Diabetes and Current ADA Guidelines

Digestion:

Carbohydrates are broken down into glucose and are absorbed into the lymph and blood stream and travel to tissue cells

Blood circulation:

almost all tissues take in glucose for energy

what is the blood circulation pathway

glucose + oxygen → energy + carbon dioxide + water

what does the liver do in glucose metabolism:

excess glucose is stored as glycogen, or is combined with fatty acids to produce triglycerides

what does the adipose tissue (fat) do in glucose metabolism:

stores triglycerides from liver

what does the muscles do in glucose metabolism:

store excess glucose as glycogen (for future needes)

what does the liver AND muscle do in glucose metabolism:

stored glycogen is broken down to provide immediate energy and to maintain fasting blood glucose levels

glycemic

control blood glucose levels in blood and how its regulated

glycolysis

the biochemical process that break down of glucose for energy (ATP)

glycogenesis

the biochemical process formation of new glycogen for storage

where is glycogenesis stored in

mainly in liver, could be in muscle

glycogenolysis

the biochemical process that breaks down store glycogen into glucose

gluconeogenesis

the metabolic process formation of new glucose from non-carbohydrate sources

lipogenesis

formation of fatty tissue from extra glucose

polyuria

increase urine production

polyphagia

increased hunger

polydipsia

increase thirst

what are the 2 hormones homeostatic balances of glucose are controlled by

insuline and glucagon

where are insulin and glucagon produced from

pancreas within the small clusters of Islets of Langerhans

what is the homeostatic range of blood glucose

70-110 mg/dL

which cells is insulin from?

beta cells

what does insulin do?

moving glucose into tissues and binds to cell membrane receptors to allow the movement of glucose into the cell

stores excess glucose as glycogen in liver and muscle, inhibits breakdown of glycogen

storing excess glucose as triglycerides in fat cells

insulin promotes what pathways?

glycogenesis and glycolysis

insulin inhibits what pathways?

glycogenolysis and glyconeogensis

which cells are glucagon from?

alpha cells

what does glucagon do?

converts glycogen to glucose in the liver

converts non-carbohydrates into glucose

conversions occurs when glucose blood plasma levels are decrease (fasting state)

glucagon promotes what pathways?

glycogenolysis and glyconeogensis

glucagon inhibits what pathways?

glycogensis and glycolysis

what are the consequences of decreased or absence of insuline?

microvascular problems

macrovascular problems

coronary artery disease

thrombotic tenencies

ketacidosis (leads to coma and eventually to death)

what are glycosylated vessels

small vessels become coated with sugars

microvascular problems involved with decreased or absence of insulin

nephropathy

retinopathy

poor circulation in extremities

neuropathy

nephropathy

small vessel of kidney become glycosylated (more prone to injury)

retinopathy

in retina in eye to blindess

poor cirulation in extremities

hand and feet. poor wound healing → develop gangrene

neuropathy

nerves in perpherial hand/feets loss of sensation/tinging

macrovascular problems involved with decreased or absence of insulin

arteriosclerosis

atherosclerosis

dyslipidemia

increased of bad fats within the blood

arteriosclerosis

1st developed

hard and thicking of blood vessel which causes prone to injury and narrowing of vessels which increases blood pressure

atherosclerosis

accumulation of fatty plaque

mild verson of coronary artery disease

how is diabetes mellitus characterized

hyperglycemia, glucosuria, polydipsia, and polyphagia

what % of the US population has diabetes?

12%

which age category has the most diabetes mellitus?

45-64 age

which age group is mostly likely to go undiagnosed?

>65, often have other condition mask diabetes

prediabetes classifications

signs and symtoms level close to diabetes

Type I classifications

aka - insulin dependent diabetes, juvenile diabetes (childhood)

as diease progress easier to determine

Type II classification

aka adult onset diabetes

gestational classification

diabetes during pregnancy

secondary classification

result of another medical condition

prediabetes

blood glucose levels that above normal but not high enough to be considered diabetic

what are prediabetics at risk for?

becoming type II diabetic, within 10 years if no interventions

how can prediabetic delay development of type II diabetes?

modest weight loss

modified diet containing fewer refined carbohydrates (sugars and starches) and more protein, fruits and vegetables

regular exercise

what is the % of cases for type I

5-10% of cases

what is the problem with type I diabetes?

little or no insulin production

what does the autoimmune system do in type I diabetics?

immume developes antibodies (viral or bacteria) attacks the beta cells

rate of onset: type I diabetes

strong genetic link, rapid onset

common body type: type I diabetes

thin or normal

why is type I have more severe illness than type II?

easier to develope ketoacidosis (DKA)

Type 1 quickly develop which builds up toxic acids in the blood and can be fatal

treatment: type I diabetes

depends on administering insulin by injection, pump, or inhalation

% cases: type II diabetes

90-95%

problem: type II diabetes

not a lack of insulin, develop resistance

causes: type II diabetes

insulin resistance of tissue cells: increase glucose, receptor no longer binds to insulin, glucose cannot enter cells

insufficient insulin production: beta cells are always stimulated and cant produce

fluctuating insulin production: slugglish beta cells, not able to regulate amount of insulin

rate of onset: type II diabetes

gradual, asymtomatic until complication appears

common body type: type II diabetes

85% are obeased

incidence: type II diabetes

epidemic proportion

treatment: type II diabetes

lifestyle changes, insulin administration, other meds

GLP-1, mimics glucagon

metformin, allows more insulin receptors to bind

what is Syndrome X (metabolic syndrome)

complication of type II diabetes

isa group of health conditions that happen together and raise your risk for heart disease, stroke, and type 2 diabetes

what is HHR

hyperosmolar hyperglycemia syndrome

rare but fatel

blood sugar levels spike to dangerously high levels—often above 600 mg/dL

who does HHR affects?

older adults, certain ethnicities (Africans and Native Americans, Hispanic) and individuals with underlying medical condition (sepsis, preexisting heart condition, or stroke)

what are signs and symtoms of HHR

severe dehydration/extreme thirst

frequent urination

confusion

drowsiness

fainting, coma, seizures

weakness, paralysis

organ failure, death

what is the difference between HHR and DKA?

HHR: glucose of >600 but often >1000mg/dL, has no ketone development, no acidosis

DKA: ~300 mg/dL

which type of diabetes does Kussmaul breathing show in?

type 1

hyperventilation

who does gestational diabetes affect?

5-10% of all pregnant women

what happens in gestational diabetes?

insulin resistance of mother’s tissue cells

the mom’s glucose crosses placeta and brings extra glucose to baby

point of diagnosis: gestational diabetes

prenatal appointment between 24 and 28 weeks of pregnancy,

S/S for mother of gestational diabetes

excessive weight gain, preeclampsia (HBP), need for c-section (large baby)

S/S for baby of gestational diabetes

macrosomia (big head), shoulder injury, neonatal hypoglycemia, increased risk of developing type II later

what is neonatal hypoglycemia

when baby is still in the womb, recieves extra glucose from mom so baby’s pancreas accomindates for the extra glucose by producing more insulin.

When baby is born, no longer geting extra glucose but body still produces the extra insulin causing to get rid of more glucose an what is in the body

what is secondary diabetes?

1-5% of diabetic cases

diabetes developes after inital conditions

what are some causes of increased glucose production of secondary diabetes

endocrine disorders: crushing diease increased cortisol

meds: protease inhibitors

hormones: thyroid, epirinephine

transient: steriods

what are some causes of decreased insulin production of secondary diabetes

exocrine disorder: cystic fibrosis

PTDM: post transplant diabetes mellitus (anti-rejection meds)

what are the symptoms needed to be tested for diabetes?

3 P’s (polyuria, polydipsia, polyphagia) and unexplained weight loss

what are the asymptomatic needed to be tested for diabetes?

overweight or obese, sedentary (physically inactive), family history (1st degree), ethnicity, female delivered baby >9 lbs or diagnosed with GDM

hypertension

decrease cholestrol, increased triglycerides

CHD history (coronary heart disease)

previous imparied GTT or fasting glucose level

previous elevated Hgb A1C

acanthosis nigrican (thicken of dark skin)

PCOS

Diagnostic test for diabetes

fasting

random

GTT (2hr) - DM

GTT (1hr, 2hr, 3hr) - GDM

Hgb A1C

what is the preferred test to diagonse diabetes?

fasting glucose

what are the requirements for fasting glucose test?

minimum of 8 hr fast

no smoking or trenuous exercise prior to speciment collection

normal range for fasting glucose

70-99 mg/dL

prediabetes range for fasting glucose

100-125 mg/dL

diabetes range for fasting glucose

≥126 mg/dL

which test is the least preferred to diagnose diabetes?

random glucose

what is the requirement for random glucose test?

presence of symptoms is required

normal range for random glucose

<200mg/dL

diabetic level for random glucose

≥200mg/dL

2hr glucose tolerance test is mainly for who?

everyone else beside pregnant women

what is the patient prep for 2hr GTT?

fasting of minimum 8 hours but 10-16hr recommended

normal intake of carbs and exericse for 3 days prior

how much glucose is ingested for 2hr GTT

75g and after 2 hour draw

normal range for 2hr GTT-DM

<140mg/dL

prediabetes range for 2hr GTT-DM

140-200mg/dL

diabetes range for 2hr GTT-DM

≥200mg/dL

which GTT test is a screening test for GDM

1hr GTT

which GTT test is a confirmation test for GDM

3hr GTT