Week 11 \u2013 Diabetes - Week 11 Diabetes Objectives Describe physiology of diabetes Identify the types and characteristics of diabetes Identify

Week 11 u2013 Diabetes - Week 11 Diabetes Objectives...

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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
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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
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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
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