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A LATERAL VIEW OF DIABETES FROM THE CARIBBEAN. Part I

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									           A LATERAL VIEW OF
           DIABETES FROM THE
           CARIBBEAN
The Hon. Errol Y. St. A. Morrison, OJ
MD, PhD, FRCP (Glasg), FACP, FRSM (UK)
Professor of Biochemistry and Endocrinology
Pro Vice Chancellor and Dean
School for Graduate Studies and Research
UNIVERSITY OF THE WEST INDIES
Mona Campus, Jamaica W.I.
THE WORLD
THE CARIBBEAN AND CENTRAL AMERICA
Hugh Jones 1955
Zuidema 1956
Morrison 1981
Atypical Diabetes; Undernutrition;
Bush teas (CAM)
& Staple root crops
Atypical Diabetes
- hyperglycaemic & aglycosuric
- asymptomatic hyperglycaemia
- intermittent insulin requirement
- aketonuric
- 13% of Diabetes Outpatient Clinic
at UHWI, Mona, Jamaica
           Francis Bacon

If a man will begin with certainties,
He shall end in doubts;
But if he will be content to begin with doubts,
He shall end in certainties!
     AN HYPOTHESIS FOR THE AETIOLOGY
     OF DIABETES MELLITUS



                   FOOD    “TOXINS”,
                   UNDERNUTRITION
FREE RADICALS
          AN HYPOTHESIS FOR THE AETIOLOGY
          OF DIABETES MELLITUS (contd.)


                            FR


Level 1
                      DAMAGE TO CELL
                        MEMBRANE
          AN HYPOTHESIS FOR THE AETIOLOGY
          OF DIABETES MELLITUS (contd.)

 DAMAGE TO CELL MEMBRANE
                                 VIRAL INFECTIONS




EXPOSED ANTIGENS   INDUCED ANTIGENS
           AN HYPOTHESIS FOR THE AETIOLOGY
           OF DIABETES MELLITUS (contd.)

                      EA     IA

Level 2               ANTIBODIES
                                       DIRECT TOXICITY


            INSULIN     GLUCOSE
                                     ISLET CELLS
          RECEPTORS   TRANSPORTERS
          AN HYPOTHESIS FOR THE AETIOLOGY
          OF DIABETES MELLITUS (contd.)


                  IR             IC
     OBESITY           GT


Level 3          INSULIN         INSULIN
               RESISTANCE     INSUFFICIENCY
           AN HYPOTHESIS FOR THE AETIOLOGY
           OF DIABETES MELLITUS (contd.)

     INSULIN                               INSULIN
   RESISTANCE                           INSUFFICIENCY




     TYPE 2             PIDDM                 TYPE 1
   NON-INSULIN        PHASIC INSULIN     INSULIN DEPENDENT
   DEPENDENT           DEPENDENT         DIABETES MELLITUS
DIABETES MELLITUS   DIABETES MELLITUS
 AN HYPOTHESIS FOR THE AETIOLOGY
 OF DIABETES MELLITUS (contd.)



Level 1: Membrane damage

Level 2: Antibody production

Level 3: Insulin resistance &
         insufficiency
      AN HYPOTHESIS FOR THE AETIOLOGY
      OF DIABETES MELLITUS (contd.)




N.B.: If the processes at levels 1, 2
      or 3 remit, then TEMPORARY
      DIABETES would result!
     AN HYPOTHESIS FOR THE AETIOLOGY
     OF DIABETES MELLITUS (contd.)



N.B.: GESTATIONAL DIABETES (GDM)
     IMPAIRED GLUCOSE TOLERANCE
     (IGT)……possible manifestations of
     level 3 activity.
The Unitarian Hypothesis
THE UNITARIAN HYPOTHESIS FOR
THE AETIOLOGY OF DIABETES
MELLITUS




HERESY TODAY?
FACT TOMORROW!
      CONSENSUS ON THE AETIOLOGY OF
      TYPE 2 DIABETES MELLITUS

       SRI LANKA, JULY 2002


OVERNUTRITION  Increase in type 2 DM
                   in childhood and
                   adolescence

UNDERNUTRITION  Low birth weight 
                   increase in type 2 DM
      CONSENSUS ON THE AETIOLOGY OF
      TYPE 2 DIABETES MELLITUS (contd.)



There is a strong association between:
     Truncal Obesity
     Diabetes Mellitus
     Impaired Glucose Tolerance
     Cardiovascular Disease
Hugh Jones 1955
Zuidema 1956
Morrison 1981
Atypical Diabetes; Undernutrition;
Bush teas (CAM)
& Staple root crops
ROOT CROPS
  a case study.
      CYANOGLUCOSIDES


E.g. Linamarin, lotaustralin (toxic
cyanide radical)
Found in root crops:
  Cassava, yucca (Manihot esculenta),
  Yams (Dioscorides group)
CASSAVA (manihot esculenta)
YAM (Dioscorides GROUP)
YAM (Dioscorides GROUP)
ENZYMATIC DEGRADATION OF LINAMARIN
   MAIN METABOLIC PATHWAY OF CYANIDE
            WITH RHODANESE


      S                                      S —S —SO3
  E         +   (S —SO3)   2-            E
      S                                      S
rhodanese       thiosulphate                     CN

                                    S        -
                                E       + SO 2 + SCN
                                            3
                                    S             thiocyanate
         METABOLIC PATHWAY OF CYANIDE
          WITH 3 - MERCAPTOPYRUVATE

            TRANSAMINATION

L – CYSTEINE          3 MERCAPTOPYRUVATE
[SHCH2CH(NH2)COOH]       [HSCH2COCOOH]
                                  CN – SULPHUR
                                  TRANSFERASE

                             SCN + PYRUVATE
Louis Pasteur


 Chance favours the prepared
 mind!

								
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