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New evidence shows that _in _ Americans born in 2000 will develop diabetes sometime during their lifetime. 1 in 3
Type 2 prevalence by ethnicity.. which population is hit the hardest? coushatta indian tribe, %80
what was the estimated economic cost of diabetes in 2007? $174 billion
______ ______ is a group of metabolicdiseases characterized by hyperglycemia resulting from defects in insulin secretion,insulin action, or both. Diabetes mellitus
Which type of diabetes involves....(ß-cell destruction, absolute insulin deficiency) Type 1
Which type of diabetes involves.... (Progressive insulin secretory defect + insulin resistance) Type 2
Impaired Fasting Glucose,Impaired Glucose Tolerance, Gestational Diabetes are all grouped into the category of _______? pre-diabetes
intrinsic and extrinsic risk factors of diabetes all lead to ________ - a condition of excess blood glucose hyperglycemia
normal fasting blood glucose = 70 - 100 mg/dl
diagnostic lab values for diabetes; 8hr fasting plasma glucose (FPG)= > or = to 126 mg/dl
diagnostic lab values for diabetes; casual plasma glucose .. done anytime = > or = to 200 mg/dl with symptoms
diagnostic lab values for diabetes; 2 hour plasma glucose.. no exercise before taking = > or = to 200 mg/dl during Oral Glucose Tolerance Test (OGTT)
patients with a casual plasma glucose test > 200 mg/dl may have diabetes symptoms such as... polyuria - urination, polydipsia - thirst, polyphagia - hunger, blurred vision,and unexplained weight loss
Additional signs & symptoms of Type 2 Diabetes Fatigue, Dry skin, Slow wound healing, and may be asymptomatic
Impaired Glucose Metabolism Insulin Resistance(Pre-Diabetes).. what scores would you expect for 1) impaired fasting glucose? and 2) impaired oral glucose tolerance testing? 1) FPG > 110 mg/dl ... but... < 126 mg/dl 2) OGTT > 140 mg/dl…but ... < 200 mg/dl
Type _ diabetes in adolescents is one of the most rapidly growing forms of diabetes in US Type 2
Risk factors of diabetes for children Obesity, Ethnic minorities,Positive family history, Puberty, Gender (female > male,Signs of insulin resistance, acanthosis nigricans, hypertension
What presents with a light-brown-to-black,pigmentation on the back & sides of the neck,axilla & groin? Acanthosis Nigricans
what are the Pancreas functions 1)of the exocrine? & 2)of the endocrine? 1) secretion of pancreatic juice that aids indigestion of all foods in the small intestine(99%) & 2)secretion of hormones, from islets of Langerhans, that control various body processes (1%)
Endocrine Function Islets of Langerhans contain: 1) ____ cells 2) ____ cells and 3) _____ cells 1) alpha 2) beta 3) delta
Alpha cells make _____ which increase blood glucose glucagon
Beta cells make ____ and ____ which decrease blood glucose amylin and insulin
Delta cells make ________ which inhibits the secretion of insulin, glucagon, & growth hormone somatostatin
What is the pathophysiology of Type 1 diabetes? ( 3 things ) 1)Autoimmune destruction of islets of langerhans beta cells2) Absolute deficiency in plasma insulin levels3) patient must take insulin to survive
Etiologic factors of diabetes type 1... 1) 2) & 3)? 1)Genetic (thrift gene theory)2) Environmental 3) Immune
What percentage of diabetes cases are Type 2? 90 - 95%
What percentage of Type 2 diabetics require inuslin? 30 - 40%
What is the pathophysiology of Type 2 diabetes? (2 things ) 1) insulin resistance 2) hepatic glucose overproduction
How are the liver, pancreas, and peripheral tissues affected by Type 2 diabetes? Liver - increase glucose productionPancreas - impaired insulin secretionPeripheral tissues - receptors defected
What is the action of sulfonylureas? stimulate pancreas to secrete insulin
What is the action of biguanides? decrease the amount of glucose from the liver and increase muscle sensitivity to insulin
What is the action of meglitinides? stimulate the pancreas to secret insulin
What is the action of alphaglucosidase inhibitors? slow breakdown of starches & glucose in the intestine
What is the action of DPP-4 inhibitors? prevent breakdown of GLP-1, lowering blood glucose only when elevated
Glucovan is a combination of what two oral agents and affects what? Metformin & Glyburide/ pancreas, liver, fat cells, muscle cells
Metaglip is a combination of what two oral agents and affects what? Metformin & Glipizide/ pancreas, liver, fat cells, muscle cells
Avandamet is a combination of what two oral agents and affects what organ? Metformin & Rosiglitazone/ liver, fat cells, muscle cells
What is the action of thiazolidindiones? increase muscle sensitivity to insulin
What is frequently associated with insulin resistance? Obesity
90% of individuals with diabetes in the US are classified as having type 2.. what percentage of that population is obese? 90%
The national standards for diabetes care includes? 6 things to check HbA1c testing,neuropathy screening, lipid control, dilated eye exam, blood pressure, and foot exams
how is hypergylcemia caused in Type 1 diabetes? absence of insulin production
how is hypergylcemia caused in Type 2 diabetes? insulin resistance + impaired insulin secretion
what are some treatment strategies for type 2 diabetes? Medical Nutrition,Physical Activity,Oral Hypoglycemic agents, Insulin therapy, Lipid control, Blood pressure control, Stress reduction
What is special about protein and type 2 diabetes? protein does not increase the plasma glucose concentrations
What mineral does Pam Scarborough say works the best to help insulin work more efficiently? Chromium
What antioxidant does Pam Scarborough say works the best for lowering blood glucose? Alpha-lipoic acid
Things to do to avoid hypoglycemia during/after exercise: have CHO(carbs) available, check blood glucose prior to exercise, inject insulin over less active or inactive muscle sites,avoid exercise during peak insulin times
Insulin is produced where? Pancreas
Insulin is made by the Islets of Langerhans by ____ cells? Beta
Insulin can be taken orally, true or false? FALSE!
___ % of insulin used in the US is by type 2 patients? 80
Insulin injection sites.. which site is the fastest to absorb? Abdomen.. 50% faster than thigh
Combination therapy in type 2... what is the rationale? different mechanisms of action, may be safer
what 2 drugs are taken for BIDS therapy? daytime - Sulfonylurea + bedtime Insulin
who benefits the most from BIDS therapy? patient early in course of dz
what 2 drugs taken together improve insulin sensitivity? Metformin + Insulin
what 2 drugs taken together decrease postprandial(after a meal) hypoglycemia? Alpha glucosidase inhibitor (acarbose) + Insulin
what 2 drugs taken together improves insulin resistance and improves insulin action inperipheral tissues? Thiazolidinediones + Insulin
what are some drugs that enhance hyperglycemia? corticosteriods, beta blockers, and Niacin-vitamin B
The HgbA1c (glycoslated hemoglobin assay) test gives the average bloodglucose over a ____ period of time? 2 - 3 month
targets for glycemic control by the ADA say a AC1 score of what range is normal? preprandial in mg/dl(plasma equivalent)? postprandial (2 hour test) in mg/dl? <7%, 80 - 120, <180
what are some complications of patients with acute diabetes? high glucose (hyperglycemia), low glucose (hypoglycemia)
what are some complications of patients with acute diabetes with hyperglycemia? Diabetic ketoacidosis (DKA)only occurs in Type 1 patients... and Hyperosmolar,hyperglycemic,nonketotic syndrome (HHNS)seen in elderly undiagnosed Type 2 patients
what are some complications of patients with chronic diabetes? macrovascular disease, infections, difficulty with wound healing,
what are some Macrovascular Complication ofDiabetes? Cerebrovascular Disease (CVD),Coronary Artery Disease (CAD),Peripheral Vascular Disease (PVD), and herosclerosis/Arteriosclerosis -hyperinsulemia contributes to placformation
what ___% of patients diagnosed with Type 2diabetes have some complications at time ofdiagnosis? 50
Created by: txst spr 2009