Transcript High blood of sugar after meal

Lecture6：
Internal secretion system diabetic and nutrition
Mechanism of After the meal high levels of sugar
food
High levels
of sugar
Pancreas
Glucose
Insulin
Vicissitude
energy
Insulin is insufficient.
Working of insulin is bad
Inherited factor, obesity
high fat diet, stress
lack of physical activity
Adrenal
Thyroid
「Adrenaline」 A heart beat number
increase, the metabolic promotion, and
the blood sugar rise are pressed.
「Noradrenaline」 The blood vessel is
shrunk, and the blood pressure is
raised.
「Glucidic corticoid」The blood sugar
level is raised. The resistance power of
the body is strengthened and it
Pineal body
「Thyroid hormone」
Improving the
vicissitude.
Promoting the activity
of the sympathetic
nerve (increasing blood
pressure
and ventricular rate)
「Melatonin」
Control the
maturity of the
body
Testicle
（men）
「Testosterone」
・ product the sperm
・ Urge Skeletal
development
「Bcogesteron」
The endometrium
becomes thick
「Estrogen」
The body wears
roundness
Pancreas
Command that
adjusts amount of
secretion of
hormone
Pituitary body
handles stress.
Ovary
（women）
Hypothalamus
Parathyroid gland
「Insulin」
It lowers the level of
sugar in the blood.
「Glcagon」
The blood sugar level is
raised.
「Growth hormone」
The synthesis of the skeletal
development and the protein is
pressed.
「Thyroid stimulating hormone」
「Gonadotrophin」
「Adrenocorticotrophic hormone」
The appeal secretion is urged on
other secretories.
「Melanin cell stimulation Holmin」
The production life of the melanin
is urged.
「Basopreshin」
The urine production and the
blood pressure increased are
pressed
「parathyroid hormone 」
Adjusting the calcium
level in blood
RH：Releasing
A hypothalamus in the center
part of the brain stimulates the
leaf the former leaf
about the pituitary and after
and the entire control of the
internal secretion is done
Adrenal cortex ACTH
Thyroid TSH
Ovary FSH and LH
Testicle LH etc
hormone
Secretion of a
hypothalamus
Ｒ
Ｈ
A hypothalamus
and pituitary
Antidiuresis
hormones of
posterior, etc
Various tropic hormones
of anterior lobe of
the pituitary gland
It acts about the internal organs of
the whole body through the
hormone from each internal gland,
and the vicissitude is controlled
Inside the brain
Mechanism of stress resistance by the hypothalamus pituitary body
adrenal substantia corticalis system
CRH is secreted
from a
hypothalamus by
the clock gene's
working to promote High value in morning
Diel rhythm
Low value in afternoon
the metabolic
activity in daytime
Meal
Sleeping
at 4:00AM, ACTH
(adrenocorticotrop
hic hormone) is
secreted from the
anterior lobe of the Pituitary gate pulse
pituitary gland, and
the vicissitude in
daytime is raised
Adrenaline
Organization
Stress
Central
nervous
system
Hypotharamus
It acts about the internal organs of
the whole body through the
hormone from each internal gland,
and the stress added by the
control mind and body of the
vicissitude is NA of the
sympathetic nerve from a large
brain: A hypothalamus is
stimulated through nerve line of
the noradrenaline. GABA controls
this reaction.
CRH secretes ACTH of the anterior
lobe of the pituitary gland from a
hypothalamus in the portal system,
and the adrenocortical hormone
increases the number of
resistance and blood sugar of the
organization
Inflammation control
Stress resistance
Pituitary
Cortisol
Sugar newborn
Na preservation
Adrenal
cortex
Organization
Yasuo KAGAWA et al. “Core, molecular biology
of human body” MARUZEN, 1997, p.333
Treatment of internal secretion disease: Correction of vicissitude by
alimentary therapy. It is a hormonal supplementation in the
depression. It is a control medicine in the hyperfunction.
• hyperpituitarism ：Treatment food of hypertension, high levels of sugar,
and hyperlipemia
• Bazopreshin Tenhana, moisture intake increase, and phlegm white and
salt limitation food Basedow 'S disease: Diabetes insipidus: Immunity
disease of TSH receptor;High energy and protein-rich diet
• Hypothyroidism: Tirokishin taking, anti-cholesterol food, and low salt
• Cushing 'S disease: Adrenal skin quality tumor removal: Low salt and
energy efficient food.
• Addison 'S disease: the adrenocortical hormone administering: It is a
high glucidic, and low fat diet at a high salt and low levels of sugar
because it is dangerous in low blood pressure by the salt loss.
• Pheochromocytoma: excessive the adrenal medullary hormone: It is high
energy food in the tumor removal and high blood pressure for the low
salt and the energy consumption.
Diagnosticcriteria
criteria of
of diabetic
Diabetes
Diagnostic
Fasting levels of plasma
fasting plasma glucose
glucose concentrations
Diabetic
Diabetictype
type
fasting plasma
glucose
(IFG)
Normal
Normal type
type
Boundary type
(Reserve)
Abnormal tolerance
of sugar
glucose load examination value for two hours
(after the meal blood sugar level)
Structure of Diabetes (2 type)
Insulin
resistance
Insulin secretion
decrease
Glucose toxicity
Glucose toxicity
Lack of insulin action
High levels of
sugar
High level of blood
sugar after meal
High levels of sugar
when hungry
Mechanism of after the meal high levels of sugar
food
Pancreas
High levels
of sugar
Glucose
Insulin
Vicissitude
Insulin is insufficient.
Working of insulin is bad
Energy
Inherited factor, obesity
high fat diet, stress
lack of physical activity
Microangiopathy
IRI decrease
alpha-glucosidase
inhibitor
Ketone urine
syndrome
Diabetics
Lose of water
GTT
Decrease
Lipid
resolution
Glucidic use decrease
in cell
Obesity
Exercise
shortage
Septicemia
Proteolyses
Endocrine abnormality
Pancreas
2 type
Diabetic
Resistance
decrease
Island
depression
Islet of Langerhans
Destruction of B cell
Insulin injection
Bulimia
Thirst
Multi urine
Diabetic coma
Weight lose
Skin suppuration
Feeling of
worthlessness
Insulin action
decrease
Pancreatic
island transplant
Artificial endocrine
pancreas
Reduced
visual
acuity
Retinopathy
High levels of sugar
prediabetic
state
Calorie
excessive
1 type diabetics
Juvenile
diabetic
nephropathy
Haemoglobin A16
Inheritance
primary cause
Meal,Exercise
Symptoms
Result of inspection
Cause of diseases
Oral preparation arteriosclerosis
Ischemic
heart disease
Cerebrovascular
disorder
2 type
Symptom and cause of diabetic
Yasuo KAGAWA. “Nourishment biochemistry”
KAGAWA Nutrition publishing, 1970, p.282
The diabetic is judged as follows.
The glucose of 75g is drunk and blood sugar rise measurement note 1)
Blood sugar measurement time
For two hours
after the load
Hungry
Density of
Glucose
（Vein plasma）
126mg/dl
above
or
200mg/dl
above
Not diabetic neither normal
110mg/dl
within
division
and
140mg/dl
within
Diabetic
Boundary
Normal
Japanese Diabetes Society: Quotation modification from diabetic diagnostic
criteria advisory committee report and 1999
１）
When one hour value is 180mg/dl or more even if it is a normal type, it is necessary to
handle the diabetic based on the boundary type compared with the one of less than 180mg/dl
because ecause danger of deteriorating is high (passage observation etc.)
An increase in disease by making of meal European-style
Comparison of 3 groups (40 or more) in Hisayama-machi
Age
adjustment
person
Hyperlipemia:Total cholesterol
Frequency
per 1961
per 1961
Kyushu University the second internal medicine department
Hisayama laboratory
Women
Men
(To Cerebral infarction
Abnormal
glucose
Tolerance
(To Cerebral infarction
Cardiac infarction)
(To diabetics)
Cardiac infarction)
Hyperlipemia
Hyperlipemia
Abnormal
glucose
Tolerance
(To diabetics)
Racial difference of gene concerning nourishmen
Caucasian
Japanese
Amount of energy place
main point
Type of energy
consumption of large
amount
Type of
tolerance hunger
Alcohol metabolism
Strong
Weak
Farming culture
Stock raising
Rice farming
Multi type
concerned energy
Milk tolerance
The Japanese develops diabetes easily because of slight obesity,
and the insulin secretion is few
The Japan-U.S. diabetic's comparison
Level of obesity
Japan
Insulin secretion
U.S
U.S
Japan
Blood of sugar when hungry
A large difference in the condition physiology
and the expression type
SOCS2(supressor of cytokine signaling 2)
Difference of multi type
Situation of obesity by BMI and belly surroundings measurement
（％）
100
80
Men
60
29.0
32.1
5.4
2.7
27.8
2.5
20.9
1.0
28.0
9.1
15.3
25.8
26.5
56.5
49
42.7
43.1
50.1
30～39
40～49
50～59
60～69
Above 70
40
20
3.6
28.7
0
Excessive only the abdominal
circumference (85cm or more)
Within BMI25 and 90cm waist
Doubt of upper-body obesity
(Above BMI 25 and Above 85cm of abdominal circumference)
Above 25 BMI only
（％）
100
80
Women
5.9
7.0
10.9
9.5
0.7
1.8
12.5
12.2
2.2
21.5
8.7
60
40
86.3
77.7
73.1
40～49
50～59
8.0
21.3
8.0
61.7
61.3
60～69
Above 70
20
0
30～39
Within BMI25 and 90cm waist
Above 25 BMI only
Excessive only the abdominal
circumference (90cm or more)
Doubt of upper-body obesity
(Above BMI 25 and Above 90cm of abdominal circumference)
9.4
"Healthy Japanese 21" middle evaluation results value
1.1
1.2
1.4
Target
value
Baseline value
Middle results
value
Obesity child
10.7％
10.2％
７％
20-29 thin women
23.3％
21.4％
15％ or less
20～69 obesity men
24.3％
29.0％
15％ or less
20～60 obesity women
25.2％
24.6％
20％ or less
27.1％／a day
26.7％／a
day
25％ or less
Adult
292g／a day
267／a day
350gor more
An increase in intake of
food to which calcium is
abundant (adult)
(average a day intake)
Milk, Dairy products
107g／a day
101g／a day
130gor more
Beans
76g／a day
65g／a day
100gor more
Brightly colored
vegetables
98g／a day
89g／a day
120gor more
It decreases about an
undernourished person
breakfast. (ratio of
undernourished person)
Junior and high school
student
6.0％
6.2％
0％
Men（20-29）
32.9％
34.3％
15％ or more
Men（30-39)
20.5％
25.9％
15％ or less
Target
Target items （Standard of index）
Increase person who sustain
proper weight
（Ratio of obesity person）
A decrease in fat energy
ratio (average a day intake
ratio)
Increase of amount of
vegetable intake
20～49
or less
（Average intake amount a day)
1.5
1.7
The Ministry of Health, Labour and Welfare 2006.10.17
Reason that business bachelor puts easily to diabetic
Eating habits
A lot of dining out.
Eating the favor of the favorite one.
A lot of association at night.
Ill-balanced
Lack of exercise
The commuting time is short,
and the distance where it walks is short.
It takes a nap at home on holiday
Stress
The stress in the office and the home is large.
In work away from home"Homesickness"
Diabetic complication (Chronic insulin action syndrome)
Retina syndrome
Cataract
Arteriosclerosis
Cerebral infarction
Facial nerve palsy
Infectious disease
Tuberculosis
Kidney
disease
Impotence
Urine road
infectious disease
Cystitis
Dysuria
Arteriosclerosis
Cardiac infarction
Skin disease
Infectious disease
Peripheral
neuropathy
3 major coexisting
diseases
Modification from
”Bookmark of lifestyle disease”
Diabetic complication
Normal
Border type
(High blood of sugar after meal)
Diabetics
Progress of symptom
Arteriosclerosis
coexisting illness
3 major
coexisting illness
Cardiac infarction
Cerebral infarction
Neurological disorder
Retina syndrome
Kidney syndrome
(Subjective symptom)
Dryness of throat, An increase in urinary output,
Becomes thin though eats a lot.
The body feels heavy. Easy to become tired
It appears like high levels of sugar 5-10 later
The self-measurement of the blood sugar came to be used widely.
Eating habits that prevent high levels of sugar to the Japanese a
lot of after the meal that is are made to be conscious
POC：point of care
The amount of collect
blood is only 3μl.
The measurement time
is 20 seconds.
450 measurement
memory
Near sales schedule of no
complete collecting blood
It collects blood in the
humerus and the forearm.
The collecting blood
device and the measuring
instrument integrate.
From collecting blood to
the measurement is full
automation.
The needle and the
electrode can be installed
beforehand. (Eight hours
ago. )
Paracentesis cordis－Blood
aspiration－Even the
measurement result display is
full automation
Change in blood sugar level during a day
Blood
sugar
All day long
high level
of sugar
After meal
high level
of sugar
Normal
Breakfast
Lunch
Supper
Caused by high levels of sugar after the meal,
Occuring cardiac infarction and the cerebral infarction
High level of blood
sugar after meal
Glucose
The blood vessel endodermis
fat is exposed to high
levels of sugar
Oxidation stress generation
Depression of cells that line the blood
vessels
Blood vessel
Cardiac infarction
Cerebral infarction
Clot formation
Arteriosclerosis
The tumor necrosis factor α and the active oxygen that moves to tallow by
obesity the macrophage and increases the insulin resistance are made
Adipose cell
Front adipose
cell
Macrophage
New treatment method of obesity:Reduction and decreased food
appetite of white fat caused by capillary vascularizati
on control medicine of adipose cell that uses Prohibitin
Reductio
n of
tallow
Brain
Signal from tallow
Newborn anti-blood
vessel medicine
Intake decrease
An energy consumption
increase
Because Prohibitin shifts from mitochondria to the
secretion fat, peptide that destroys the capillary cell
of tallow to the Prohibitin uniting peptide is
connected, it administers, and it decreases tallow
Improvement of
glucose tolerance
Insulin resistance
decrease
Treatment expense of diabetic
Nourishing meal thing
guidance fee
Artificial dialysis
Retina photocoagulation
Renal transplantation
( Only the operation fee)
yen / a month
600,000yen / a month
170,000 yen
1,448,000 yen
Related risk
High levels of sugar and after the meal mortality rate
Treatment for Hypertension
Meals
The aptitude energy intake is observed.
Nutritionally balanced dietary composition
Exercise
It does three times a week during 20－30 minute
it as for aerobics during a day.
The medical checkup is indispensable.
Questionnaire of 50 diabetics of work away from home
Man
Middle age (40’s-60’s)
There is a diabetic among two degree of relationship
Meal dines out chiefly
Mealtime for a less than 10 min.
Mealtime is irregular
The amount of the meal once is large
There is entertainment two times or more during the week
Many chances of the drinking
Like meat
It doesn't cook for oneself
The method of preventing
after the meal high levels of sugar
Eat slowly
Exercise after meal
The dietary fiber is taken enough
The blood sugar normalizes when breakfast is increased and
supper is decreased
The type life at Japanese night is one cause of a diabetic increase
Change of HbA1c between guidance before and after,
energy of breakfast and supper
T test
before
12months later
before 12months later
Breakfast energy
before 12months later
Supper energy
Kayoko ADACHI, “Method of guiding handy nourishment in insulin non-dependency diabetic and examination
at guidance continuance” 『The Japanese journal of Nutrition』, 56(3), 1998.6 p.156-170
Enpowerment of preventing Diabetes
• Esteem and independence support of medical treatment
person of person's of attending a lecture idea.
• Knowledge and blood sugar measurement technique
giving for self management.
• The object person is a responsibility in the result that
sets a possible target.
• Evaluation that improves self-effect feeling when it is
possible to achieve it.
• Discover the cause if there is a trouble and the evasion
method.
• Making to the activity to the custom is important in
continuation in daily life.
• It is necessary for meal and the movement in the family
friend's cooperation.
KAGAWA Nutrition University
“Nutrition Clinic” result value 2005
収縮期血圧
Systolic
arterial pressure
*
93
92
91
Metabolic syndrome: It
succeeded in the internal
organs obesity, high blood
pressure, high levels of
sugar, and abnormal lipid
improvements
Metabolic syndrome limit value
90
134
132
130
Metabolic syndrome limit value
128
126
124
The diastolic phase of uterine
122
contraction, HDL, and TG are
120
improved
118
116
114
Before guidance
3months
later,
6months
later
受講前
3ヵ月後
6ヵ月後
89
88
87
Insulin
* インスリン
Impedance and the
body fat percentage of
DEXA decrease
similarly, too
86
85
Before受講前
guidance
6 months
6ヵ月後later
14
Insulin
インスリン（μU/ml)
Waist surroundings（cm）
94
pressure
Systolic arterial
収縮期血圧（ｍｍHg)
Waist surroundings (cm)
*
12
10
8
6
4
The insulin resistance is a basis of Metaboliｃ
syndrome. Blood sugar x insulin ÷405 when
it is HOMA-R = hungry is improved from 3.5 to
1(normality).
2
0
受講前
Before
guidance
3ヵ月後 later,
3months
6ヵ月後 later
6months