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Caused by an absolute or relative deficiency in the action of insulinResistance to insulinInsufficient insulin secretionBothPossible abnormally high amounts of glucagon and other counterregulatory hormonesGrowth hormoneSympathomimetic aminesCorticosteroidsInsulin secretion in Type 1 Diabetes is normally deficient to non existent Type 2 Diabetes may have normal, high, or low insulin secretionHyperglycemia [fasting blood glucose (BG) > 110mg/dL] is a common finding in all types of diabetesLong-term complications include:Microvascular disordersMacrovascular disordersNeuropathic disordersVII.VIII.Increased Risk for Diabetes: blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetesFasting blood glucose (FBG) 100 – 125 mg/dL2 hour post prandial (during OGTT) 140 – 199 mg/dL IX.X.II.CLASSIFICATIONXI.1.Type 1 diabetes: Usually caused by an autoimmune destruction of beta cells of the pancreas, resulting in absolute deficiency of insulinUsually occurs in children and adolescents – but may occur at any ageProne to ketoacidosis~ 10% of all diabetes cases are type 1Screening for type 1 diabetes is not recommendedXII.3
2.Type 2 diabetes:Caused by the presence of insulin resistance with an inadequate compensatory increase in insulin secretionMost patients have abdominal obesityPatients often have “metabolic syndrome” – a clustering of abnormalities sometimes referred to as “insulin resistance syndrome”Patients with metabolic syndrome are at increased risk of macrovascular complicationsXIII.Clinical Identification of the Metabolic SyndromeXIV.Any 3 of the 5 components must be present:XV.1.Abdominal obesityoWaist circumference >40 inches (male)oWaist circumference >35 inches (female)2.Triglycerides ≥ 150 mg/dL3.HDL cholesterolo< 40 mg/dL (male)o< 50 mg/dL (female)4.Blood pressure ≥ 130/85 mmHg5.Fasting blood glucose ≥ 110mg/dLXVI.3.Gestational diabetes mellitus: Glucose intolerance first recognized during pregnancyComplicates ~ 7% of pregnanciesMost patients will return to normoglycemia postpartumXVII.4.Other types secondary to specific causes:Often caused by genetic defectsEndocrinopathiesDrugsoGlucocorticoidsoniacinoatypical antipsychotics (olanzapine) InfectionsXVIII.III.RISK FACTORSXIX.Type 2 diabetesXX.1.Family history (parents or siblings with diabetes)2.Obesity ≥ 20% over ideal body weight4
Body mass index (BMI) ≥ 25 kg/m23.Habitual physical inactivity4.Previously impaired glucose tolerance or impaired fasting glucose5.Hypertension (≥ 140/90 mmHg in adults)6.HDL cholesterol ≤ 35 mg/dL7.Triglycerides ≥ 250 mg/dL8.History of gestational diabetes mellitus (GDM)9.Delivery of baby weighing > 9 pounds10.History of vascular disease11.History of polycystic ovary disease (PCOS)XXI.