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  Micro nutrients in diabetes 03/29/2024 10:09am (UTC)
   
 

             
Micro nutrients in diabetes
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    Diabetes Mellitus is usually associated with wide spread biochemical disturbances. Till

date many trace elements have been proposed in etiopathogenesis of diabetes mellitus and its short and long term complications.


Role of Magnesium ions
    Magnesium is a key factor in oxidative phosphorylation in step wise carbohydrate

metabolism and is also proposed to have some effect on action of insulin. Yet its status in diabetes mellitus is largely enigmatic.


    In IDDM with DKA there is gross urinary loss of magnesium particularly during intensive

insulin and fluid therapy. This loss is reported in more than 55% of patients after initiation of therapy. Leading to hypomagnesemia. On the other hand some studies show raised magnesium level in diabetic patients with poor renal function.


Causes of Hypomagnesemia in DM.
   1. Fluid and insulin therapy : In patients with IDDM and DKA there is gross urinary loss of

magnesium due to osmotic action of hyperglycemia in association with decrease renal tubular handling of increase magnesium delivery which is a direct consequence of high fluid infusion.
 

   2. Hyperadrenalism : In IDDM there is a increased level of counter regulatory hormones,

Which add to reduced magnesium levels in such patients.
 

   3. Hyperaldosteronism
 

Effects en magnesium deficiency in DM
   1. Hypmagnesemia is associated with life threatening cardiac arrhythmia's with

concomitant hypokalemia.
 

   2. Increased risk of development of retinopathy.
 

  3. Increased risk of coronary disease due to increased atherogenesis due to platelet

      reactivity.
 

  4. High risk for development of nephropathy.
 

Role of magnesium supplementation.
   1. To prevent arrhythmia's.

     2. To improve glycemic control : Both by oxidative nietabolism as well asw increased

        insulin sensitivity.
   3. Prevention of atherosclerosis.
   4. Prevention of retinopathy : It has been consistently found -that hypomagnesemia is

       associated with high incidence of diabetic retinopathy. So magnesium supplementation 

       in association with strict glycemic control can prevent a delay progression of

       retinopathy.


    Zinc ion (German : of unknown origin) described by Liborins a traveler who also

mentioned that Zinc was discovered in India.


Introduction
    Zinc is an essential factor for more than 90 enzymes of which at least 20 are metallo

enzymes. The key metabolic regulatory and catalytic function.


    Absorption : Zinc is actively absorbed in small intestine mainly duodenum against a

concentration gradient of which almost 50% is available in circulation from dietary sources.
In Plasma 60% is albumin bound rest is bound to amimoacids and serum globulin's.


Sources
  
Richest sources are sea foods, oyster meat, nuts etc.
   Excretion is mainly through faeces.

Role in Carbohydrate metabolism
    1. Zinc causes in vitro release of insulin from pancreas during glucose stimulation.

        Mechanism of this is not known.
    2. Crystallization of insulin in hexameric from is essential for basal insulin level in blood

        which causes prolonged glycemic control. So zinc deficient individuals have less stable

        hexameric form, so rapid degradation of insulin occurs leading to glucose intolerance in

        previously well controllled diabetics.
    3. Zinc is an integral part of pancreatic carboxy peptidase essential in intestinal protein

        metabolism.
 

Other roles of Zinc
    1. Insulin storage in B-cells is mainly in hexameric form. These crystals are released into

        portal venous circulation and variation in zinc insulin molecular ratio have been crystals 

        are released into this property, so in efficient storage as well as defective release of

        insulin occurs.
    2. Zinc enhances hepatic insulin binding by increased expression of GLUT-2 receptors on

        liver cells.
    3. Zinc stimulates lipogenesis in adipose tissue. In diabetes mellitus
 

Zinc deficiency is seen more commonly in NIDDM / MODY than IDDM.
   Causes of Zinc deficiency in Diabetes are following :-
   1. Increased urinauy loss of zinc due to glycosuria leading to osmotic effect on zinc

       excretion.
   2. Polygenic role : Family relatives of diabetes mellitus heavy zincurea than control.

       Without having overt symptoms of diabetes. Suggesting a genetic predisposition.
   3. Aminoacid urea can increased zinc excretion possibly through competition with serum

       proteins for zinc binding and resultant increase in ultra filtrated fraction of zinc. This is

       seen after aminoacid infusion zinc excretion was increased upto 100%.
    4. Disturbed metabolism of zinc metalloenzymes have been suggested as possible cause.
 

    In effective zinc deficiency in diabetic is a result of increased zinc excretion in urine which

is not compensated by increased intestinal absorption.


Effects of Zinc deficiency
   1. Impaired glucose tolerance
   2. Blunted insulin action due to rapid degradation and decrease sensitivity.
   3. Impaired wound healing.
   4. Acrodermatitis enteropathica.
   5. Hypogonadism
 

Chromium
    In 1970 it was approved that Chrominm is a essential trace element for normal glucose

and lipid metabolism recent years the role chromium has emerged as exciting advancement in management of diabetes.


    Chemical role : Chromium is an integral part of so called Glucose Tolerance Factor

(GTF) a chromium nicotinate complex which enhances insulin efficiency through increased number of insulin receptors and enhanced binding. And post receptor events intracellularly.
Sources : Rich sources are organ meats, mushrooms, wheat germs, and processed meats etc.


    Absorption: Chromium is mainly absorbed from small intestine 30- 40% of oral dose is

available in circulation.


    Daily Recommendation : Infants 10-60 microgram/day. Children 20- 80 microgram/day

(1 to 3 years), 4-6 years 30-120 microgram/day, 6-11 years 50-200 microgram/day. Adults 50-200 microgram/day.


   Chromium is used mainly as
       1. Chromium Chloride (brewer's yeast)
       2. Chromium Picolinate
       3. Chromium Nicotinate
           All the three salts contain trivalent Cr3+ ions.
 

Causes of Chromium deficency
   1. Nutritional : Most of then people have got less than 50 microgram Chromium per day as

       compared to normal 200 microgram/ day.
   2. Increase Urinary Chromium excretion : Acute rise and blood glucose is associated with

       rapid urinary loss of chromium.
   3. Aging : It is seen that infants have highest levels of chromium in their blood. As age

       advances their chromium level decreases gradually. So older people who are also

       diabetic (NIDDM) are more prone to develop chromium deficiency.
 

Role in Diabetes
   1. Improvement in glucose metabolism
   2. Decrease insulin requirement, thus preventing emergence of insulin resistance.
   3. Improved lipid metabolism, thus reducing incidence of atherosclerotic cardio vascular

       events. Chromium is shown to increase serum HDL level and slight reduction in LDL.

   4. Chromium causes loss of body fat probably through insulin mediated sympathetic out

       flow to cause increased thermogenesis, this helps to maintain their weight and attending

       risk of obesity.
   5. Synodrome X : It's a combination of obesity, hypertension, and diabetes which devlops

       in patients with insulin resistance. Chromium by virtus of its insulin sensitizing action and

       better lipid metabolism can prevent the development of this complication.
   6. Wound healing may be improved by increased FGF, IGF expression particularly useful

       in diabetic wounds.
   7. As an Immuno-modulator : As many immune cells express insulin receptors and

       impairment in their function is seen in diabetes so chromium supplementaion can be of

       some benefit.
   8. As chromium is closely complexed to nicotine acid and tryptophen it can affect

       neurotransmitter function in brain
   9. Control of BP by better insulin action.
   10. Chromium may play a role in the body's antioxidant agent by preventing lipid

       peroxidation thus limiting the progress of chronic disease and aging.
 

Complications of Chromium therapy.
    Recent studies have shown that therapeutic chromium picotinate supplements for a long

period can lead to damage of chromosome in metaphase stage of replecations cycle.
 

REFERENCES
       1. Ripas, Ripar Zinc and Diabetes Mellites-Mineral Med 1995, 86 (10) 415.21
       2. Morris B.W. Griffiths H, Kemp G.J. Comlahan between abnormalties in chromium &

           glucose metabolism in a group of diabetics clin. Chem 1988; 34; 1525-26.
       3. Hypomagenisemia and Diabetes Mellites Tosiello L. Arch Intern Med. 1996 June

           10,156 (11) 1143.

                              

 
  What is Diabetes?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  CONTENTS



1. Diabetes mellitus : a historical review


2. Insulin-some physiological considerations,


3. Epidemiology of diabetes mellitus


4. Pathogenesis of diabetes mellitus in young


5. Impaired glucose tolerance


6. Secondary diabetes mellitus.


7. Laboratory diagnosis and work up for assessment of complications & of diabetes mellitus


8. Oral glucose tolerance test.


9. Neurological involvement in diabetes mellitus


10. Glycation products in diabetes mellitus


11. Diabetes mellitus in adolescence


12. Diabetic keto acidosis


13. Case of brittle diabetes


14. Lipoprotein disorders in diabetes mellitus


15. Diabetes and cardiovascular system


16. Myocardial infarction in diabetes


17. The Syndrome of insulin resistance.


18. Gastro intestinal manifestation of diabetes mellitus


19. Pregnancy and diabetes


20. Skin manifestations of diabetes mellitus


21. Diabetic nephropathy


22. The diabetic foot


23. Sexual dysfunction m diabetes mellitus


24. Joint and Bone manifestation of diabetes mellitus


25. Alcohol and diabetes mellitus


26. Live: and. diabetes mellitus


27. Management of infections m diabetes


28. Diabetes mellitus and surgery


29. Canter arid diabetes


30. Diabetes in elderly


31. Non drug therapy of diabetes mellitus


32. Nutrional approaches in the management of diabetes mellitus


33. Insulin therapy in diabetes mellitus


34. Insulin sensitivity


35. Insulin resistance


36. Oral drugs in non insulin dependent diabetes


37. Lactic acidosis


38. Use of indigenous plant products in diabetes


39. Prevention of diabetes mellitus


40. Pancreatic transplantation in Type I DM (IDDM)


41. Hypoglycemia


42. Diabetes and eye


43. Diabetes mellitus and pulmonary tuberculosis


44. Pitfalls in diagnosis and management of diabetes mellitus


45. Mortality patterns in diabetes mellitus


46. Diabetic education


47. Diabetes mellitus and associated syndromes


48. Diabetes mellitus: socio economic considerations


49. Obesity and diabetes mellitus


50. Proinsulin


51. C-Peptide


52. Glucagon


53. Drug induced diabetes mellitus


54. Insulin anologues


55. Insulin delivery system


56. Micro nutrients in diabetes mellitus


57. Defects in glucose metabolism in neonates


58. Sulphonylurea failure


59. Diabetes control and complications


60. Diabetes mellitus & oral health


61. Common procedures for recording data in diabetes


62. Profile of a lean Type-2 diabetes mellitus


63. Management of post prandial

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