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Week 11 – DiabetesObjectivesDescribe physiology of diabetes.Identify the types and characteristics of diabetes.Identify diagnostic criteria.Identify hemoglobin A1c goals.Discuss risk factors for type 2.Discuss goals for diabetes management.Diabetes MellitusGroup of physiological dysfunctions characterized by hyperglycemiaoDeficiency of insulinoInsulin resistanceoExcessive glucagon secretionTwo main typesoType 1: absolute deficiency of insulin secretionoType 2: combination of resistance to insulin action and inadequate insulin secretory responseDiabetes Mellitus: Other TypesGestational diabeteso2%–5% of all pregnanciesoLate in pregnancyoGlucose levels back to normal after deliveryLatent autoimmune diabetes in adults (LADA)oIs a form of type 1oDevelops slowly over many yearsMaturity-onset diabetes (MODY)oIs a form of type 2oIs caused by defect in single geneCystic fibrosis-related diabetes (CFRD)Drug- or chemical-induced diabetesoGlucocorticoid useoHIV/AIDS treatmentoOrgan transplantationStatistics From American Diabetes Assoc.Prevalence: 29.1 million Americanso9.3% of populationo1 out of 11 peopleo1 out of 3 people by 2050 (projected increase)Expenditures: $245 billion
oDirect costs include inpatient and outpatient care.oIndirect include lost work and wages.oHospitalizations account for majority of cost.oMost expenditures go to managing complications rather than preventive education.Type 1 Diabetes5%–10% of diabetesImmune mediatedAbsolute insulin deficiencyInsulin dependentMost common in youthoCan be diagnosed at any ageRisk of ketoacidosisoKetoacidosis occurs when no insulin is in production.oBody must break down fats instead of carbohydrates for energy.oKetones are the by-product of that process.Type 1 SubclassesType 1A: autoimmuneType 1B: autoimmune destruction of pancreas due to genetic susceptibility plus an environmental precipitant (e.g., virus)Latent Autoimmune Disease in AdultsBody attacks insulin-producing beta cells of pancreas.Condition presents with an insidious onset of hyperglycemia.Patients with LADA frequently are diagnosed with type 2.It is associated with autoimmune diseases.oGraves' diseaseoHashimoto's diseaseoThyroiditisoPernicious anemiaPatients lack signs of insulin resistance.Patients are normal weight to slightly overweight.Patients have positive autoantibodies.oInsulin antibodiesoGlutamic acid decarboxylase (GAD)oIslet cell antibodiesPatients have low endogenous insulin.oLow C-peptide levelsType 2 DiabetesMore common form
o95% of all diabetesoMost common in adultsoRising in youthInsidious onsetNonimmuneInsulin resistanceoDecreased sensitivity of tissue to glucose uptakeHave impaired beta cell functionDo not need exogenous insulin for survivaloMay be important for treatmentAre not prone to ketoacidosis