autoimmune or ideopathic process destroys beta cells- they're not able to produce insulin anymore. Autoantibodies to beta cells or insulin hormone dev in 90% of pts with Type I diabetes, & are often present years before clinical sx. Can occur in any age but usually early.
Type II diabetes patho
Secretory defect of beta cells results in excessive insulin production (insulinemia). It then dwindles over time, too low. Insulin resistance develops. Insulin binds to cells but res factors prevent it form shuttling glucose into cells where it's used or stored as glycogen.
This cycle contributes to beta cell destruction.
Syndrome X (aka prediabetes, metabolic syndrome)
What's the connection?
obesity, part an apple-shaped, visceral abdominal fat dist, unhealthy chol lev, high BP, insulin resistance.
Insulin resistance stimulates the beta cells to rel more insulin. B cells get tired, ins prod declines, resulting in elevated B glucose lev.
Impaired fasting glucose is often first sx diabetes risk.
What age should people be screened for diabetes for? Esp if overweight?
What happens to intracellular fluid when glucose is elevated?
Fluid moves out of them, into extracellular fluid. Intracellular dehydration.
What happens when glucose spills into urine?
Glucose pulls water and dlytes along and contributes to dehydration.
What happens w oxygen transport to tissues in elevated glucose levels? What are other results of this?
Oxygen essential for macrophage mobility and growth of granulation tissue. Glucose also supports microbial growth. Susceptible to infections.
Glycation occurs when gluc or fruc bonds to protein molecules during metab.
AGEs- advanced glycation end products- what happens when excess? Microvascularly?
Med sized vessels?
damage healthy tissue by attacking nerve's myelin sheath, leading to demyelination. This is how the crystalline lens of eye and retina and glomeruli cap membranes get damaged microvascularly.
In med sized vessels (coronary, carotid)- AGEs accumulate which promotes atherosclerotic plaque. Glycation also stiffens collagen in BV walls, leading to HTN.
fam hist, obesity, af am, hisp am, nat am, as am, pac Is, over 45, prev id'ed impaired fasting glucose or impaired gluc tolerance, HTN (equal or over 140/90), high dens lipoprotein chol less than or equal to 35 or trig level of greater or equal to 250 mg/dL)
hx or gest diabetes or del of babies over 9 lbs.
sx- 3 p's, weight loss w
plasma gluc lev of greater than or equal to 200mg/dL,
an oral gluc tol val of greater than 200 mg/dL,
an oral gluc tolerance value of greater than 200mg/dL after drinking a 75-gram glucose load
or fasting plas gluc greater than 126 mg/dL after 8 hour fast.
Whatever dx test should be repeated in one week to confirm.
Usual treatment reg for Type 2
diet, exercise, meds
ntr, meal planning, weight control-foundation
6 main components
on list in amount spec contain equal # of kcal, approx equal in g protein, fat, carbs
How does exercise dec blood glucose
increasing uptake of glucose by muscles and improving insulin utilization
When to start on insulin w Type II
Oral agents can't maintain glucose levs or are contraindicated w/in pt's target range, sx inc and fasting plas gluc levs exceed 350 mg/dL
injection- pt dials in approp dose, then subcut. Needle tip single use. Easy to read
newest insulin deliv, rapid acting ins 24h/day, thru catheter under skin. Pump holds cartridge of insulin w/ subcut cath q 3 days.
Basal- calc by provider, adjusted accdng to BG levs
Bolus- determined by # carbs ing is prog before or imm after carbs consumed. Correctional- to cover elevated BG lev
Newest insulin route is
inhalation. Contra in lung probs
Type I diabetes- check
What does A1C measure?
Less common test?
nonrev glycosylation of hemoglobin molecules. Reflects BG lev over 2-3 month per. Less than 7 (6 in book)%.
In anemia or where hemoglobin mol aren't gonna be reliable test- BG levs from prev 1-2 weeks