{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

Insulin not managing diabetes very well transplant

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

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...
View Full Document

{[ snackBarMessage ]}