Insulin not managing diabetes very well transplant

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Unformatted text preview: glucose not needed excess glucose is metabolized to polyols (sorbitol, fructose) direct toxic effect on cells • water follows the glucose entering these tissues causes tissues to swell and potentially rupture • can lead to blindness, kidney disease, neuropathy, dementia 3. other mechanisms: • high NADH/NAD+ ratio (disrupt ETC) • glycogen accumulation in non- insulin dependent tissues • dyslipidemia (high triglycerides, low HDL) • increased susceptibility to oxidation (more inflammation) cancer, cardiovascular disease Medical Management of Diabetes Diagnosis • based on plasma glucose levels o random glucose – at some point during the day o fasting glucose – first thing in morning before eating o 2 hour oral glucose tolerance test (2hOGTT) – to see if blood glucose spikes and then stays high after drinking glucose Oral Glucose Tolerance Test • involves ingesting a drink that contains a standardized amount of glucose (usually 75g) • a blood sample is taken in the fasted state, prior to drinking the glucose drink • after the fasting blood sample is taken, the glucose drink is then ingested • a second blood sample is taken two hours later to determine how well the glucose in the drink was cleared from the blood Fasting Glucose • fasting glucose could be normal in diabetes but blood sugar could spike high after • fasting glucose could be high, and could spike high after • fasting glucose may not give a good indication of whether a person has diabetes o need to know fasting glucose and what happens after they eat Diagnosis of Diabetes in Canada • FPG ≥ 7.0 mmol/L OR • Casual PG ≥ 11.0 mmol/L + symptoms of diabetes OR • 2hPG in a 75g OGTT ≥ 11.0 mmol/L Gestational Diabetes • 1 hr plasma glucose using 50g glucose load ≥ 10.3 mmol/L Diabetes Care Team • physician/endocrinologist • RN (may be a certified diabetes educator) – do a lot of medical education o CDE – additional training in diabetes • RD (may be a CDE) • social worker – important in pediatric and adolescent diabetes • pharmacist – how drugs interact • physical activity spet – exercise routine Diabetes Treatment • glucose levels as close to normal as possible (rolling hills) • monitor: o blood glucose levels fasting 2 hours after meals o hemoglobin A1c – glycosylated hemoglobin measured at medical appointments represents 3- month glucose control glucose often attaches to Hb when there is high blood glucose levels Hb lasts about 3 months Blood Glucose Monitoring Goals • when younger: want to make sure cells have enough glucose, want to avoid hypoglycemia HbA1c • results from having high levels of glucose in the blood • not as useful in gestational diabetes – GDM normally only lasts ~6 months: second and third trimesters Good Glycemic Control Leads to Fewer Complications The Diabetes Control and Complications Trial • treatments: o intensive: ≥ 3 injections plus glucose monitoring o control: 1- 2 injections (traditional) • outcomes: o complications – retinopathy, nephropathy, neuropathy • results: o 76% lower risk of eye disease o 50% lower risk of nephropathy o 60% lower risk of neuropathy • tighter control results in a huge decrease in complications UKPDS – United Kingdom Prospective Diabetes Study • patients with newly- diagnosed type 2 diabetes • randomized to two groups: o diet and exercise only (less intense) o diet, exercise, and oral drugs or insulin (more intense) • conclusively showed that: o DM tends to worsen over time o a...
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This document was uploaded on 03/03/2014.

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