Caused by an absolute or relative deficiency in the action of insulin

Caused by an absolute or relative deficiency in the

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Caused by an absolute or relative deficiency in the action of insulin Resistance to insulin Insufficient insulin secretion Both Possible abnormally high amounts of glucagon and other counterregulatory hormones Growth hormone Sympathomimetic amines Corticosteroids Insulin secretion in Type 1 Diabetes is normally deficient to non existent Type 2 Diabetes may have normal, high, or low insulin secretion Hyperglycemia [fasting blood glucose (BG) > 110mg/dL] is a common finding in all types of diabetes Long-term complications include: Microvascular disorders Macrovascular disorders Neuropathic disorders VII. VIII. Increased Risk for Diabetes: blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes Fasting blood glucose (FBG) 100 – 125 mg/dL 2 hour post prandial (during OGTT) 140 – 199 mg/dL IX. X. II. CLASSIFICATION XI. 1. Type 1 diabetes: Usually caused by an autoimmune destruction of beta cells of the pancreas, resulting in absolute deficiency of insulin Usually occurs in children and adolescents – but may occur at any age Prone to ketoacidosis ~ 10% of all diabetes cases are type 1 Screening for type 1 diabetes is not recommended XII. 3
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2. Type 2 diabetes: Caused by the presence of insulin resistance with an inadequate compensatory increase in insulin secretion Most patients have abdominal obesity Patients 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 complications XIII. Clinical Identification of the Metabolic Syndrome XIV. Any 3 of the 5 components must be present: XV. 1. Abdominal obesity o Waist circumference >40 inches (male) o Waist circumference >35 inches (female) 2. Triglycerides ≥ 150 mg/dL 3. HDL cholesterol o < 40 mg/dL (male) o < 50 mg/dL (female) 4. Blood pressure ≥ 130/85 mmHg 5. Fasting blood glucose ≥ 110mg/dL XVI. 3. Gestational diabetes mellitus: Glucose intolerance first recognized during pregnancy Complicates ~ 7% of pregnancies Most patients will return to normoglycemia postpartum XVII. 4. Other types secondary to specific causes: Often caused by genetic defects Endocrinopathies Drugs o Glucocorticoids o niacin o atypical antipsychotics (olanzapine) Infections XVIII. III. RISK FACTORS XIX. Type 2 diabetes XX. 1. Family history (parents or siblings with diabetes) 2. Obesity ≥ 20% over ideal body weight 4
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Body mass index (BMI) ≥ 25 kg/m 2 3. Habitual physical inactivity 4. Previously impaired glucose tolerance or impaired fasting glucose 5. Hypertension (≥ 140/90 mmHg in adults) 6. HDL cholesterol ≤ 35 mg/dL 7. Triglycerides ≥ 250 mg/dL 8. History of gestational diabetes mellitus (GDM) 9. Delivery of baby weighing > 9 pounds 10. History of vascular disease 11. History of polycystic ovary disease (PCOS) XXI.
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  • Spring '14
  • Ramey, Cathy

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