Glucose metabolism disordersÂ
Types of diabetes (prediabetes, type 1 and type 2)Â
PreDmM = glucose intolerance, Islet cell–specific antibodies, Screening forÂ
prediabetes and DM should be considered in all individuals who areÂ
overweight or obese, regardless of age, and for all adults aged 45 years andÂ
older.
- severe insulin deficiency resulting from beta cell destruction, whichÂ
produces hyperglycemia due to the altered metabolism of lipids,Â
carbohydrates, and proteins
- abnormal secretion of insulin, resistance to the action of insulin in theÂ
target tissues, and/or an inadequate response at the level of the insulinÂ
receptor.
Types of diabetes- Two types: Type 1 and Type 2- Improper function of the hormone insulin,Â
secreted by the pancreas. Hyperglycemia is a hallmark sign of diabetes.
Prediabetes: Impaired glucose tolerance (IGT) describes a prediabetic state of hyperglycemiaÂ
where a 2-hour post-glucose load glycemic level is 140 to 199 mg/dL.
Type 1 (insulin deficiency)- Presents mostly during childhood. Genetic predispositionÂ
plus some sort of environmental trigger. Results in an auto-immune disorder inÂ
which the immune system attacks the beta cells of the pancreas to prevent themÂ
from producing insulin (decreases production). Inhibits this first step in the insulinÂ
pathway.
Type 2- Presents mostly during adulthood. Strongly associated with a geneticÂ
predisposition. Accompanied with other predisposing conditions, such as obesity orÂ
hypertension. Inability of these cells throughout the body to respond to insulin. TheÂ
pancreas continues to secrete insulin. The cells throughout the body that are unableÂ
to adequately respond to it.
-induced diabetes- caused by medications Most commonly occurs with a group ofÂ
medications that are known as glucocorticoids (steroids) such as in asthma orÂ
chrons.Â
Presentation: acute, subacute, and asymptomatic
most severe presenting situation and can be life threatening for both type I andÂ
type II diabetes. very sick over a relatively short period of time, usually only a coupleÂ
of days.
S/S: nausea, vomiting, and abdominal pain leads to severe dehydration. Confusion orÂ
unconscious as a result. In type I diabetes, this is known as diabetic ketoacidosis. 30% ofÂ
individuals with type I diabetes will initially present before diagnosis. DKA- acidotic dueÂ
to the production of ketoacids
Type 2 diabetes: 2% ofÂ
individualsÂ
hyperosmolar nonketotic state- ketones are not produced. Can occur with either type I
or type II diabetes.
weeks toÂ
months.
S/S: Generally, just not feeling as well. Fatigue, increased thirst, frequent urination, orÂ
even weight loss. Most common form of presentation in Type 1 diabetes (70%).Â
Type II diabetes affects nearly 10% of the population.Â
Those with the risk factors of type II diabetes should be routinely screened. MostÂ
common means by which type II diabetes is diagnosed.Â
Diagnostic criteria - ADA criteria for diagnosing DM -
Random BG >200 (week 5 quiz question)
3 Ps of DM: polyphagia, polydipsia, polyuria (week 5 quiz question)
least 8 hrs
-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performedÂ
as described by the WHO, using a glucose load containing the equivalent ofÂ
75-g anhydrous glucose load dissolved in water.
a method that is NGSP certified and standardized to the DCCT assay.Â
patient with classic s/s of hyperglycemia or hyperglycemic crisis (polyuria,Â
poly dipsia, weight loss), a random plasma glucose ≥200 mg/dL (11.1 mmol/L) CurrentÂ
guidelines for the diagnosis of DM include any one of the following:
• Glycosylated hemoglobin (A1C) of 6.5% or higher
• Symptoms of diabetes (e.g., polyuria, polydipsia, weight loss) plus a random plasmaÂ
glucose level of 200 mg/dL or higher
• Fasting plasma glucose level of 126 mg/dL or higher (following 8 hours of no caloricÂ
intake)