Week 11 – Diabetes
Objectives
Describe 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 Mellitus
Group of physiological dysfunctions characterized by hyperglycemia
o
Deficiency of insulin
o
Insulin resistance
o
Excessive glucagon secretion
Two main types
o
Type 1: absolute deficiency of insulin secretion
o
Type 2: combination of resistance to insulin action and inadequate
insulin secretory response
Diabetes Mellitus: Other Types
Gestational diabetes
o
2%–5% of all pregnancies
o
Late in pregnancy
o
Glucose levels back to normal after delivery
Latent autoimmune diabetes in adults (LADA)
o
Is a form of type 1
o
Develops slowly over many years
Maturity-onset diabetes (MODY)
o
Is a form of type 2
o
Is caused by defect in single gene
Cystic fibrosis-related diabetes (CFRD)
Drug- or chemical-induced diabetes
o
Glucocorticoid use
o
HIV/AIDS treatment
o
Organ transplantation
Statistics From American Diabetes Assoc.
Prevalence: 29.1 million Americans
o
9.3% of population
o
1 out of 11 people
o
1 out of 3 people by 2050 (projected increase)
Expenditures: $245 billion
o
Direct costs include inpatient and outpatient care.
o
Indirect include lost work and wages.
o
Hospitalizations account for majority of cost.
o
Most expenditures go to managing complications rather than
preventive education.
Type 1 Diabetes
5%–10% of diabetes
Immune mediated
Absolute insulin deficiency
Insulin dependent
Most common in youth
o
Can be diagnosed at any age
Risk of ketoacidosis
o
Ketoacidosis occurs when no insulin is in production.
o
Body must break down fats instead of carbohydrates for energy.
o
Ketones are the by-product of that process.
Type 1 Subclasses
Type 1A: autoimmune
Type 1B: autoimmune destruction of pancreas due to genetic susceptibility
plus an environmental precipitant (e.g., virus)
Latent Autoimmune Disease in Adults
Body 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.
o
Graves' disease
o
Hashimoto's disease
o
Thyroiditis
o
Pernicious anemia
Patients lack signs of insulin resistance.
Patients are normal weight to slightly overweight.
Patients have positive autoantibodies.
o
Insulin antibodies
o
Glutamic acid decarboxylase (GAD)
o
Islet cell antibodies
Patients have low endogenous insulin.
o
Low C-peptide levels
Type 2 Diabetes
More common form
o
95% of all diabetes
o
Most common in adults
o
Rising in youth
Insidious onset
Nonimmune
Insulin resistance
o
Decreased sensitivity of tissue to glucose uptake
Have impaired beta cell function
Do not need exogenous insulin for survival
o
May be important for treatment
Are not prone to ketoacidosis
