve as this basal rate. And then at meal time they’ll
take an additional dose of the rapid-acting insulin
to cover these boluses to help the body transition from the post-absorptive here
to the absorptive state, to absorb the energy in
the meal they just ate. Now it’s important to know that this graph demonstrates the principle
of the Basal-Bolus Strategy, but it is somewhat of
an oversimplification and that proper insulin management requires one to be very
diligent with their insulin dosing and administration. This is especially important in regards to the bolus doses here. And this is because the amount of insulin that someone’s gonna need
to take with each bolus dose will vary depending on
what their blood sugar is at that time as well as
on how many carbohydrates they’re planning on eating. So in order to properly
manage their insulin regiment, individuals with type one
diabetes must regularly check their blood sugar levels and adjust their insulin dosing accordingly. Now type one diabetes
can be a very serious and potentially even lethal disease. However, with diligent adherence
to the Basal-Bolus Strategy and regular appointments
with one’s physician in order to adjust the insulin dosing as well as monitor for complications, someone diagnosed with type one diabetes can still live a very
healthy and long life.

21 thoughts on “Treating type I diabetes | Endocrine system diseases | NCLEX-RN | Khan Academy

  1. Question:
    1) Even without food, does these insulin and glucagon secreted in definite time? Because if a person will eat in absorptive period, will the body produce insulin same amount as in post-absorptive state?

    2) What will happen to the production of glucagon and insulin if a person CONSISTENTLY eat in non-definite time (any time a person wants)

  2. IT AMAZES ME HOW STUPID THESE DOCTORS TRULY ARE.
    FINDING OUT YOU HAVE DIABETES COULD BE SCARY? MOST PEOPLE DO NOT HAVE DIABETES AT ALL. YEARS BACK SUGER LEVELS OF 250 WERE NORMAL. MY FRIENDS DAUGHTER WHO IS A PHARMACIST TOLD ME WHEN SHE WENT TO SCHOOL THE NUMBER WAS 225 CLOSE TO THE NUMBER I STATED. THE PHARMACEUTICAL COMPANIES LOWERED THE FIGURE TO 125 TO PUT EVERYBODY ON MEDICATION. ONCE YOU TAKE THESE DIABETES MEDICINES YOUR BODY STOPS PRODUCING INSULINS BECAUSE IT IS BEING PUT INTO THE BODY EXTERNALLY AND THE BODY THEN SHUTS DOWN PRODUCTION OF INSULIN PERMANENTLY DAMAGING THE BODY'S ABILITY TO PRODUCE INSULIN. AFTER TAKING THESE DIABETES MEDICATIONS THEY WILL EVENTUALLY DESTROY YOUR KIDNEYS AND PUT YOU ON DIALYSIS FOR THE REST OF YOUR LIFE 3 DAYS A WEEK IN 4 HOUR INTERVALS. OLD BLOOD PRESSURE NUMBERS WERE 160/100 AND BEFORE THAT 180/90. CHOLESTEROL MEDICINES ARE ALSO A SCAM. WHAT THEY ARE CALLING BAD CHOLESTEROL IS THE WASTE PRODUCED FROM THE CELL AFTER IT BURNED THE GOOD CHOLESTEROL WHICH IS GOING OUT OF YOUR SYSTEM. WHAT THEY ARE DOING IS LOWERING THE WASTE THAT THE BODY IS EXPELLING AND IN TURN DAMAGES YOUR LIVER AND OTHER ORGANS AND THEN CAUSING PARKINSON'S, ALZHEIMER'S, DEMENTIA BECAUSE THESE STATIN DRUGS SHRINK THE BRAIN WHICH IS MADE OF PURE CHOLESTEROL. WAKE UP PEOPLE THE DEVIL IS IN THE DETAILS.

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  6. DIABETIC ERADICATION IN ADVANCE
    No treatment, no medicine, no operation, no cost.
    Stop sugared food in advance: save our children from diabetic and cancer in advance.
    The public do not know that our daily eating SUGAR is a chemically created highly poisonous sweet. This chemical poisonous sugar causes DIABETIC with hundreds of connected diseases and hundreds of CANCERS, from children to aged. It is evident from the comparison of sugar/sugared food consumption statistics and above diseases from the last 50 years. The foolish health experts/highly intelligent in trillions medicine business are blind to see this fact. They are undergoing trillions 95% non-curing chemical medicine business concealing the fact from public that sugar is a chemical poison , every where, motivating to eat sugar from children to aged also eating by themselves, world wide, searching in darkness for the cause of diabetic and cancer. There is no other chemical poison entering in human blood daily in very high quantity except sugar. Hence, strictly stopping sugar production and consumption world wide is the best way to eradicate DIABETIC, CANCER and 70% existing diseases in advance.
    P.R.Gopalakrishnan ( Traditional Physician) Sreenandanam, KSEB Post No. FN/64, Opp. Milk Society, Near Nallur Market, Feroke.P.O., Kozhikode, Pin. 673631, Kerala, India. Ph. 9895836480, 7356008221

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