As usual prevention is the best bet Insulin resistance often improves with

As usual prevention is the best bet insulin

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Once Type 2 diabetes develops it is very difficult to reverse. As usual, prevention is the best bet. Insulin resistance often improves with weight loss
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15 Metabolic Syndrome (“Syndrome X”) Combination of disorders increasing risk of diabetes or cardiovascular disease At least 3 of the following: Elevated fasting glucose >100mg/dL Increased triglycerides >150 mg/dL Reduced HDL levels <50 in women and <40 in men Elevated blood pressure >130/85 mmHg Central Obesity = Increased adipose tissue around the waistline – big risk for Type 2 >35” in women and >40” in men Gestational Diabetes Glucose intolerance first detected during pregnancy Women with GDM at high risk for complications of pregnancy, mortality, and fetal abnormalities Development of DM 5-10 years after delivery Risk factors: Family history of diabetes Obesity Glycosuria History of stillbirth or spontaneous abortion, fetal anomalies in a previous pregnancy, or a previous large- or heavy-for-date infant Of advanced maternal age (over 25 y/o) Five or more pregnancies ADA recommends: Glucose tolerance test between week 24-28 for women who have not been previously identified as having glucose intolerance Exempt: younger than 25 y/o, normal body wt prior to pregnancy, no family history of diabetes or poor OB outcome, not members of high-risk ethnic/racial group (Hispanic, Native American, Asian, African-American)
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16 Diagnostic Methods for Measuring Blood Glucose FBC - Fasting blood glucose Levels are measured after food has been withheld for 8-12 hours Diagnostic: levels >125 mg/dL on 2 occasions (levels between 100-124 are prediabetes) Casual (Random) blood glucose Done without regard to meals or time of day Diagnostic: elevated glucose (>200 mg/dL) in the presence of classic DM symptoms (polydipsia, polyphagia, polyuria, & blurred vision) OGTT - Oral Glucose tolerance test Orally administer 70 mg of glucose in 300 mL of water, then check after 2 hours With sufficient insulin release, blood glucose levels return to normal within 2-3 hours after ingestion of a glucose load Diagnostic: higher levels of blood glucose remaining elevated for longer periods of time Glycosated hemoglobin (HbA1c) Measures HbA1c levels which reflect the amount of hemoglobin into which glucose has been incorporated Glucose entry into RBCs is not insulin dependent; the rate at which glucose becomes attached to hemoglobin depends on the blood glucose level & is irreversible The level of HbA1c provides an index of blood glucose levels during the previous 2-3 months (roughly the lifetime of blood cells) The ADA recommends corrective measures for HbA1c levels greater than 7% Urine tests Urine ketones—for type 1 and those prone to ketoacidosis Categories of Risk Normal FPG: <100 mg/dL OGGTT: <140 mg/dL A1C: 3.9-5.6% Impaired fasting plasma glucose/ impaired glucose tolerance (pre- diabetes) FPG : 100-125 mg/dL OGGTT: 140-199 mg/dL A1C: 5.7-6.4% Diabetes FPG: >126 mg/dL OGGTT: >200 mg/dL A1C: >6.5%
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