Incidence northern countries is there a vitamin d link

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Unformatted text preview: zation has started from epinephrine release • Central Nervous System o headache, confusion, visual disturbances, motor weakness, palsy, ataxia, personality change o for DM treated with insulin, can progress to unconsciousness these symptoms indicate there is insufficient glucose reaching the brain Treatment of Hypoglycemia • prompt provision of a simple carbohydrate o 2- 3 tbsp of sugar in water, fruit juice, hard candy • if unable to consume food, administer glucagon (through IV in hospital) • IV glucose is used if glucagon is unsuccessful at bringing out of coma • provide food when fully aroused Hyperglycemia Classifications • pre- diabetes o impaired fasting glucose (IFG) o impaired glucose tolerance (IGT) • type 1 DM • type 2 DM • pre- existing DM in pregnancy o type 1 o type 2 • gestational diabetes (GDM) Plasma Glucose Levels for Diagnosis of IFG, IGT, and Diabetes FPG (mmol/L) 2hPG in 75g OGTT IFG 6.1 – 6.9 AND < 7.8 IGT < 6.1 AND 7.8 – 11.0 IFG and IGT 6.1 – 6.9 AND 7.8 – 11.0 Diabetes ≥ 7.0 OR ≥ 11.1 Impaired Fasting Glucose • fasting glucose increased (6.1 – 6.9 mmol/L) • can happen in combination with IGT or alone • no clinical signs – silent condition • increases risk of progression to diabetes, but differs between populations o 8% over 6 years (Oregon) o 72% over 7 years (Pima Indians) o average: ~20% progression in 5- 10 years Impaired Glucose Tolerance • hyperglycemia post feeding (7.8 – 11.0 mmol/L) • no clinical signs • higher risk of progression to type 2 o ~20- 25% go on to develop type 2 DM o those with both IFG and IGT have ~45- 65% chance of developing DM (within 5- 10 years) Overview of Type 1 • about 10- 15% of DM • starts usually before 20 years of age, but can get type 1 at any point in life • absolute deficiency of insulin – body no longer producing insulin • peak incidence at 5 years and puberty o two clusters: 4, 5, 6 and 12, 13, 14 • different countries have different incidence • Northern countries – is there a vitamin D link? – but some countries don’t follow the pattern Natural History of Type 1 • destruction of islet cells and beta cells over a short period of time by the immune system • genetic predisposition • environment- genetic interaction • 80- 90% of beta cells lost, minimal insulin secretion Type 1 Etiology • genetic – 25- 50% of monozygotic twins • exposure to something in the environment increases immune system susceptibility to autoimmune disease o 85- 90% of those with type 1 DM have circulating antibodies for beta cells, insulin, or other beta cell antigens o increased risk with early exposure to cow’s milk (< 3 months) o is there a transmissible agent? – increase incidence in winter • what kind of environmental exposure causes this to happen? • greater number diagnosed in winter – is there a virus that triggers immune system? o enterovirus? • don’t know how quickly beta cells are destroyed o asymptomatic period may last months or years Signs/Symptoms • polyuria • glucosuria • polydipsia • dehydration • polyphagia • fatigue • weight loss • muscle and fat wasting – gluconeogenesis • ketoacidosis Ketoacidosis • lipid used for fuel o ketones...
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This document was uploaded on 03/03/2014.

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