Skip to main content
Loading Explore guides…
Blood Glucose Regulation · Acedra
Home
Explore
Medicine
Blood Glucose Regulation
Sign in to save
Chat
If YouTube asks you to sign in, open the video on YouTube.
Watch on YouTube
Reload player
Transcript
181 segments
Copy
Hide video
0:03
hello everybody how are you this is dr najib today we are going to talk about
0:11
that how blood glucose is regulated within normal limit in human body right our main topic is that how normal glycemia is maintained in a healthy normal person right because what is diabetes diabetes is a group of metabolic disorders in which the common string is hyperglycemia due to either deficiency of insulin or due to reduced action of insulin right so before really we go into the details and depth of diabetes mellitus let's discuss the very basic and foundation of
0:51
the diabetes mellitus that normally in a healthy person how blood glucose level is maintained in a narrow range and why it is so important to keep the blood glucose in a normal range right so let us talk about what is the normal range normal range is let's suppose this is your
1:15
i just make hypothetical diagram and in this hypothetical diagram
1:24
blood glucose should be maintained somewhere between yes
1:33
normally in a healthy person blood glucose should stay right should stay somewhere
1:41
more than 60 right and fasting blood sugar fasting
1:49
fasting blood sugar should not go more than 100 milligrams per dl again listen and a normal healthy person today our all discussion is about a healthy person and healthy person fasting blood sugar should not go above the 100 milligrams per deal right and minimum blood sugar which you are allowed to have is around 50 to 60 milligrams per deal but once you once once you take a cardboard carbohydrate rich meal once you take carbohydrate
2:28
rich meal of course lot of glucose is being absorbed from gastrointestinal system and in your blood glucose levels start going up right now here it is very important to know that after two hours of after two hours of taking the food right or we should say within two hours of taking the food
2:59
glucose level controlling mechanisms should be so strong in a person that blood glucose level postprandially after two hours should not be more than 140 milligrams not more than 140 milligrams per year 100 ml or dl right same here same here right this is what yes it is not fasting once you have taken the food once you have taken the food blood sugar will start going up and then insulin and other factors will come into play and they will start
3:40
controlling the blood sugar level so blood blood glucose level should not produce a very strong spike in the blood right because i will tell you later that blood glucose level goes too high in the blood it is very dangerous for us right so what happens that postpanderially two hours post
4:03
prandially postprandial after food your blood glucose should be
4:10
should not be more than 140 140 milligrams and once you take food right before
4:22
two hours blood glucose might jump above that again listen very carefully if if i wake up and i'm in a fasting state my blood sugar should not be more than 100 and not less than 60 right okay this is fasting blood sugar then i take carbohydrate-rich meal if i take carbohydrate-rich meal my blood glucose after two hours should be controlled within 140 milligrams per dl but during that before two hours it might jump up but it is still not allowed to go more than
5:06
more than 200 milligrams per dl and this is also called random
5:14
blood glucose level right so in a way we can say that these are four important figures you should remember right again in a fasting state blood glucose should be somewhere between 60 to 100
5:33
after taking the food and passing of the two hours your blood blood sugar level should not be more than 140 and randomly sometimes we have just taken the food just two hours have not passed maybe just 20 minutes have passed or 40 minutes have passed a lot of blood glucose is absorbing maximum level you are allowed to have is 200 milligram per day now this is within normal range right from here
6:05
up to here it is normal range above it there is a trouble if blood glucose shoot above
6:16
these values if fasting blood glucose is more than 100 or to our postprandial blood glucose is more than 140 milligram per dl or random blood glucose level is more than 200 milligram per dl if it goes more than that it is dangerous it is dangerous and i will tell you that what are the dangers
6:43
blood glucose become toxic if blood glucose level become more than normal then it become toxic i will explain what toxicities it produces in the same way if blood glucose falls below that even that is also dangerous that is also dangerous
7:06
right now we have to discuss after discussing this now there are three questions number one
7:14
why it is so important to keep the blood glucose normal why to keep it normal number two
7:24
if blood glucose goes above the normal limits right what happens hyperglycemia hyper glycemia
7:38
what are the dangers why the glucose which we love so much become toxic substance it must be a question then if blood glucose falls below 60 or 50 milligram per dl again there is a question what is the question why it is dangerous
8:04
what are the dangers of it means we have to talk about three things first of all before we talk about the regulation of blood glucose we'll talk later that regulation of blood glucose within these limits there are many substances which play their role encryptings are there insulin is theirs and then other substances related with insulin should be discussed then there are substances we don't allow the blood glucose to fall below right these substances are glucagon
8:36
epinephrine norepinephrine cortisol and growth hormone but i will go to discuss these substances or hormones later in detail first i want to answer this question that why we need normal level of blood glucose why blood glucose become toxic above the normal range and why it become like a lost precious substance below the normal range first of all normal range why we need blood glucose in a limited level you can say we talk about two levels that fast in 100 and postprandially
9:17
one for it should be below 140 milligram per dl fasting should be below 100 now this narrow range is mostly maintained whatever why it is so the reason being that in our body there are some very important organs very very important organs which live solely on glucose
9:41
their metabolism mainly depends on glucose there are some very important organs right which cannot use fatty acids which cannot store the glucose in form of glycogen in enough amount and these organ need continuous supply of glucose if glucose is too low those organs are in trouble if glucose is too high some other organs are in trouble so first of all what are the organs in our body for which we need to maintain the blood glucose level in
10:19
normal range answer is first of all your central nervous system yes and neurons
10:29
neurons brain it needs constant supply of glucose
10:36
central nervous system needs constant supply of glucose neurons needs constant supply of glucose and they need a good amount of glucose you know neurons have lot of sodium potassium 80 pages and they have lot of channels and so and though lot of ionic changes are coming into that the action potentials are going on so for all these things they have to keep their metabolism active and they need a constant supply of glucose again i will repeat my central nervous system hopefully
11:08
yours is also the same right we need constant supply of glucose why multiple reason number one
11:16
glucose can easily cross the blood band barrier right glucose glucose can easily cross blood band barrier central nervous system cannot use the fatty acid as energy why central system central nervous system cannot use fatty acids as energy very simple reason yes the reason is that
11:40
fatty acids which we call it free fatty acid they are really not free as we say married women are free but actually they are not free in the same way free fatty acids are not free free fatty acids are sticking with the albumin and pre-albumen
11:57
free fatty acids in the blood are not free they are attached with
12:02
albumin and every albumin has luckily up to eight to ten fatty acids and as albumin cannot cross the blood-brain barrier so fatty acids cannot also cross the blood-brain barrier and if both of them cannot cross the blood-brain barrier it means that fatty acid which is one of the common fuel in our circulatory system for many organs is useless for central nervous system right so this is one thing number two central nervous system can use an other nutrient which is called
12:36
ketone but normally ketone body body level in the blood is very low and if they become very high central and glucose glucose is not there enough central nervous system can use ketone as energy source but with difficulty so most efficient and most preferred fuel of central nervous system is your glucose and you need to maintain your glucose level within the normal range for optimal functioning of central nervous system is that clear number one organ number two organ is yes
13:15
here is your beautiful eyes and here is retina here is retina retinal epithelium retina that also solely depends on glucose right central nervous system mainly uses glucose or only uses glucose as a preferred source in the same way retina retina can also use only
13:49
glucose retinol and central nervous system actually i write down central nervous system because there's something going down and someone misunderstand what i have drawn so this is central nervous system then there is one more organ yes something very important in our body which require glucose which depends on glucose which uses glucose as preferred fuel yes who is going to tell me yes you guys there is another substance yes no kidneys kidney can use fatty acid
14:27
yes germinal epithelium germinal epithelium in in your testes or in your ovaries germinal epithelium
14:42
germinal epithelium which lead to gametogenesis
14:49
right it may be present in of course in your in your gonads
14:56
never underestimate the powers of germinal epithelium you know why because these are our genitalia this is the only organ in our body genitalia which can defeat the death
15:14
these are the only organs in our body which can defeat the death with the time we get old our body becomes wasted but if we have produced our kids of course our genitalia must have played some role and germinal epithelium must have produced what is this gametogenesis in which meiosis should have occurred and then sperms or ova should be produced right this is the sperm or ova which can we carry our dna to the next generation and when we are dead our dna is still
15:50
living in our children and then grandchildren and so and so forth so genitalia are very important never underestimate their power and don't be too ashamed of the genitalia be proud of that if your genitalia working good that then you can defeat the death by producing the kids and your path by passing your dna to the next generation before you die but the problem is even this germinal epithelium in the genitalia is germinal epithelium it is
16:21
mainly dependent on glucose uh if i want to be more specific glucose is preferred what fuel so central nervous system retina germinal epithelium these are the minimum three organs all good doctors should know that these organs are dependent on the glucose and we have to keep the normal supply of glucose to them is that right this is the main reason why we need glucose normal supply and these tissues again i will repeat central nervous system retina or german epithelia
17:04
it is german or germinal germinal okay it is not german okay germinal epithelium these three organs use glucose as preferred fuel and we have to maintain reasonable glucose levels in the blood
17:24
now we come to the real trouble the real trouble is if glucose level is more than normal if there is hyperglycemia if there is hyperglycemia why it is dangerous
17:42
apparently if we have more glucose our brain should be more happy is that right apparently
17:52
our retina should be happy and even your or mind germinal epithelium should be super happy but there is a problem moderation is the beauty of life anything too too much or too less both is bad when glucose becomes more than normal that become toxic substance in our body right so let me explain first that when glucose becomes more than normal what happens let's come over this side
18:23
when glucose become too much for example glucose is not 140 milligram or 120 milligram right per dl let's suppose is an unfortunate person in which blood glucose is not being regulated well and his blood glucose level is let's suppose 500 milligrams per deal
18:47
for example there is a person in which blood glucose regulatory mechanisms are not working well and when this person takes carbohydrate-rich meal his blood glucose level goes too high if his blood glucose level becomes too high right what are the problems number one is all extra cellular fluid will become hyper osmotic what will happen that your extra extra cellular fluid extra cellular fluid will become yes hyper osmotic
19:30
right now here are the cells right and in between here is glucose and extracellular fluid if there is too much glucose and it is hyperosmotic it will suck the fluid out of the cells and many tissues will dysfunction and you will feel fatigued again i am repeating if blood glucose level really goes too much high generally what happens in the body generally speaking that this hyper osmotic extracellular fluid is that right that will suck the water out of
20:10
cells and cells become somewhat dehydrated and these dehydrated cells don't perform optimally don't perform autumn optimally so this is one problem which occurs due to hyperglycemia all over the body in all tissues is that right second second is we should see the effects of hyperglycemia especially on the kidney especially on the kidney what happens in the kidney let's suppose here is your very beautiful what is that kidney
20:50
and of course you have two kidneys and every kidney you have about 1.2 million nephrons
21:01
as i mentioned in every lecture i mentioned your millionaire as far as nephrons are concerned but unfortunately they don't produce dollars they just produce urine right so you have millions of nephrons now in every kidney you have 1.2 million nephrons now let me see that how nephrons malfunction the function is disturbed when there is too much glucose in the blood right let's suppose here is one nephron and this nephron i draw draw out
21:39
i bring it out and we see what happens there this is bowman's capsule proximal convoluted tubule here is loop of henle descending part then
21:53
ascending part then distal ascending part and then there is distal convoluted tubule and collecting tubules and many collecting tubules come together and eventually they make collecting ducts and here is your urine drop
22:16
urine is being produced right now when your blood glucose level is very high when your blood glucose level is very very high then what will happen that blood vessels afferent arterioles will bring more glucose to the capillaries of
22:36
glomeruli right and normally what happened glucose is freely permeable glucose is freely permeable so a normal healthy person glucose filters from the glomeruli into the nephron and
23:00
in normal person most of this glucose is reabsorbed from here back to the
23:10
back to the blood there are special mechanisms and proximal convoluted tubules right and there are many mechanism one of them is sodium glucose co linked sodium
23:23
sodium glucose linked transporters they take take glucose from here
23:31
right and they will take within the cell and in the cell beso lateral side this is the apical side of the membrane which is facing to the lumen and this is the basolateral side of the membrane right now these special type of glucose transporters are present only on apical side of the membrane and then there are special channels right these are called glucose transporters type 2 they are present on basolateral side so whatever glucose enters it will through this pass out
24:10
right back to the blood so practically
24:16
if your glucose is within normal range
24:20
now listen carefully practically if your blood glucose level is within normal range
24:28
then most of the glucose which is filtered which we call it filtered load of glucose most of it is reabsorbed most of it is recaptured it is reclaimed by the proximal convoluted tubular cells back to the blood right so you can say if you are somehow having some special type of tongue you can taste here it is sweet but as you go forward sweet sweetness become less because most of the glucose is gone back to the blood and normally we don't allow
25:05
any significant amount of glucose to be lost into urine in most of the people am i clear now if your blood glucose level goes pathologically high if blood glucose levels goes very high right then what happens if there's more glucose in the blood as i told you 500 milligram per deal then
25:30
filtered amount of glucose will be more we say there will be very heavy filtered load of glucose and all these reabsorption mechanism will be overwhelmed they will be overwhelmed they will be not able to reabsorb all of the glucose and if there's too much glucose coming here then some of
25:54
more glucose comes more absorbed more glucose comes more reabsorbed but at a level when glucose goes beyond the normal range so much glucose arrives here that some of it cannot be reabsorbed and glucose start
26:11
yes some of the glucose was not recaptured or reclaimed or reabsorbed so this glucose will pass to the more distal part of what is this nephron and this glucose will appear into urine this glucose will appear into urine so what will happen like glucose urea glyco surya will start
26:35
but this is not the only problem of course this is one problem that when blood glucose level goes very high not only all extra cellular fluid in the body become what hyperosmotic and pulls the water out of the most of the cells of the most of the tissues and cells under a dehydrated condition malfunction there are not these are general problem in the body special problem comes when a high amount of glucose is going being filtered into nephron and if nephron cannot reabsorb all of
27:11
it right glucose start appearing into urine now when you are losing glucose into urine actually you are losing a form of energy in the urine you are losing calories into urine this is one problem
27:26
but it produces another problem that this glucose which is moving forward it will drag the water with it it will pull the water with it what happens most of the glucose is reabsorbed here and lot of water is also 60 to 70 percent of the water is also reabsorbed here right but if glucose is not being absorbed and it is moving forward it will pull the water with it
27:54
then more than normal amount of water will be pulled in the lumen along with the glucose due to its osmotic effect and more water will appear into urine and then you will pass excessive amount of urine right if and every if per day in 24 hour if your urine amount become more than three liter who says you have started polyurea now it means one problem was that there was glycosyria number two was that this glucose was pulling lot of what water with it
28:31
because it was pulling a lot of water with it so it was also producing some sort of diuresis what it was producing digest of course this diuresis is also producing dehydration in the body if you don't control and if body is getting dehydrated of course then your with center thirst center in in hypothalamus will be activated and and when those thirst center are activated you will feel more thirsty and if water is available you will take more water we save polyurea and
29:09
with polyurea you have pulley dipsia and if lot of calories are being lost you will lose the weight and even weight loss can occur and you will feel more hungry due to loss of calories and there may be polyphagia is that right so multiple problems are occurring there that number one
29:29
normal blood glucose is high very high hyperglycemia the glucose filtered into nephron is too high right then this high amount of high load of glucose cannot be reabsorbed by the proximal convoluted tubules because it is more than the capacity of the possible convoluted tubule to reabsorb when it becomes more than that lot of glucose appears into urine and that produces glycosuria and this glycosuria what this glycosuria is doing with this osmotic
30:02
effect it drags excessive amount of water with it it does not allow the nephron to reabsorb the water properly so flow of water also increases flow of water through the tube also increases when flow of the water increases we say that there is diuresis but with this rapid flow
30:29
of the fluid produces one more problem and that is very serious problem this rapid flow of the fluid through the nephron lumen produces one more problem normally what happens first we compare normal then we talk of normal normally when there is normal level normal glucose in blood normal level of glucose is filtered most of the glucose is reabsorbed along with that lot of water is reabsorbed and fluid is moving here slowly or fastly
31:00
slowly when fluid is moving slowly then what happens that cells of the epithelium
31:08
cells of the epithelium of what is this
31:12
nephron in different part of the nephron right those cells are able to when water is when glucose level is normal most of the glucose reabsorb most of the water reabsorbs right then less water is left normally in the lumen which is moving very gradually inside the
31:35
nephron and when this fluid is moving very gradually these cells have less time or more time to work on the fluid more time because water is flowing slowly if water is flu moving slowly then
31:54
the processing of luminal fluid become more effective by the nephron cells and electrolytes are properly reabsorbed and excreted due to that reason electrolyte balances maintained well in the blood but now imagine abnormality person with high glucose level in the blood high glucose load here lot of glucose is reabsorbed but still lot more is going into urine glycosodia is produced then there is osmotic effect of this glucose so what happened lot of water is also going when
32:34
glucose followed by water with osmotic effect when rapidly passing what will happen the chances of
32:43
epithelial cell of nephron to work on fluid and electrolyte are less is that right so due to this
32:55
rapid flow induced by the osmotic effect of the glucose epithelial cells are unable to work properly to reabsorb the new what is that electrolytes or to secrete certain electrolytes that will lead to electro electrolyte imbalance so not only blood glucose problem is there
33:18
not only there is glucose urea not only this diuresis there is electrolyte imbalance
33:27
imbalances also imbalance is also there you can just imagine that as if the there are a lot of proteins here which are capturing the electrolytes you imagine those proteins are like monkeys those monkeys are capturing what electrolytes right water is going and electrolytes are like mangoes electrolytes are like mangoes water is going electrolytes mean mangoes are going and water is going slowly and monkeys are catching the mangroves and enjoying
34:04
but if water suddenly become very fast can mangoes be cat caught not so monkey will try to catch but due to rapid flow electrolytes will be dragged very rapidly and appear into urine so blood electrolyte balance or extracellular electrolyte balance will be disturbed too now you understand that very high blood glucose level is not good why it is not good overall in the body it produces
34:35
hyper osmotic extracellular fluid and that sucks the water or pulls the water out of the cells in most issues and relatively dehydrated cells don't work optimally secondly we must know when blood glucose level is very high what are the effects on the kidney when blood glucose level is high glucose load on the kidneys high kidney epithelium cannot reabsorb most of the glucose glucose appear into urine glucosuria that glucose drag pulls the water
35:09
with it what is that digest is a polyurea when water more water is passing through the lumen it takes faster flow and this fast flow of the fluid does not allow the epithelial cell to properly recapture certain electrolyte and electrolyte maintenance in the body is also disturbed right now these are some effect of unfortunately some effect of hyperglycemia these are only some effects then there are long term effects if the mechanism in your body
35:48
which controls the blood glucose and maintains it within normal limit if those mechanisms are disturbed as it happens in diabetes mellitus if those mechanisms are disturbed
36:01
not only poorly urea or polydipsia or polyphagia or electrolyte imbalance occurs if this type of problem is long term again i will repeat if you have a tendency to have hyperglycemia if you have a tendency to have hyper glycemia chronically for long time the long term complications occur then long term complications occur we have discussed in the previous lecture we have discussed in the previous lecture that if for okay let us come here
36:48
long term complication can be due to hyperglycemic peaks long long term complications due to hyperglycemia what happens that if hyperglycemia now i'm going to draw a blood vessel here this is a blood vessel and this is your what is this endothelium these are your endothelial cells now if blood glucose levels become very high right
37:16
they damage glucose itself is directly toxic to endothelial cells
37:23
glucose can directly high high level of glucose can directly damage the cells with every hyperglycemic peak these cells become dehydrated number one number two high level of glucose for long time for months and years will react with certain proteins here and produce
37:44
glycation products what are glycation products that there is a certain protein different proteins here cellular or extracellular glucose react with those proteins and when glucose react with those protein that produces glycated product we call them those products are called advanced glycation and products and products so in chronic cases
38:15
where you have a long term term tendency to develop hyperglycemia again and again and again right because glucose hyperglycemia controlling factors in your blood are not working well and after every meal glucose goes beyond the normal limits right there is chronic insult to your endothelium right it means now this disease is converting not only hyperosmotic disease it is converting into vascular disease now it is becoming vascular
38:54
disease because it is damaging the endothelium when it is damaging the endothelium and basement membrane under the endothelium basement membrane under the endothelium and with this age products right advanced glycation and products these age products right they produce lot of damage here
39:18
for example they can produce cytokines they can force the cells here to produce growth factor they can force lot of production of this abnormal glycated proteins to which glucose is sticking they become malfunctional so they as i mentioned that more cytokines are produced here
39:43
more growth factors are produced here more you can say reactive oxygen species is produced here right more proliferation of the smooth cells and more deposition of the extracellular fluid extra extra you can say collagen and such substances are deposited here which are abnormal and eventually that may lead to the formation of atheromas a throma atherosclerotic disease will come especially in large vessels so we say that long
40:21
term long term hyperglycemia may lead to macro vascular complications or diseases that large and medium-sized vessels right they are damaged so much that they develop lot of atheromatous plaques and in these diabetic patients the atheromas or atherosclerotic diseases developing earlier than the normal population developing more widely and a traumas are more severe and dangerous and unstable
40:59
you are getting it again i'm repeating actually now i'm trying to tell you something else that chronic damage by the glucose and damage to the endothelium and eventually production of lot of advanced glycation and products convert the whole system into inflammatory disease of the vessels
41:21
right because they are cytokines because there are growth factors because there are infiltration of neutrophils and macrophages and lymphocytes because a lot of proteases released there because local cells are proliferating too much so all this lead to a macrovascular disease which appears pathologically as widespread very aggressive rapidly developing right dangerous atherosclerotic disease and this atherosclerotic disease clinically manifest
41:58
in which vessels especially it produces coronary artery disease myocardial infarction can is more common of course you can talk about cerebral vascular disease
42:11
right there are more what are these in central nervous system arteries damage which may lead to a ischemic stroke most commonly but hemorrhagic can occur then a thrombus can develop in your limbs right peripheral arteries peripheral yes arteries
42:36
atherosclerotic disease especially ischemia and this type of ischemia is very common in the lower limb which with added with the neuropathy and infections and vascular disease leading to ischemia male necessitate at some advanced stage unfortunately lymph imputation
42:59
is that right diabetic foot then not only this one vessel usually students forget
43:07
the vessel which is going to the kidney we call it renal vascular disease renal vascular disease this renal vascular disease is actually renal arteries not talking about the glomerular disease and other disease related within the kidney right so a thromos may develop there and that may lead to what happened reduce blood flow to the kidney so this in this way high glucose level
43:37
lead to macrovascular diseases and some organ it loves to produce micro vascular diseases as i mentioned in previous lecture that the target of the microvascular diseases that again high glucose has damaged the basement membranes and those baseball membrane in certain organs smaller vessel certain organ smaller vessel baseball membranes become very thick but cracky they do have multiple cracks they develop multiple pores they develop multiple you can see holes and those
44:18
again in those organs in which microvasculature is disturbed and microvascular disease occur you should remember retina retinopathy retinopathy then you can remember yes neuropathy different types of neuro pathies right which may be autonomic neuropathy or somatic neuropathy somatic neuropathy may be motor neuropathy or sensory neuropathy the sensory neuropathy may be
44:48
symmetrical or asymmetrical we will have a full lecture on neuropathies diabetic neuropathies are very important we'll talk in detail right so for a while you just believe me that diabetes leads to
45:03
microvascular neuropathy right small vessels then in the kidney nephropathy small vessels in the kidney especially we can talk about vessels in the gloom or like a pillary system that is damaged by the diabetes so nephropathy with this so what we see that it is very important to keep the blood glucose level in normal limit blood glucose level go beyond the normal limit and above the normal limit it can produce generalized dehydration in the body
45:40
right and hyperosmotic extracellular fluid it can lead to the police urea police and of course then diuresis and then electrolyte loss and electrolyte imbalance in the blood then in the long run it can produce macromuscular disease it can produce microvascular disease and many more complications right for example it can produce cataract then it can lead to more infections in the previous lecture i explained that why hyperglycemia lead to ineffective you
46:13
can say immune system and how neutrophils and macrophages are drunk with high what is that glucose and they don't perform well and i have explained it in the previous lecture the more infections so it means that when blood glucose levels are very high acutely or chronically that produces lot of dysfunction in our vascular system and other systems is it clear now i want to talk about okay this is understood clearly that we should not allow the blood glucose
46:49
level to go beyond a certain limit it means our body must have very powerful mechanism to prevent hyperglycemia we will talk about that when we talk about insulin and related substances we must have very very powerful mechanism that once we eat the food
47:11
after that there's a tendency to reabsorb lot of glucose and that glucose if not immediately stored right that may produce spike hyperglycemic spikes and these repeated hyperglycemics spikes after every food can damage our body so there are very strong mechanisms to blunt those spikes of glucose right we'll talk that in insulin now we come to the other question that why it's so imp why it is so important that blood glucose level should not fall beyond a certain limit this
47:48
is also a question why we should keep our blood glucose level around 50 to 60 milligram per dl
47:57
for example if my blood glucose levels become faulty what's bad in that answer is i have already given that there are some tissues which mainly depend only on glucose what were those tissues your central nervous system your retina and your very very sacred what is that germinal epithelium
48:18
right and rpcs even love to use glucose preferentially right so these are basically glucose using tissue i will talk mainly that let's suppose due to some reason i've missed my food right regular time and my fasting become prolonged now my central nervous system is using glucose continuously and heavily so eventually blood glucose levels will start falling now blood glucose levels when they are falling they should not be allowed to
48:52
fall beyond a certain limit because if they fall beyond the certain limit will be troubles i will tell you what are the troubles but before that i tell you what are the characters which we say anti-fall characters empty fall characters these are glucagon when glucose is gone glucogon comes and it sports the glucose level then it has its friends the gang of glucagon as a group they are called counter regulatory hormones right they try to sport here so there is glucogon here
49:26
gluca gone here which is sporting the glucose upward right then i will mention with glucagon yes what are the other friends epinephrine and norepinephrine epinephrine and norepinephrine then there is more substances which come to help to glucagon to maintain the blood glucose level so that it is your brain keep on getting the supply of glucose as long as possible so here another friend is coming into play and what is that called and then there is one more growth hormone even a
50:06
little role like baby roll is played by thyroxine so substances we don't allow the glucose to go up
50:14
the most important is insulin most important is insulin so we can say insulin is anti-rise factor
50:24
but there are anti-fall also many factors all of them we will see later in detail have certain mechanisms by which they support the blood glucose level if you are not eating they try their best that blood blood glucose level should remain within normal limits and should not fall too much and during that these gangs gang of four okay i should remove this these counter regulatory hormone while maintaining the blood glucose levels by different mechanisms which i will explain later
50:57
while maintaining they arrange the alternative fuels like ketone bodies for central nervous system they arrange the alternative fuel but for a while we will just focus on that in a person
51:12
he was in fasted state and he couldn't get to eat anything right what will happen that glucose will progressively fall if someone has these mechanisms not functioning well or fasting goes into starvation and it becomes super long that glucose is really down your body will react very angrily especially your yes especially your central nervous system because the central nervous system is not getting its favorite candies what are the favorite
51:47
candies glucose and central nervous system is not getting its favorite what fuel glucose right it is not a happy central system it is angry central nervous system it is you can say strong or weak weak so we say neurologically person will develop signs and symptoms of glycopenia glycopenia mean less glucose or we call it glycopenic neuro neurological manifestations glyco penic
52:31
neurological manifestation for example the people who develop hypoglycemia they have some problems related with central nervous system for example first of all their behavior become becomes altered altered behavior
52:49
this is specially recognized in diabetic patient but if they go into hypoglycemia this is specially recognized by the close friends and close family member that person's behavior is a little abnormal but as glucose goes down it keep on bringing more and more worrisome complications like person become irritable person become
53:11
irritable then there will be yes confusional state what is confusion by the way yes when you see a beautiful girl you become confused what is confusion what is confusion
53:31
you don't know confuse yes
53:39
yes anyone who is not well oriented very good anyone who is not well oriented in time place and person don't tell time space and person we are not in space if we are not clear about time that it is morning or evening or night or what day or time place we are not sure we are in hospital or we are an ambulance or we are in the home or we are in the kitchen we are in washroom we are confused
54:07
or time and person we don't know people who are visiting us their doctor or nurses or our beloved relatives or friends when we are not able to process these things our environment clearly right when what happens what is confusion confusion is yes when you are not well oriented in time place and person so what happens when central nervous system is getting less glucose percent develop confusional problem and sometimes this is very sad situation sometimes confusion and
54:50
irritability this confusion and at the top there's irritability both things together actually produce a very dangerous combination and that combination is yes hyper active hyper excited confusional state which is called delirium what is that called delirium so actually hypoglycemia can produce even delirium what is delirium that person become highly confused and with that confusion he
55:22
is not drowsy he is not slow he become very active and angry and may start doing the things which are very unpleasant right so what is happening your central nervous system is not getting its beloved favorite candies glucose glucose has gone too low right so central nervous system neurons are malfunctioning and during this malfunction what is happening behavioral changes are there irritability is there confusion is there delirium is there even seizures can be theirs
55:58
seizures can be there and coma and in extreme cases very very rare cases it may lead to death right then these are neurological yes manifestation of glycopenic what
56:19
central nervous system but another system occurs what happens when your blood glucose goes down there are glucometers present in your hypothalamus we call them glucose sensing cells
56:34
in the hypothalamus in the hypothalamus there are special group of cells which are able to
56:43
yes estimate blood glucose level and if those cells become too active when blood glucose level goes to down those cells which are called glucose sensors what are they called glucose sensors they activate the sympathetic nervous system they do many things one of them is autonomic dysfunction
57:08
sympathetic overflow even in some people parasympathetic overflow right again i am repeating these are called autonomic manifestation of hypoglycemia what are these called these are called autonomic manifestations of hypo glycemia and what what are these autonomic manifestations these are neurological manifestation but due to autonomic dysfunction right and this autonomic dysfunction it will lead to yes second group of problems here
57:43
i should show here this is hypo thalamus here is your beautiful pituitary right the hypothalamus glucose sensor actually sense that blood glucose level is very low and at very near the
58:02
glucose sensing cells there are autonomic centers right same in the hypothalamus those autonomic centers are abnormally disturbed and when those autonomic sensors are disturbed that will lead to yes that will lead to adrenergic problems hyperactive energy increased
58:23
epinephrine norepinephrine in the body we call it adre
58:29
allergic problems and it can lead to cholinergic problems
58:37
due to dysfunction of parasympathetic nervous system more manife more pronounced are adrenergic what are adrenergic when adrenalinergic system is over functioning that may lead to yes tremors
58:54
that will lead to palpitations palpitations right what is palpitation yes my friend when someone palpate your heart that is palpitation what is palpitation
59:13
okay he is saying that when you are aware of your heartbeat that is palpitation maybe in literature he is right but in medical terms we say unpleasant awareness of your cardiac activity for example if you are with your partner and you are very happy and you develop palpitations you don't go to the doctor do you and there are some other physiological activities when you are performing your heart rate goes up you don't say i'm having palpitation and
59:41
jump out of the bed and go to the cardiologist no the pleasant awareness of your cardiac activity is not palpitation in medical terms maybe in literature actually when you are
59:56
having unpleasant awareness of cardiac activity either you feel heart is thumping against your chest or you perceive some missed what beats right so when cardiac activity is perceived
1:00:17
as abnormal right we call it medical terms palpitations so what happens when adrenergic activity comes that will lead to palpitation because of the energy activity adrenergic sympathetic system norepinephrine and epinephrine norepinephrine comes from coming from the nerve endings and epinephrine coming from the adrenal medulla when they act on the heart they lead to positive chronotropic action heart rate increases they lead to positive ionotropic action
1:00:51
contraction of the heart increases even they lead to positive dromotropic action increase conduction in the heart conduction in the conduction velocity in the heart so what i'm saying that these adrenergic drugs can produce positive chronotropic action heart rate become more they lead to positive ionotropic action the strength of contraction strength of contraction become more degree of strength of contraction by myocardium become
1:01:21
more this is what every doctor knows then there are good doctors they know that when conduction pathways especially av node when it start conducting fast under the adrenergic influence this is called positive dromotropic action what is it called positive dromotropic action then if adrenaline becomes too much many cell myocardial cell they become hyper excitable and when they become pathologically hyper excitable and have a tendency to produce arrhythmias we say this
1:01:56
positive bathmotropic action should i write it okay i will write it here these five thing positive chronotropic action heart rate goes up chronotropic then positive ionotropic action mean
1:02:14
increase strength of strength of contraction then i said increased conduction in the heart that is positive dromotropic action dromo tropic action dromotropic action then there is increased excitability increased abnormal excitability increase for example if astronaut is having normal excitability that is of course natural but if myocardial cells develop under the adrenal energy influence what increased abnormal excitability which increases the risk for
1:02:54
arrhythmias we say there is positive bath monotonication it has nothing to do with the bath bathmetropic action right and if you're look one thing is how strongly you
1:03:11
contract that is inotropic action but how rapidly you contract right that is the velocity of contraction that is called clinotropic action that is called
1:03:27
linotropic action so actually this adrenergic flow leads to all these things over adrenergic flow on the heart and all these things some of these things like fast heart rate or strong contraction of the heart or heart going out of the rhythm all these things can manifest as palpitation as unpleasant awareness of the cardiac activity right along with that there are tremors there are palpitations and of course one of the
1:03:59
very common thing which is related with the adrenergic overflow and that is anxiety that is
1:04:06
anxiety so this person who is hypoglycemic will develop develop tremors and palpitations and become anxious then he might develop some cholinergic problems he might develop some cholinergic overflow problems now what could be the cholinergic overflow problems that may lead to sweating that may lead to hunger and paresthesias sweating
1:04:37
you know your sweat glands they are supplied by the cholinergic nerves neurons right so there will be increased sweating right then with that what what else could be there
1:04:50
yes increase hunger now you understand hungry man is an angry man
1:04:57
because he is too hungry glucose level is down sympathetic overflow is there sympathetic overflow is producing excitability and anxiety at the top he's feeling hungry and anxious angry and then with that parasthesias paris theseus when abnormal sensations in the body for example you may find hypo parasthesias where they are reduced sensations or there may be hyper sensations which are called hyper parasitic so paresthesias may be over sensitivity like in the
1:05:39
skin pins and needle or under sensitivity when some part of the body become numb right this might occur in cholinergic disturbance too right now this is what we have seen
1:05:52
i will just rapidly rapidly summarize it up to now what we have discussed i know we have discussed in detail but it is important clinically what number one what is normal blood glucose level we talked about fasting blood glucose level should not be more than 100 milligram per day then we said to our post perennial blood glucose level should not be more than 140 milligram per deal and random blood glucose level should not be more than 200 milligram per
1:06:23
day but if anti rise factors are not working well like insulin if it is not working well then blood glucose level goes up and if blood glucose level goes up hyperglycemic complications will occur
1:06:39
right now normally which three tissues are dependent on glucose only central nervous system
1:06:47
retina germinal epithelium of the gonads and some people want to talk specially about rbcs right okay then we can come to when glucose level goes up what are the problems very briefly number one when there's too much glucose in your body an extra cellular fluid extracellular fluid becomes hyperosmotic it sucks of water out of the cells cells become relatively dehydrated we call it cellular dehydration and that lead to cellular dysfunction
1:07:21
and this high glucose load which appears into you can say bowman space and the nephron tubules the nephrons are unable to reabsorb all glucose lot of glucose is lost in urine producing the loss of calories producing weight loss or polyphagia right when glucose level is being lost with that it is also leading to uh pulling lot of water due to osmosis and pulley that is producing diuresis the polyurea and when glucose is lot of glucose is passing through the lumen
1:07:59
without being absorbed it is pulling the water with it the rate of flow of the luminal fluid becomes so fast that luminal fluid cannot be processed well by the nephron cells or you can say epithelial cells of the nephron and what happens that electrolyte balance cannot be maintained by the kidney and electrolyte imbalance will occur and if hyperglycemia occurs repeatedly and again and again and there is chronic tendency then advanced glycation and products will produce and
1:08:36
they will produce a lot of dysfunction in the body we'll discuss that detail in uh future lectures but briefly i'm saying that these products will produce a semi-inflammatory situation right and especially they will produce macrovascular diseases and advance atherosclerotic disease and its manifestation and microvascular diseases like retinopathy and and nephropathy and neuropathy right and with that some other complications like infections or cataracts or
1:09:10
diabetic foot is very important we'll have a full lecture on that not right now so the due to this reason we should not allow the blood glucose to go above the normal limits then why we don't allow the blood glucose go below the normal limits again the story is the same that brain needs continuous supply of the glucose so we have to support the glucose level at least a certain minimum level
1:09:33
like 50 to 60 milligram per deal if glucose level become less than that then central nervous system will become glycopenic it will develop develop deficiency of glucose and that glycopenic effect that glycopenic effect will produce a lot of manifestations by the central nervous system and abnormal outflow of the autonomic nervous system central nervous system will dysfunction due to very low glucose and that might lead to behavioral changes irritability confusional state
1:10:06
delirious delirious situations even caesar's coma and death rarely death occurs or because glucose sensing cells are sensing that glucose level is very low they stimulate the sympathetic nervous system and sometimes even parasympathetic system also too much so adrenergic symptoms will appear in the body and hyper adrenergic system and hypercholine allergic system hyper right energy system commonly you will develop the tremors you will develop the palpitations and you might
1:10:39
develop the anxiety and when cholinergic overflow occur that might lead to what kind of problems yes that will lead to excessive sweating that may lead to you can say parasthesias and that may lead to hunger right now we'll take a break and after that we'll continue this lecture is that right and after that after the break we are going to study a very important thing that is
1:11:08
anti-rise factors we'll talk about insulin and its friends after the break we'll talk about insulin and its friends like incorrect what is the role of increasing
1:11:22
in releasing high amount of insulin when glucose is taken overly what are incretins right how insulin is produced and released what are c peptides and a myelin which are co-secreted with insulin and what is their importance that we'll talk about in the after the break and then we'll have a little more break again and then we'll talk about anti-fall factors we'll talk that how glucagon works epinephrine works norepinephrine works cortisol and hormone
1:12:00
growth hormone all of them work together to and try their best to keep the blood glucose level within normal range and don't allow too much until alternative fuel like ketones are arranged in the body ketogenesis occur okay class dismiss for a while thank you
Here to help you learn
Sign in to keep a private conversation with your course tutor.
Ask me anything about the material…
Sign in to chat