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10_DM+wrap+up - N116A2010 Pathophysiology&Consequences...

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N116A  2010
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Pathophysiology & Consequences Acute effects of insulin deficiency (effects on C, P & F metabolism) Long term complications Clinical Trials in Diabetes & implications for Nutrition DCCT & EDIC DPP & DPPOS, ACCORD MNT Goals & Recommendations
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Type 1 Diabetes Autoimmune disease – absence of insulin production Impaired Glucose Tolerance–  “Pre-Diabetes” Variable etiology Decreased ability to regulate blood glucose Type 2 Diabetes Relative lack of insulin, and decreased or lack of response to insulin at tissues  Gestational Diabetes –  DM developing during pregnancy
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Fig 17.10 in Text Grouped according to macronutrient substrate metabolism (C, P, F) Insulin deficiency, whether absolute (as in Type 1 DM) or relative  (as in Type 2 DM), results in signs and symptoms Polyuria, polyphagia, polydipsia,  And also include others such as: ketosis, wt loss, etc. Understand the metabolic pathophysiology behind the clinical  manifestations
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Limited/or No glucose uptake by cells → ↓ intracellular glucose → polyphagia Glucagon stimulates ↑ hepatic glucose output → hyperglycemia → glucosuria occurs when renal threshold for glucose is exceeded → osmotic diuresis → therefore polyuria occurs → → dehydration leads to polydipsia Cellular dehydration & shrinking (hyperglycemic, hyperosmolar syndrome) → nervous system malfunction (irritability, fatigue, blurred vision) If polyuria is unable to be corrected → low blood volume → circulatory failure to periphery, kidneys, brain, etc… death possible
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↓ TG synthesis, ↑ lipolysis due to counterregulatory
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