Sensitivity decrease in the number of insulin

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Unformatted text preview: esponsiveness to insulin. sensitivity Decrease in the number of insulin receptors. Hyperglycemia due to a relative deficiency of insulin related Hyperglycemia to insulin resistance and beta cell dysfunction. to Inadequate secretion of insulin or an insensitivity which Inadequate leads to hyperglycemia. leads Diagnostic Criteria Diagnostic Nonpregnant Adults: – random glucose > 200 mg% plus symptoms – OR: fasting glucose > 126 mg%, twice – OR: fasting glucose < 126 mg%, but OGTT is OR: > 200 mg% at 2 hours 200 Impaired Glucose Tolerance: – fasting glucose < 126 mg%, 2 hr OGTT is fasting between 126-200, 0-2 hr is > 200 mg% between Clinical Manifestations Clinical Type I Onset of Type I diabetes may be associated with Onset ketoacidosis. Polyuria---due to osmotic diuresis from glucose not reabsorbed. not Polydipsia---response to fluid loss. Polyphagia---due to gluconeogenesis Weight loss---impaired metabolism Glycosuria--inability of kidney to reabsorb Glycosuria--inability glucose. Clinical Manifestations Clinical Type II polyuria polydipsia blurred vision weight gain Compare Type 1 and Type 2 Type 1 Onset Onset Weight Immune-mediated Ketoacidosis Insulin secretion Beta cell function Beta HLA-linkage HLA-linkage Any age Underweight Yes Yes No No Yes Type 2 Adults Obese No No Yes Yes No Gestational Diabetes Gestational A disorder of glucose tolerance that is diagnosed disorder during pregnancy. during Gestational diabetes mellitus occurs in 4% of Gestational pregnant women, may recur with subsequent pregnancies, and tends to resolve at delivery. It is associated with a markedly increased risk—up to 50% in obese. Placental hormones and weight gain are contributing factors. factors. Resembles Type II DM. Onset 24-28 week gestation. Risk factors---obesity, 40 years, family history of Risk Type II DM and previous Gestational DM. Type High birth weight and neonatal hyperglycemia High common complications. common Pre-Diabetes Impaired glucose tolerance and impaired fasting glucose tolerance Intermediate stages between normal glucose metabolism and diabetes Represent risk factors for the development of diabetes and onset of cardiovascular disease Screening for Diabetes All adults older than age 45 at least every 3 years for type 2 Individuals with risk factors should be screened earlier or more frequently No screening requirements for type 1 Complications of Diabetes Complications diabetes ketoacidosis hypoglycemia atherosclerosis CVA PVD retinopathy inability to heal paresthesia renal failure carpal tunnel carpal syndrome syndrome peridontal disease gangrene amputation Complications of Diabetes Complications Ketoacidosis Ketoacidosis Occurs primarily in Type I diabetes. Failure to receive adequate amounts of Failure insulin results in continued fat metabolism, which produces ketones bodies leading to acidosis. DKA results in severe metabolic, fluid, and DKA electrolyte disturbances. electrolyte May be life threatening. Ketoacidosis Ketoacidosis Precipitating Factors non-compliance stress infection trauma pregnancy thyroid storm Diabetic Ketoacidosis Clinical Manifestations Clinical abdominal pain nausea vomiting metabolic acidosis fruity breath odor Kussmaul’s respirations altered LOC coma death if untreated Chronic Hyperglycemia Chronic Vascular Dysfunction -Macrovascular---damage to large vessels -Macrovascular---damage -Microvascular---affects capillaries -Microvascular---affects Neuropathic Dysfu...
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