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what is diabetes?
- disturbance in metabolism of
- glucose
- protein
- fat
- leads to vascular complications and neurological
- arthrosclerosis
- kidney disease
- blindness
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what is insulin?
- hormone that decreases blood glucose
- acts on:
- CHO-- glucose
- stimulates the active transport of glucose into the cells
- regulates glucose metabolism
- high levels of insulin inhibit conversion of glycogen to glucose
- low levels of insulin stimulate conversion of glycogen to glucose-- increasing blood glucose levels
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fats
- promotes fatty acid synthesis and the conversion of fatty acids into fat
- inhibits the breakdown of fat
- low levels of insulin cause fat to break down
- fatty acids are stored in the live
- increases production of lipoproteins
- increases rish of CVD
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Proteins
- inhibit conversion of protein to glucose
- enchances protein synthesis
- low levels of insulin allows large amts of amino acids to circlulate in the blood
- increases risk of gout
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Counter hormomes
- hormones that increase blood glucose
- glucagon
- glucocorticoids
- growth hormone
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TYPE 1- auto immune
- Insulin dependent
- no production of insulin
- honeymoon period- shortly after diagnosis and last until complete destruction of beta cells ability to produce insulin is gone.
- INJECTION OF EXOGENOUS INSULIN NEEDED
- Age of onset
- early
- juvenile
- maybe occur middle and older age
- Cause- etiology
- auto immine disease-- cell mediated destruction of beta cells of pancreas
- onset- sudden and severe
- risk factors
- genetic predispostion
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TYPE 2- all other forms
- Insulin production
- insulin resistant
- hyperinsuleineamia/ decreased prod of insulin
- Age of onset
- after 40s
- children
- adolescents
- EXOGENOUS INSULIN maybe
- Risk factors
- central obesity
- lack of activity
- family genes
- over 40
- hist of gest dia
- african americans
- native americans
- having baby over 10lbs
- presence of
- acanthosis nigricans
- thickening of the skin and skin folds- darkening
- cutaneous papillomas- skin tags
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Metabolic syndrome- insulin resistance syndrome
- the body cells resits the action of insulin, the usual consequence is an increased prod of insulin to override the resistance at the cell level
- Hyperinsulineamia
- excess insulin in body- large role in health issues
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Metabolic Syndrome
- obesity BMI > 25
- Central obesity
- waist >40 inches men >35 women
- waist to hip >1.0 men > .8 women
- impaired glucose tolerance
- high serum insulin
- low HDL
- high LDL
- low grade inflammation of endothelial tissue
- hypertension- 130/85
- atherosclerosis- heart disease
- gout
- polycystic ovary disease
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who does diabetes affect?
- 23.6 million- 7.8%
- 6 million undiagnosed
- 57 million people have pre diabetes
- 90% type 2
- More women
- AA, hispanic, NA
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Screening
- >40
- obesity
- family history
- high risk ethnic group
- hist of Gest diabetes
- baby weighning over 10lbs when delivered
- HDLS- <35mg/dl
- triglyceride level- >250 mg/dl
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Diabetes diag tests-- 2 separate occasions
- Fasting blood glucose- FBG
- 126 mg/dl or diagnostic
- normal- 70-100 mg/dl
- no caloric intake for 8 hrs
- Random glucose level >200 mg/dl with symptoms
- polydipsia- thirst
- polyphagia- urination
- wt loss- excessive wt loss, no energy, melting away
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Oral glucose tolerance test-- OGTT
- diet of 150-300 gm of CHO xz 3days
- fast p MN
- 75 grams CHO load- glucola
- Monitor BG levels
- 30 min, 1 hr, 2hr(most common), 3 hr, 4hr, 5hr(reactive hypoglycemia)
- can't smoke, eat, drink during test
- must rest
- 2 hr- > 200mg/dl
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Glycosylated hemoglobin
HbA1c
- measures BG over a period of time
- RBC lifespan- 120 days
- glucose attaches to hemoglobin
- result shows average blood glucose level over 3-4mths.
- montior adherence to treatment
- motivator
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Fructosamine levels
- glycated serum protein- glycated albumin
- reflects glucose levels over several weeks
- if pt fruc is increased, then the pt average glucose over the last 2-3 weeks has been eleveated.
- the higher the fruct concentration the higher avg BGL
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Impaired Fasting Glucose
IGT- Impaired Glucose Tolerance
Bordeline diabetes- Prediabetes
- IFG- 100-125
- IGT
- 2 hr OGTT bt 140-199
- associated with increased risk of macrovascular disease
- treatment
- wt loss
- increase physical act
- same as type2
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Diabetes symptoms- classic
- Polydipsia
- Polyuria
- Polyphagia- famine in state of plenty
- unexplaned wt loss
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type 2 complications
complication of the disease may be first symption
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Diabetes symptoms
- infection
- delayed wound healing
- vascular changes
- retinal damage
- HPT
- PVD- per vas disease
- MI
- Kidney damage
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Diabetes management ind
- Diabetes control and complications trial
- tight control
- <7.2% HgbA1c or BG <155 mg/dl avg
- self monitoring blood glucose SMBG
- normal- always <140(even after meals)
- acceptable- max 180 to prevent exceding renal threshold and dehydration
- Prevent complications up to 75%
- eyes
- kidneys
- Nerv Sys
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ADA
- <7% HgBa1c
- BP <130/80
- total CHO- <200 mg/dl
- LDL- <100
- HDL- >50
- Tri- <150
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Diabetes Management
- diet
- exercise
- medication
- insulin
- oral hypoglycemics
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TYPE 1 treatment/management
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