This video presents the following about diabetes mellitus:

Definition of Diabetes Mellitus. Molecular structure of Insulin Clinical importance of the C-Peptides.

Classification of diabetes mellitus. Defects of Insulin secretion. Defects of Insulin actions.

Classes presented are:

1. Type 1 diabetes mellitus.
2. Type 2 diabetes mellitus.
3. Maturity onset diabetes mellitus.
4. Genetic causes resulting in molecular polymorphism.
5. Exocrine pancreatitis.
6. Infections.
7. Endocrine pathologies.
8. Drugs.
9. Gestational diabetes mellitus.

In this lecture Dr. Syed presents the following topics about Insulin: 
1. Structure, synthesis, and maturation of an insulin molecule. 
2. Components of a vesicle containing the insulin molecule. 
3. Immunogenic components that may be present in the insulin containing vesicle. 
4. Insulin release mechanism. 
5. Physiological factors that regulate insulin. 
6. Pharmacological factors (drugs) that regulate insulin. 
7. Glucagon-Like Peptide Hormones (GLP) 
8. Gastric Inhibitory Peptide (GIP) 
9. Effect of autonomic system on insulin release 
10. Effect of stress on insulin release

11. Effect of drugs on insulin release

Dr. Syed presents pathological events leading up to the type 1 diabetes mellitus (T1DM). Topics covered are:
+T1DM is an autoimmune disease.
+Role of genetic mutations and allele inheritance for DQ, DR3 and DR4 in the HLA region on chromosome 6p21.
+Role of polymorphism in insulin, CTLA4, and other molecules.
+Role of incorrect T cell training in Thymus.
+Role of cytotoxic T cells in beta cell damage. Leading to insulitis.
+Role of humoral/antibody response causing beta cell damage. Leading to insulitis.
+Incorrect formation of MHC molecules increasing affinity for the self-antigens.
+Other autoimmune diseases that may be present with T1DM.

This video discusses the following:

Classes of type 1 diabetes mellitus based on the signs and symptoms.

Early onset type 1 diabetes mellitus.

Diabetic ketoacidosis.

Silent type 1 diabetes mellitus.

Explanation of:

Polyuria/Glycosuria

Polydipsia

Catabolic state/weight loss/polyphagia

Lens blurring and visual problems 

Reasons for the recurrent candidial infections.

Diabetic Ketoacidosis (DKA) is the second most common presentation of type 1 diabetes mellitus. (First most common being early onset diabetes Mellitus.)
In this first part of the lecture we discuss:
The reason for the higher propensity of type 1 diabetes mellitus patients to develop DKA.
Polyuria/Glycosuria/Polydipsia
Hypovolemia/Hypotension
Tachycardia/Skin Turgor
Kussmaul Breathing
Fruity Odor
The role of Insulin, Glucagon, Epinephrine, and Hormone Sensitive Lipase is discussed.
Potassium level disturbance in patients presenting with DKA.
Mechanism of acidosis in DKA.

Diabetic Ketoacidosis (DKA) is the second most common presentation of type 1 diabetes mellitus. (First most common being early onset diabetes mellitus.)
In this second part of the lecture we discuss:
Mechanism of the gastrointestinal (GIT) symptoms.
Bicarb levels in DKA.
A quick comparison of the metabolic disturbances in DKA and HHS.
The impact of acidosis and membrane potential predisposing cell to arrhythmias.
Metabolic picture of DKA.
Working up the labs' data for DKA patient.
Calculating osmolality.
Calculating expected PaCO2 levels using Winter's equation.

This lecture presents the management approach for the patients presenting with diabetic Ketoacidosis.
Following management methods and the principles behind the management are explained:
 Volume replenishment, volume types, the reason for choosing various types, benefits of the volume replenishment, and the complications of aggressive volume replenishment.
 Insulin administration. Caution for insulin administration when potassium levels are low. The amount of insulin to administer and the rate of fall of glucose levels. 
 Why do insulin and glucose need to continue even after a good glucose level has been established?
 What to expect in terms of potassium levels? How to manage potassium? How to correlated potassium levels to insulin and volume?
 What labs and signs and symptoms to monitor and how to adjust when ref-flags show up?
 How to approach bicarb deficiency?

This short video identifies the patients that must receive insulin.
All type 1 diabetes mellitus patients.
Type 2 diabetes mellitus patients that fit the criteria shared in the video.
 

Notes

For the type 2 diabetes mellitus patients, here is the criteria.

a) If the first line therapy fails, then consider the second line of oral drugs. However, in case HbA1c is greater than 8.5% then consider insulin instead of another oral agent.

b) type 2 diabetes mellitus patients that fit the following criteria:

• HbA1c levels equal or greater than 9.5%.
• Fasting blood glucose levels equal or greater than 250 mg/dL.
• Random blood glucose levels greater than 300 mg/dL.
• Ketosis.
• Unexplained weight loss associated with hyperglycemia.
• A hyperglycemic patient whose status (type 1 diabetes mellitus vs. type 2 diabetes mellitus) is not known.

Further considerations:

• first line therapy is metformin.
• Assure the patient that it is not a personal failure to start on insulin. Instead, it is important to manage hyperglycemia reliably.
•  

In this part of the insulin therapy webinar, Dr. Mobeen presents:

• Insulin types
• Differences among various types of insulin.
• Mnemonic to remember insulin types.
• Objectives of the insulin therapy.
• Considerations for the dose adjustment.
• Insulin dose adjustment considerations for various physiological or pathological conditions. For example:
• Pregnancy
• Exercise
• Obeseity
• Various eating habits.
• Hospitialized patient.
• Patients with infections.
• Elderly.
• Patients with chronic kidney disease.
• Patients with liver disease.
• The dawn phenomenon.
• The somogyi effect.
• Dose calculation:
  • Total daily insulin (TDI)
  • Calculating basal insulin dose/units.
  • Calculating bolus insulin dose/units.
• Insulin therapy types:
  • Intensive insulin therapy.
  • Conventional insulin therapy.
  • Sliding scale insulin therapy.
• Insulin injection sites and their properties:
  • Abdomen
  • Thighs and buttocks
  • Arms
• Insulin syringes.
• Insulin mixing.
• Insulin filling in the syringe.

Dyslipidemia is a serious factor in cardiovascular disease, and its management is paramount in minimizing risk .

In this talk, Dr. Syed presents the model for insulin resistance presented by Dr. Barbara E. Corkey. She was awarded the Banting Lecture 2011 award for her article: Hyperinsulinemia: Cause or Consequence? Based on her groundbreaking model there have been many approaches to attempt to reverse type II diabetes mellitus (T2DM). We will look at the evidence of T2DM reversal, and then go over the highlights of various studies that have demonstrated the T2DM reversal using varying approaches.

Frederick Banting - Wikipedia
https://en.wikipedia.org/wiki/Frederick_Banting

Barbara Corkey | Chobanian & Avedisian School of Medicine
https://www.bumc.bu.edu/busm/profile/barbara-corkey/

Banting Lecture 2011 | Diabetes | American Diabetes Association
https://diabetesjournals.org/diabetes/article/61/1/4/15978/Banting-Lecture-2011Hyperinsulinemia-Cause-or

Insulin Resistance & Prediabetes - NIDDK
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance

Banting Lecture 2011 | Diabetes | American Diabetes Association
https://diabetesjournals.org/diabetes/article/61/1/4/15978/Banting-Lecture-2011Hyperinsulinemia-Cause-or

Bariatric Surgery for Type 2 Diabetes Reversal: The Risks | Diabetes Care | American Diabetes Association
https://diabetesjournals.org/care/article/34/Supplement_2/S361/28238/Bariatric-Surgery-for-Type-2-Diabetes-Reversal-The

Bariatric Surgery to Treat Type 2 Diabetes
https://my.clevelandclinic.org/health/treatments/21153-bariatric-weight-loss-surgery-for-treating-diabetes

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care | American Diabetes Association
https://diabetesjournals.org/care/article/42/5/731/40480/Nutrition-Therapy-for-Adults-With-Diabetes-or

International Experts Outline Diabetes Remission Diagnosis Criteria | ADA
https://diabetes.org/newsroom/press-releases/2021/international-experts-outline-diabetes-remission-diagnosis-criteria

Nutritional basis of type 2 diabetes remission | The BMJ
https://www.bmj.com/content/374/bmj.n1449

Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin - PubMed
https://pubmed.ncbi.nlm.nih.gov/30301822/

Case Report: Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194375/

Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years - PubMed
https://pubmed.ncbi.nlm.nih.gov/33521540/

HbA1c Calculator - HbA1c
https://www.hba1cnet.com/hba1c-calculator/

Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841829/

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial - PubMed
https://pubmed.ncbi.nlm.nih.gov/29221645/

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial - CORE Reader
https://core.ac.uk/reader/196576423

NIH study finds heavily processed foods cause overeating and weight gain | National Institutes of Health (NIH)
https://www.nih.gov/news-events/news-releases/nih-study-finds-heavily-processed-foods-cause-overeating-weight-gain
Resting energy expenditure in short-term starvation is increased as a result of an increase in serum norepinephrine | The American Journal of Clinical Nutrition | Oxford Academic
https://academic.oup.com/ajcn/article/71/6/1511/4729485?login=false
Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism1,2 - ScienceDirect
https://www.sciencedirect.com/science/article/pii/S000291652327495X?via%3Dihub

Ozempic and Wegovy have Semaglutide as the active agent. Semaglutide is a synthetic GLP-1 molecule that is modified to bind reversibly with albumin. This allows the slow release of these products. These drugs are also modified to escape the rapid inactivation by DPP4. Ozempic is approved for the management of type II diabetes mellitus and protection against cardiovascular events like death, stroke, and heart attacks in diabetic patients with cardiac comorbidities. Wegovy is approved for weight loss in obese and overweight individuals and also approved for protection against cardiovascular events like death, stroke, and heart attack in obese or overweight individuals with cardiovascular comorbidities.

Semaglutide helps regulate blood glucose, slows gastric emptying, produces the feeling of satiety, and acts on area postrema in medulla oblongata to cause nausea.

Objectives of this talk are:
1. What are incretins?
2. What is GLP-1?
3. What are Semaglutides?
4. Approval for Ozempic and Wegovy.
5. Blood glucose regulation by Semaglutides.
5. Slow gastric emptying (ileal brake) by Semaglutides.
6. Effects of Semaglutides on the brain tissue to produce satiety and nausea.
7. Dosage of Semaglutide for glucose regulation vs. weight loss.
8. Blackbox warning.
9. Side effects.
10. Explanation of the side effects.

FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight | FDA
https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or

Ozempic for weight loss: Does it work, and what do experts recommend?
https://health.ucdavis.edu/blog/cultivating-health/ozempic-for-weight-loss-does-it-work-and-what-do-experts-recommend/2023/07


Semaglutide delays 4-hour gastric emptying in women with polycystic ovary syndrome and obesity - PubMed
https://pubmed.ncbi.nlm.nih.gov/36511825/

The metabolic role of vagal afferent innervation | Nature Reviews Gastroenterology & Hepatology
https://www.nature.com/articles/s41575-018-0062-1

Glucagon-like peptide-1 inhibits gastropancreatic function by inhibiting central parasympathetic outflow | American Journal of Physiology-Gastrointestinal and Liver Physiology
https://journals.physiology.org/doi/full/10.1152/ajpgi.1998.275.5.G984

Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss | Gastroenterology | JAMA | JAMA Network
https://jamanetwork.com/journals/jama/fullarticle/2810542


Wegovy® Pen Instructions | Wegovy® (semaglutide) Injection 2.4 mg
https://www.wegovy.com/taking-wegovy/how-to-use-the-wegovy-pen.html

Wegovy: Uses, Side Effects and Weight Loss
https://www.drugwatch.com/drugs/wegovy/#:~:text=Wegovy%20carries%20a%20black%20box,same%20effects%20occur%20in%20humans.


Why Ozempic Causes Diarrhea and How to Manage Your Symptoms - GoodRx
https://www.goodrx.com/ozempic/diarrhea

Incretin - Wikipedia
https://en.wikipedia.org/wiki/Incretin

Glucagon-Like Peptide-1 Receptor Agonists for Chronic Weight Management - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533252/

What Is an L-Cell and How Do We Study the Secretory Mechanisms of the L-Cell? - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218725/

Enteroendocrine cell - Wikipedia
https://en.wikipedia.org/wiki/Enteroendocrine_cell#:~:text=in%20the%20duodenum.-,L%20cell,in%20the%20duodenum%20and%20jejunum.

What is ilial brake?
inslag.indd
https://scholarlypublications.universiteitleiden.nl/access/item%3A2956466/view