hello everyone I hope I am clearly visible and audible to you guys I am Dr Priyanka sachdev here and I welcome you all for today's session so in this session I am going to teach you a very important disease a very important pathology that is diabetes mellitus I am going to teach you diabetes mellitus in a very unique way so what is unique in that I will teach you diabetes mellitus in a integrated way what do you mean by integrated way so I will teach you the uh a pathogenesis starting from physiology first I will teach you the anatomy of pancreas then the physiology of insulin that then I will come on the pathogenesis of type 1 type 2 all diabetes mellitus then the clinical features complications everything and not only this in the end we will study the pharmacology portion also which is very important that is anti-diabetic drugs or oral hypoglycemic agents along with the various insulins right so we will study diabetes from all the subjects wherever applicable not only from pathology point of view so that is the the thing so I'm going to teach you diabetes mellitus in an integrated fashion in multiple sessions so let me start this is the first session of diabetes mellitus so let me start now we know that human has pancreas can you see a human body of course you can can you see a pancreas inside a human body can you see this pancreas is intra-abdominal organ no anatomically it is one organ but histologically and functionally pancreas is having a dual function what's the dual function of the pancreas pancreas is having two parts one is EXO grind part one is underground part so what what do you mean by exocrine part and endocrine part exoplan portion of the pancreas secrete enzymes and these enzymes are useful and digestion right the endocrine portion of the pancreas secretes hormones insulin glucagon and these hormones are useful or required for maintaining a homeostasis in the Blood and Tissue glucose level right so we have enzymes we have hormones which are secreted from corresponding exocrine and endocrine part of the pancreas okay the pancreas although you can see it is one organ anatomically but histologically and functional it is having two functions and histologically also these are the two portions of the pancreas can you see this is the same pancreas if I'm cutting it and making a slide of it you can see you can see in the slide what are the portions in the slide can you see these ducts these are the ducts these are the ducts and these drugs are known as uh these ducts are secreting it is the exocrine part and they secrete enzymes these are known as sc9 these ducts are known as acini it is the exocrine part but this is not my concern today I'm not going to teach you exuberant part today exocrine portion pathology of pancreas is different but I'm not going to teach you that today today I am interested in endocrine part of the pancreas so where is the endocrine part of the pancreas this one is the endocrine part of the pancreas can you see endocrine part of the pancreas is known as eyelet of langerhans the SS silent right it is known as eyelet of langerhans it is a collection of multiple cells there are basically four types of cells the four different type of cells are there I will tell you the names and they secrete four different hormones so can you see this is the endocrine portion it is known as eyelet of langerhans endocrine right it secretes hormones it secretes hormones and this is the sc9 it is the exocrine part it's secretes enzyme so histologically pancreas is having two different portions it is in front of you I am interested in this portion the islet of langerhans as I told you this is asinai as I have already told you this is the C9 but I'm not going to teach you acini these are the Ducks with secrete enzymes right and this portion in the center this one this one is eyelid of manganes in the eyelid of langerhans there are four cells what are the forces Alpha cell beta cell Delta cell pancreatic polypeptide cell so these are the four types of cells which secrete four different types of hormones in blood so alpha cells secrete glucagon beta cell secrete insulin Delta cell secretes somatostatin and pancreatic polypeptide cells secrete pancreatic polypeptide BP right so these are the four different hormones secreted by four different type of cells in islet of flankanens so you can see Alpha this is the Delta cell this is beta cell you can see Alpha cell so Alpha Beta Delta we have various types of cells right these are the four major cells apart from it we have two minor cells also so this portion I am going to teach you today that is eyelet of Langer hands eyelid I'm going to teach you today which is having various types of cells right now how you will prove that this eyelid of langerhans is a collection of four different type of cells four major and two minor also so I'm interested in major so how you will prove you have to prove it with the help of immunoperoxide staining staining so what what basically we do we will take antibodies we will take antibodies against different hormones as I have told you alpha cells secrete uh glucagon so please take antibodies against the glucagon so glucagon antibodies will go and bind with alpha cells only so this is the same collection of islet of langerhans this is the same collection of pilot of langerhans and this is also the same collection of islet of langerhans multiple cells are collected you can see three different diagrams of the same eyelid of langerhans but I have used different antibodies if I am using antibodies of insulin it will stain beta cell if I am using antibodies of glucagon it will it will stay in Alpha cell and if I am using antibodies against somatod Statin it is the sustaining Delta cells so you can see in the three diagram in the three diagrams maximum cells are beta cells after that alpha cells and after the Delta cells so various cells are stained it is it is in front of you you can make it out these all brown cells are beta cells these all brown cells are alpha cells and these are the Delta cells we are using different stained antibodies so it is known as immunoperoxide staining we can see right so the same thing is written you can read it uh we can see the various types of cell using electron microscope also so in the electron microscope the various types of cells are visible to you these are beta cells these are alpha cells and these are Delta cells so they have little bit change in their structure right okay let me move ahead you can see the beta cells have characteristic granules each containing a dense and rectangular cone hello you can see these are the beta cells right alpha cells and Delta cells also have granules but you know it is somewhat different the structure is different okay we don't want to go in detail in structure these are the four major cells apart from it we have two minor cells also so what are the two minor cells D1 cells and antichromethane cells T1 cells secrete a hormone known as VIP Vaso active intestinal polyp applied and Andrew bromophen cells secretar hormone known as serotonin so total so let me come on Diabetes before that let me revise what we have studied in pancreas so we have started human have pancreas okay in pancreas although anatomically it is a single organ but histologically and functionally it is having double function it is having dual functions so what is the dual function of the pancreas it is having endocrine part and it is having exocrine part right the endocrine part I am interested it is known as eyelet of langerhans langerhans and it secretes hormones it secretes hormones I am interested in that exocrine part is known as sc9 and it secretes enzymes it secretes enzymes I'm not going to teach you exocrine part let me come on endocrine part in endocrine part in highlight of langerhans there are total six cells the four major and two minor Alpha Beta Delta and PP are the four major cells VIP and Enterprise chromophene are the two minor cells which hormone they are secreting can you name the hormone okay Alpha cell secrete glucagon beta cell secrete insulin Delta cell secrete uh Delta cell secretes somatostatin and pancreatic polypeptide secret pancreatic polypeptide VIP cells are actually these are the D1 cells I have written it incorrectly D1 cells so D1 cells secrete VIP they secrete VIP Vasco intestinal polypeptide and antroprofen cell secret serotonin so please have a look on it we have understood it now let's move on Diabetes so if you know the anatomy of the pancreas and histology of the pancreas understanding diabetes will be very easy for you I am teaching you diabetes mellitus right not diabetes insipidus I'm teaching you diabetes mellitus so what do you mean by diabetes mellitus what do you mean by diabetes mellitus in diabetes mellitus it is a group of disorder which have one feature that is hyperglycemia what do you mean by hyper glycemia what do you mean by that hyper means more glycemia means glucose glycemia means glucose so the individual the person will have more glucose level in the blood more glucose in the blood that is the disease known as hyperglycemia so diabetes mellitus is diagnosed when the blood glucose level becomes too high so what is the normal blood glucose level when you will call it high what is the normal blood glucose level so if you talk about normal blood glucose level if you are fasting by fasting I mean from the last eight hours I have not eaten anything so it is known as fasting so fasting blood glucose level normal level is 8200 80 200 grams per deciliter this is normal blood right and if you are post meal if you are post meal if you have eaten your meal taken your meal and you are measuring it after two hours after the meal so what is the normal range normal range for that so normal range for that will be up to 140 up to 140 it will be normal less than 140 is normal have you got it so this is the normal so I have taken my breakfast in the morning so if you check my blood sugar level it will be 100 to 140 KB I am not diabetic right if I'm fasting in the morning if you check my blood glucose level it is 8200 right so but when blood glucose level becomes too high now both will increase uh the fasting will also increase and post pendulum will also hide so the person is diagnosed as I will tell you the criterias from which point what is the critical criteria above which you will call the person as diabetes 100 say 125 will be pre-diabetic if it is more than 126 it will be diabetic 140 say 199 it will be pre-diabetic more than 200 is diabetic so we have three range normal pre-diabetic diabetic we will come on all these points in diagnosis of diabetes but let's understand the definition of diabetes so what is definition of diabetes it is hyperglycemia hyper means more glycemium is glucose level so it is more glucose level in the blood that is hyperglycemia now who regulates the blood glucose level now can you see a beautiful diagram I have drawn for you can you see in this diagram in this diagram this is the blood vessel of a human being these are the cells of the human being of various organs these are the cells right so there is a homeostasis in the glucose level between the blood and the cell which is maintained by two hormones the two hormones are in insulin and leukagon we already know that insulin is secreted by beta cells of the pancreas and glucagon is secreted by alpha cells of the pancreas yes or no yes we already know it so insulin and glucagon are the two hormones which are secreted by Alpha and beta cells of the pancreas respectively right now see the arrows see the arrows look at the arrows so insulin is the hormone uh which which transfer see the arrow it is transferring the blood glucose level into the cell so glucose from the blood is transferred into the cell and is stored in the cell in the form of the glucagon uh glycogen glycogen it will be stored in the cell in the form of the glycogen as a storage form of the glucose so basically insulin is decreasing blood glucose level it is Shifting the glucose from the blood to the cell glucagon is doing just reverse glucagon secreted by Alpha cell of the pancreas it is doing just reverse it is splitting the glycogen from the cell and moving it to the blood so moving it to the blood so glucagon is increasing blood glucose level right so we have a humans have a capacity to decrease blood glucose level and to increase blood glucose level according to the need according to the need we can increase and decrease our blood glucose level but it is maintained within normal range what do you mean by according to the need just suppose if a person it's fasting it's fasting from the last eight hours I have not eaten everything anything so my blood glucose level will fall but body do not want that it will fall below 80 below 70. so my brain will get less glucose the body do not want that human body do not want that so at that time during fasting State glucagon will come and roll glucagon will come and roll and glucagon will shift the glycogen into the blood and increase the blood glucose level because we are fasting from last eight hours and reverse will happen just after the meal if I am having my breakfast lunch dinner these are the three major meals human me human normal human beings did so after breakfast lunch or dinner if I'm eating anything the food is going in my git from the food the glucose is absorbed from the git and the glucose will go in blood so immediately after meal my blood glucose level increases tremendously body do not want hyperglycemia also so at that time insulin will come and roll and Insulin will shift all the glucose present in the blood into the cell so during male insulin is to create it during fasting State glucagon is secreted and insulin and glucagon according to their you look at the arrows according to their action they maintain normal blood glucose level so during fasting State we have low insulin and high glucagon and during meals during meals we have high insulin and low glucagon looking at this diagram you can make it out what I mean right I am saying during fasting we have high glucagon and low insulin of course and during meals we have high insulin and low glucagon of course because you can understand what is the difference ultimately we want to maintain blood glucose level between 80 to 100 grams per deciliter this is our ultimate motto using these two hormones throughout the day whether we are fasting or whether we have eaten anything in both the scenario we want that blood glucose level should be between 80 to 100 80 200 grams per deciliter give me a thumbs up if you got it this is the biggest thing you have a concept you have got it right now what is happening in diabetes let's come on our topic directly what is diabetes what's the problem in diabetes in diabetes we don't have any problem with glucagon we have problem with insulin so make a crossover insulin now you will say what is the problem with insulin there can be two problem either the insulin is absent either it is absent because it is secreted by beta cell of the pancreas beta cell of the pancreas are destroyed they cannot synthesize on solar right so insulin is either absent in the blood or it is present but it is non-functional it is non-functional it cannot show its function it cannot it is present but it cannot shift the glucose from the blood to the cell so glucose will remain in blood only so this is known as quantitative defect quantity quantity is lesser and this is known as qualitative effect so insulin can be quantitative or qualitatively defective either it is absent that is quantity is less or decreased in amount or it is present but is non-functional so this non-functional means incident quality is not good right in both the scenario what will be the end result in both the either is absent or non-functional it cannot shift glucose it cannot shape glucose see the arrow this arrow is gone it cannot shift glucose from blood to cell so there will be two problems there will be two problems what will be the two problems blood glucose level will increase and cell glucose level will decrease both are problematic both are problematic and this is the disease known as diabetes mellitus so what is the definition of diabetes mellitus in diabetes mellitus insulin is either absent or it is non-functional so in both of these scenarios uh the blood glucose cannot be shifted into the cell and blood glucose level will rise and cell glucose level will form you will ask them what is the problem in that just suppose I am a human being and inside me just suppose um my blood glucose level is more more it is more than 100 fasting or more than uh 200 the post-prandial so do I have any problem with that now a Mary under blood glucose comprehensions technically what is the problem to me what is the problem symptomatically symptomatologically do I have any problem yes I will have some problems so if blood glucose level is high tremendously for many years for long time it is not for one day I'm talking for a long time I'm asking I'm talking about five years ten years the blood glucose level is high so that glucose will go in all the organs and cause damage to the atoms it is the ant organ disease right so it will cause damage to basically three organs the retina of the eye right the nerves coming from out of the brain and the kidneys these are the three organs which got damaged because of the high blood glucose level in the blood have you got it so these are the three complications of the diabetes you can say diabetes retinopathy diabetes nephropathy nephropathy and diabetes neuropathy so diabetic retinopathy neuropathy nephropathy these are the most three common complications of the diabetes if the person is not treated for the diabetes if blood glucose level remained high for many years the three organs will be damaged they will damage permanently sometimes diabetic persons don't take the treatment they they say yeah blood glucose level is high if I measure it is high but it is not giving any trouble to me so why I should take the treatment why I should take insulin why I should take oral hypoglycemic agents or any tablet why so if the person is not taking for many years both the kidneys will be damaged and in the end the person will be having chronic renal failure bilateral renal failure and the only option is dialysis person will be on dialysis right in nephropathy this is the nephropathy in neuropathy there will be abnormal Sensations overall in the body especially in the limbs right in retinopathy the retina is damaged and you have studied that in Ophthalmology right so that is the complication of high blood glucose level in the blood now what is the complication of low glucose in the cell the cell will have low also all the cells are starving you know starving they don't have glucose now have you heard a proverb have you heard another proverb so this is the same situation if you understand Hindi you are getting what I mean so this is the same situation this cell is facing this cell cannot utilize glucose although having abundant of glucose throughout in the blood having abundant of glucose at the right at the doorstep but the cell cannot take it so see the irony see the I am pity on the cell see the irony of the cell this cell is is surrounded by the blood the blood is full of glucose But the irony is that cell cannot take the glucose have you got it so that is so the cell will be starving for the energy both are problematic so what is the problem now you tell me you tell me what is the problem in diabetic person who will tell me what is the problem in diabetic person in a diabetic person body have a trouble in moving glucose from blood to cell see which arrow is gone this arrow is gone this is functional so blood to cell this cannot be done either due to insulin is absent there can be two problems either insulin secretion is less or its action is less either it is present or both or both right so qualitative or quantitative effect now there will be two problems blood glucose level is high cell glucose level is low both are problematic if blood glucose is high for many years it will cause multiple organ damage specially three organs retina kidney and nerves diabetic retinopathy neuropathy nephropathy the three complications and if the cell are cell glucose level is low so cell will starve for the energy they cannot synthesize ATP despite having abundant of glucose right at the doorstep they cannot take it see the irony have you got it so this is diabetes this is diabetes I hope you got the basics of the diabetes everyone I want thumbs up from everyone this was a very important concept I told you right now diabetes is the leading cause of morbidity and mortality throughout the world these are the five topmost country in the world which is having highest prevalence of diabetes highest prevalence of diabetes number one is India number two is China then U.S then Indonesia then Japan these are the five countries in the world which is having highest prevalence of the diabetes Now on an average if we talk about India let's talk about India in India out of every 107 percent have diabetes so seven percent is the incidence rate of the diabetes so out of every 100 Seven Persons are newly diagnosed as diabetes every year every year out of every hundred the next hundred the next seven next hundred next seven so this is the incidence rate of the diabetes in India you can say right let me come on the classification we have understood till now we have understood the definition of diabetes so this is the definition of diabetes don't learn the definition understand that in this diagram so diabetes is a disease is in which there is a problem with insulin hormone the problem can be two either the hormone is absent that is quantitative defect or it is present but non-functional so it is qualitative effect or both of them in this scenario insulin will not shift the blood glucose level into cell so blood glucose level will rise and cell will fall both are problematic if blood glucose levels will rise it will cause damage to multiple organs specially three organs and if Cell glucose level will fall the cell will star for the energy despite of having abundant glucose right at the doorstep I want thumbs up in the comment box everyone if you got this concept whether you are watching it live or whether you are watching it recorded I want to want a thumbs up do you have any doubt in this please write down in the chat box I will address it address your doubt as soon as I will see it have you got it let's come on the classification let's come on the classification of the diabetes right let's come on the classification of the diabetes diabetes is basically of two type type 1 diabetes and type 2 diabetes the two types I will I'm going to teach you in detail so Type 1 Diabetes Type 2 diabetes I will teach you both in detail the third type of Diabetes that is genetic defect in the beta cells of the pancreas beta cell function genetic these are known as molding these are known as Modi what do you mean by full form of Modi what is the full form of Modi it is maturity onset diabetes of the young mody maturity onset diabetes of the young so this genetic defect diabetes are the bodies there are six type of Modis I will teach you all so Modi one Modi 2 Modi 3 Modi 4 modify and Modi six I will teach you the various enzymes which are defective in these Modis so these are the maturity onset of genetic defect in the diabetes I will teach you this also right after that we have genetic defect in the insulin I'm not going to teach you this exocrine part of the pancreas defect I'm not going to teach you this endocrinopathy is acromegaly Cushing syndrome not teach you this in detail there are many infections which cause diabetes which cause diabetes so these are the organisms these are the three organisms which cause damage to the beta cells of the pancreas so beta cells of the pancreas are damaged so the person will be diabetic so what are the three infectious organisms learn their names so it is cytomegalovirus number one Coxsackie B virus number two and rubella virus number three so all are viruses there are three viruses which cause damage to the beta cell of the pancreas and the person can have diabetes because of the infection there are many drugs there are many drugs which cause hyperglycemia in a person so the person will have diabetes the hyperglycemia means diabetes person have diabetes because of the drugs if you stop the drugs the blood glucose level again will become normal so in this scenario no treatment is required just stop the offending agent whatever is the offending agent causing the blood glucose level to rise stop that offending agent the person will again will be eugenic right uh so eoglycemic right so what are the drugs enumerate them it is steroid the most common drug the most common culprit steroid thyroid hormone interferon Alpha protease Inhibitors beta beta Agonist you know beta Agonist so these are the there are many others also these are the important drugs which causes hyperglycemia apart from it there are some syndromes the genetic syndromes which are associated with diabetes so down syndrome Clinton syndrome Turner syndrome and federal syndrome so learn the name of these four syndromes apart from it the last but not least I will teach you in detail is gestational diabetes mellitus that is diabetes during pregnancy diabetes during pregnancy is gestational I will teach you this in detail so basically I will teach you type 1 I will teach you type 2 I will teach you genetic defects of beta cell that is one by one and these I will not teach you in detail you learn the names only among these I will teach you only gestational so I am going to teach you these in detail other you should know the classification right so type one hand type 2 hair modi's hair gestational apart from it infections drugs genetics syndrome learn this classification by yourself so we are done with classification also so let's start with type 1 and type 2 no let's start so these are the two most important diabetes which I am going to teach you in detail after that we will study Modis also after that we will study gestational diabetes mellitus also don't worry we will study everything right let me start with type 1 and type 2 first let me finish these two type 1 diabetes what is another name given to Type 1 Diabetes Type 1 diabetes is only 10 and type 2 diabetes is 90 right right type 2 is very common type 1 is rare it is not very common type 1 diabetes is only 10 there are two names given to Type 1 Diabetes Type 1 diabetes is known as juvenile answer diabetes because most commonly it is diagnosed at younger age or adults adolescent age or juvenile age it is also known as insulin Tibetan diabetes mellitus IDDM insulin dependent diabetes mellitus because the only treatment for type 1 diabetes is insulin do you know insulin tablet it is not oral form insulin is injectable it comes in the form of the injection and person has to take subcutaneous injection with every meal before every meal or after every meal so basically human take 3 big meal breakfast lunch dinner right so three times a day the person has to give injection to himself or herself before every meal or after every meal with every meal you can see so insulin is an injectable drug it is an injectable treatment that is the only pity for this patients so these patient has to take multiple injections throughout the day three to four injections throughout the day whenever they eat they have to take insulin and insulin is injectable right insulin is the only treatment there is no oral hypoglycemic agent right for a treatment which which can be given to these so type 1 diabetes it is only 10 percent two names are given juvenile onset diabetes and Insulin dependent diabetes mellitus you got the meaning of Booth why it is known as Gemini because it is diagnosed at juvenile age right why it is known as insulin independent diabetes because the only treatment for these patient is insulin have you got it so I am done with type 1 diabetes let's come on type 2 diabetes let's come on Type 2 Diabetes Type 2 diabetes is 90 of the cases of the deputies ninety percent of the cases of the diabetes is Type 2 it doesn't it is also known as non-insulin dependent diabetes mellitus that is an IDDM now this is a misnomer uh why does the misnomer looking at the term you may feel that insulin is not required for their treatment no this is not the case this is not the case it is a misnomer uh non-insulin dependent insulin is not only treatment if you diagnosed any person with type 2 diabetes which occurs mostly after 50 years of age 40 or 50 years of it occurs in old age right maturity onset it occurs in old age right middle age or old age so if you diagnose any person with type 2 diabetes first offer diet restriction lifestyle modification exercise after that offer oral hypoglycemic agents there are many tablets available for that right metformin is the drug of choice and if it is not controlled even with metformin and other oral hypoglycemic agents even after lifestyle modification exercise diet control then the last option is insulin it is not that insulin is not given in the treatment it is given but it's a last resort not as the first Resort like it was in type one so what is the summary till now what we have learned we have learned that diabetes mellitus is type type 1 and type 2 type 1 and type 2 type 1 is 10 type 2 is 90 right type 1. is known as juvenile onset diabetes type 2 is known as maturity onset diabetes type 1 is known as insulin dependent diabetes mellitus type 2 is known as non-insulin dependent diabetes mellitus right so that is the somebody till now I have given you this is a misnomer it is not the thing that is insulin is not given in the treatment insulin is given but as a last resort not as the first result here insulin is the only treatment that's why it is known as sensual independent and juvenile and maturity is the age at which they are diagnosed at which they occur right we are done with type 1 and type 2 con nomenclature let me come on the risk factors of the diabetes there are many risk factors for the diabetes if anyone having a family history of type 2 either the mother or the father or any family history of type 2 diabetes the person is having higher risk of developing diabetes my mother's maternal side many diabetic persons are there my paternal side also many diabetic persons are there my both parents are diabetic so I am having high chances that after 50 years or 40 years I will be diabetic I only by by taking the you know proper um uh lifestyle modification by doing exercise diet restriction right now starting right now I can postpone it but I cannot avoid it I will be diabetic in future I cannot neglect it but I can postpone it as much as possible by doing lifestyle modification right okay so family history is the biggest risk factor obesity if someone is obese overweight so he is having high risk of type 2 diabetes I will tell you the reason why obesity increases the risk of type 2 diabetes I will tell you pathologically what is the reason when I will teach you type 2 diabetes in detail right the third is physical inactivity nowadays most of the having office jobs so in office of most of the hours the person is sitting even I teach four hours by sitting on a chair so physical exercise is very less so the sedentary lifestyle is there so that will lead to obesity right and that can increase the risk of type 2 diabetes the race and ethnicity blacks Asians and Pacific Islanders are at higher risk of diabetes because of their race and ethnicity uh previous identification of impaired glucose so if if a person is having impaired blue fasting with blood glucose level or impaired glucose tolerance that is a pre-diabetic person is at high risk of developing diabetes as compared to a non-diabetic person right history of having gestational diabetes imagine a lady she got pregnant and during pregnancy she is diabetic before pregnancy she was not diabetic and just after delivery of the baby she become normal again she is non-diabetic but after 50 years of age she is having high chances of developing diabetes because she was diabetic at the time of the pregnancy so gestational diabetes mellitus or delivering a baby heavier than poor kg at Birth these are the risk of developing diabetes in that lady in future right hypertension is a risk for diabetes if someone is hypertensive he is having high risk of developing diabetes in future right dyslipidemia if HDL good cholesterol is low and LDL and triglycerides that is bad cholesterol is high so person is having high risk of developing diabetes right pcod is a risk right acanthosis and history of muscular diseases so these are the 10 risk factors for diabetes mellitus please learn the risk factors right okay so let me start with diabetes now till now what we have understood till now what we have understood we have understood the introduction what is diabetes we have understood the classification what are the various types of diabetes type 1 detail type 2 quantity let's start the biggest thing we have understood glucose homeostasis also with the help of two hormones insulin and glucagon incidents secreted during meals and looking on secreted during fasting State and how insulin and glucagon together acting in human blood and uh maintaining uh normal blood glucose level so glucose homeostasis we have already understood the next topic which I want to start before teaching you pathogenesis of various type of diabetes is insulin regulation the physiology let me teach you physiology first then I will come on pathology and medicine and pharmacology I will come on that but let me teach you physiology so how insulin is synthesized how it is released and after releasing how insulin is chewing its action that is the biggest thing I want to teach you here and after that I will come on the pathogenesis of the diabetes have you got it have you got it say yes or no have you got it so let me start with insulin regulation okay but the link is expiring I have to end this lecture and I will teach you please don't miss next lecture part two of this series right of this diabetes series please watch the part two in part two I'm going to cover all these I'm going to cover insulin regulation then I will teach you the pathogenesis of type 1 and type 2 diabetes the modes various types of genetic debris Modi type one two three four five six and gestational diabetes mellitus so I will teach you pathogenesis of all of them not only this I will discuss the clinical features the triple P polyurea polyphagia polydipsia the mechanism of these three peak in in diabetes I will teach you the complications of the diabetes that is keto acidosis and hyperosmolar comma the two complications the pathogenesis of the complication and how we diagnose diabetes in a diabetic person and after that we will come on the pharmacology portion that is the treatment of the Deputy so I am going to take this series in three or four parts so it is a big topic you will cover diabetes from all 19 subjects wherever applicable starting from Anatomy till medicine surgery I will cover everything of the diabetes so don't dare to miss the next lecture the link is expiring I'm ending this lecture and please join the next lecture just a second give me a minute so thank you very much for being with me I really enjoyed teaching you this this lecture hopefully same you have learned a lot from your side also the next class the next lecture will be uh after one hour after one hour there will be part two of the series that is diabetes mellitus 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