MS Diabetes

pancreatic islet cell destruction and a total deficit of circulating insulin:
Type 1 DM

insulin resistance w/a defect in compensatory insulin secretion:
Type 2 DM

serious complications w/ DM:
atherosclerosis
CAD
stroke
leading cause of end stage renal disease
blindness
nontraumatic amputations

cells that produce hormones in pancreas located where:
islets of Langerhans

3 kinds of cells in islet of Langerhans-
Alpha cells produce:
Beta cells secretes:
Delta cells produce:

-glucagon- stim. breakdown of glycogen in liver
-insulin-resp for movement of glucose across membranes
-somatostatin-inhibit prod of glucagon & insulin/ slow GI motility

breakdown of liver glycogen:
formation of glucose from fats and proteins:
when is glucagon initiated:
glycogenolysis
gluconeogenesis
when blood glucose falls below abt 70 mg/dL

insulin actions:
prevents excessive breakdown of glycogen
facilitates lipid formation
inhibits breakdown of stored fats
help move amino acids into cells for protein synthesis

insulin release regulated by:3


peak:
return to baseline:
blood glucose
decreases when glucose decreases
when eat- levels rise
3-5 minutes
2-3 hours

characterized by hyperglycemia, breakdown of fats and proteins, ketosis:
Cause:
Type 1 diabetes

destruction of beta cells (usually autoimmune)
< alpha and beta, >glucagon

risk factors for type 1 DM: 3 classes
genetic
environment-viral(mumps,rubella,coxsackievirus B4)
chemical (smoked meat)

S&S of type 1 DM: 6
polyuria—polydipsia
less energy—polyphagia (eat more food)
wt loss (from water loss, fat & protein breakdown)
malaise
fatigue
blurred vision

treatment for 1 DM:
exogenous source of insulin to maintain life

characterized by insulin availability, but resistance in perpheral tissues:
2 DM

T 2 DM risks: 9
-history in parents or siblings
-obesity – esp visceral obesity
-physical inactivity
-race/ethnicity
-women-gestational DM, 9 lb baby, polycystic ovary syndrome
-HTN >130/85
-HDL >35mg/dL
-triglyceride >250 mg/dL
-metabolic syndrome

S&S of T 2 DM:
slow onset
polyuria
polydipsia
blurred vision
fatigue
paresthesias
skin infections

treatment:
diet
exercise
meds
LAGB – lapband/ RYGB – Roux-en-Y gastric bypass

normal fasting glucose:
diagnosis of DM – fasting:
Normal glucose tolerance – 2 hrs:
Diagnosis 2hr test:
100
>126
<140 >200

false blood glucose tests-
hematocrit:
meds:
test strips:

high hematocrit= false high glucose
overdosesof many meds (ascorbic acid, GSH, uric a.)
strips- incompatible w/ meter/air or humidity exposure

meds for T 1 DM:
T 2 DM:
insulin
oral hypoglycemics, insulin

IV insulins:
other route for the rest:
regular only
subcutaneous- can do regular also

insulins for continuous SQ infusion:
regular
rapid-acting

4 preferred insulin injection sites:
abdomen, deltoid, thigh, hip

Study insulin info pg 529-530

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