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## Glucose Function and Regulation
- Primary energy source for tissues, especially brain and CNS
- Brain uses ~120g glucose/day of total 160-200g/day
- Brain cannot store glucose or metabolize other substrates except ketones
- RBCs depend solely on glucose due to lack of mitochondria

## Hormonal Regulation
### Insulin (Anabolic Response)
- Liver: Promotes glycogen synthesis, glycolysis, fatty acid synthesis
- Muscle: Stimulates glycogen synthesis
- Adipose tissue: Activates lipoprotein lipase, promotes fatty acid uptake

### Glucagon (Catabolic Response)
- Released during hypoglycemia
- Liver: Activates glycogen breakdown, gluconeogenesis
- Adipose tissue: Promotes lipolysis and fatty acid release

## Diabetes Mellitus Classification

### Type 1 Diabetes
- Previously called insulin-dependent diabetes
- Usually presents in childhood/adolescence
- Requires insulin therapy
- Risk of ketoacidosis
- May follow viral infection damaging pancreatic β-cells

### Type 2 Diabetes
- 90% of all diabetes cases
- Usually presents after age 40
- Associated with obesity and family history
- Ranges from insulin resistance to secretory defects
- Less likely to develop ketoacidosis

### Other Types
- Genetic defects (MODY types 1-3)
- Pancreatic diseases
- Endocrinopathies (acromegaly, Cushing's syndrome)
- Drug-induced
- Gestational diabetes

## Diagnostic Criteria
- Fasting plasma glucose ≥7.0 mmol/L
- Random plasma glucose ≥11.1 mmol/L
- 2-hour post-glucose load ≥11.1 mmol/L

## Complications

### Vascular Complications
- Macrovascular: Coronary artery, cerebrovascular, peripheral vascular disease
- Microvascular: Affects retina (retinopathy) and kidney (nephropathy)
- Leading cause of death: cardiovascular disease

### Other Complications
- Increased susceptibility to infections
- Diabetic neuropathy
- Foot ulcers and gangrene
- Joint problems
- Cataracts

## Monitoring and Management

### Blood Glucose Monitoring
- Regular testing using glucose strips
- HbA1c measurement for long-term control (6-8 weeks)
- Fructosamine for shorter-term control (2-4 weeks)

### Treatment Approaches
- Type 1: Insulin therapy
- Type 2: Diet, exercise, oral medications (metformin, sulphonylureas)
- Regular monitoring of complications
- Blood pressure control
- Lipid management

## Acute Complications

### Diabetic Ketoacidosis
- Common in Type 1 diabetes
- Characterized by hyperglycemia, acidosis, ketones
- Triggered by infection, stress, or inadequate insulin

### Hyperosmolar Non-ketotic Coma
- More common in elderly Type 2 diabetics
- Severe hyperglycemia without ketosis
- High mortality rate

### Hypoglycemia
- Common complication of insulin therapy
- Can lead to confusion, coma
- Requires immediate glucose administration

## Prevention and Monitoring
- Regular blood glucose monitoring
- HbA1c testing every 3-6 months
- Regular screening for complications
- Lifestyle modifications
- Patient education on self-management

This comprehensive overview reflects the current understanding of diabetes mellitus, its classification, management, and complications as presented in the source material.

مُلخص المحاضرة الثانية 👇🏻

## Normal Lipid Levels and Functions
- Lipids serve as energy stores and structural components of cells
- Normal fasting plasma levels:
- Triglycerides (TG): 50-150 mg/dl
- Phospholipids: 150-250 mg/dl
- Cholesterol: 140-250 mg/dl (varies by population, age, gender)
- Esterified cholesterol: 65-75% of total

## Fatty Acids
- Mostly straight chains with even number of carbon atoms
- Major categories:
1. Monounsaturated (Palmitoleic, Oleic)
2. Polyunsaturated (Linoleic, Linolenic, Arachidonic, Eicosapentaenoic)
3. Saturated (Myristic, Palmitic, Stearic)

## Lipoproteins
### Classification by Density
1. Chylomicrons
- Transport exogenous lipids from intestine
- Not present in fasting plasma
2. VLDL (Very Low Density Lipoproteins)
- Transport endogenous lipids from liver
3. LDL (Low Density Lipoproteins)
- Transport cholesterol to cells
4. HDL (High Density Lipoproteins)
- Returns cholesterol from peripheral tissues to liver

### Electrophoretic Classification
- α-Lipoproteins (corresponds to HDL)
- β-Lipoproteins (corresponds to LDL)
- pre-β Lipoproteins (corresponds to VLDL)

## Hyperlipoproteinemias
### Primary (Genetic) Causes
- Familial Hypercholesterolemia (FH)
- Defined criteria:
- Adults: cholesterol >7.5 mmol/L
- Children under 16: >6.7 mmol/L
- LDL cholesterol >4.9 mmol/L in adults

### Secondary Causes
1. Hypercholesterolemia
- Hypothyroidism
- Nephrotic syndrome
- Cholestatic jaundice
2. Hypertriglyceridemia
- Diabetes mellitus
- Alcoholism
- Chronic renal disease
- Estrogen therapy

## Relationship with Atherosclerosis
- Increased total cholesterol and LDL correlate positively with IHD
- Increased HDL correlates negatively with IHD
- Increased triglycerides show weaker positive correlation with IHD

## Treatment
### Lipid-lowering Drugs
1. Statins
- Significant cholesterol and LDL reduction
2. Fibrates
- Primarily reduce triglycerides
3. Bile salt sequestrants
4. Ezetimibe
5. Nicotinic acid
6. Omega 3

## Investigation Guidelines
- 12-hour fasting before blood collection
- Avoid testing during acute illness
- Wait 3 months after acute events
- Standard profile includes cholesterol, triglyceride, and HDL measurements

## Clinical Cases
1. 23-year-old woman
- Cholesterol 11.4 mmol/L
- Family history of premature cardiovascular disease
- Diagnosis: Familial hypercholesterolemia

2. 43-year-old man
- Mixed hyperlipidemia
- ApoE2/E2 genotype
- Diagnosis: Type III hyperlipoproteinemia

3. 15-year-old woman
- Severe hypertriglyceridemia
- Acute pancreatitis
- Diagnosis: Lipoprotein lipase deficiency

مُلخص المحاضرة الثالثة 👇🏻