Diabetes Lecture.PAsymposium

Diabetes Lecture.PAsymposium - Management of Diabetes and...

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Management of Diabetes and Initiating Insulin Therapy PSPA Conference October 29,2010 Holly Jodon, MPAS, PA-C Assistant Professor, Gannon University PA Program President, American Society of Endocrine PAs Metabolic Disease Associates Erie, Pennsylvania Disclosures Consultant Amylin Pharmaceuticals, Inc. Eli Lilly and Company Educational Grant Boehringer Ingelheim Objectives At the conclusion of this session, participants will be able to: *- Review the current clinical guidelines regarding evaluation for suspected diabetes mellitus and the recommended evaluations once the diagnosis is made /- Apply gained knowledge regarding risk stratification, patient screening, and therapeutic options to clinical practice ^ Describe common complications of diabetes mellitus and interventions that may help decrease complications > Understand the various therapeutic options for diabetes mellitus by mechanism of action and current recommendations regarding use Pathophysiology of Insulin Activity Type 1 Diabetes Insulin deficiency High Blood Sugar Insulin Resistance High Insulin levels Normal BS -+ IGT Type 2 Diabetes High -* low Insulin levels High Blood Sugar Pathophysiology of DM 1 r Low or no insulin resulting in Hyperglycemia r Infants to young adult < 30 years old (previously called juvenile) r Following a viral illness or other autoimmune disorders Autoimmune = Antibody positive Idiopathic = Antibody negative r Genetic ? 35% of monozygotic twins African-American Asian-American
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Pathophysiology of DM 2 - Insulin resistance resulting in Hyperinsulinemia - Prediabetes distinguished by Impaired Glucose levels - As p cell failure progresses - Hyperglycemia ensues - 40 years old, but now younger age of onset (used to be called adult onset) - Genetic 90% of monozygotic twins Pacific Islander, Asian African-American Hispanic-American Native American Pathophysiology of DM 2 Incretin Effect Truncal Obesity Pancreas Liver jl^ BP^ _Jjy£erglycemia__ Adipose tissue « Free Fatty Acids Skeletal Muscle Insulin resistance t Hepatic | Glucose uptake JG/ucose uptake Glucose Production _ Adapted from DeFrtreo RA. Prated 1868:37:667-667 _ Natural History of Type 2 Diabetes Type 2 Diabetes is a Progressive Disease 100 75 V, - diabetes Post prandial Hyperglycenia ^ Tyj*2 Diabetes Pha**i V ©'J" Diabetes v. Phase IB Dlabe(« "^ Pha«B x -12 -10 -6-20 2 6 10 14 Years Since Diabetes Diagnosis Lebovttz He Wafieres Rev. 1999:7:1 39.193. Onset of DM 1 <- Acute *• Weight loss f Fatigue r- Diabetic Ketoacidosis (DKA) Note: p cell destruction may be slower in adults so onset may not be acute Onset of DM 2 /- Slow : decade prior Dx f Obesity r Polyuria 8Jor polydipsia f Polyphagia i- Blurry vision *• Erectile dysfunction (ED) r Balanitis or Vaginitis /- Dry skin / poor wound healing /- Skin tags '• • ^ Acanthosis nigricans : Insulin Resistance
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Screening for Diabetes > 45 years old every 3 yrs
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This note was uploaded on 02/18/2012 for the course PAS 600 - 601 taught by Professor Garrubba during the Fall '10 term at Chatham University.

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Diabetes Lecture.PAsymposium - Management of Diabetes and...

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