1 insulin is secreted from pancreas when blood glucose ifs high

2- insulin on receptor binds

3 glut 4 goes to cell surface and up takes glucose

Diagnosis of type 1 diabetes

etiology

Usually diagnosed in youth

Fasting glucose is > 126

casual>200

etiology: destruction of beta cells 

1hr post prandiol >140

>100 after 3hours

50mg of glucose given.

risks: child developement of disease, mother risk of disease. 5-10%of women experience this 

What determines pre diabetes

Ac1 : 5.7-6.4

fasting:100-125

regular:140-199

Insulin resistance in tissues: liver, fat,muscle.

pancreas insulin dysfunction Of releasing

insulin resistance in peripheral tissues.

insulin secretory dysfunction

increased endogenous glucose production

adipocytes altered

diagnosed in adulthood

overweight 

controlled

polyuria, polyphagia, polydipsia

blurry vision

felling tired

slow wond healing time

limited or no glucose taken up by cells

low intracellular glucose causes hunger

high unination because the body is trying to rid of the glucose

excess fluid loss cause the polydipsia

when this cannot be corrected this can cause low blood volume which leads to circulatory failure.

electrolyte imbalance, > dehydration> hypvolmia

also lowered pH and then the ketoscidosis> leads to labored breathings and mental change could lead to coma

Macrovascular: CVD atherosclerosis and HTN

microvascular: nephropathy and retinopathy, neuropathy

maintian blood glucose, 3 or more injuection daily with 4 more or more blood glucose tests daily

dietary insruction...

reduced risk of all categories and declined A1C by 1%

better glucose control the less risk

followed 1441 ppl to see if glycemic control helpswith intensive therapy compared to conventional

showed that intensive brough A1C down to 7 and they brought down retino,neuroand nephro disease down by alot

weight optimization

healthy diet

increased physical activity

pharmoacotherapy

DPP : does modest weight loss in those with pre diabetes delay the onset of DM?

what was the experiment and out come?

wt loss of 7%, metaformin twice daily- with conventional diet , placebo - with conventional diet 

compared to placebo, lifestyle intervention decreased risk by 58% and the metformin decreased diabetes by 34%

after three years the percent risks went down

Average glucose of A1C

blood pressure

cholesterol including LDL and 

yes it has greater effects:

the experiment: wt loss of 7% at 1 yr and maintain wt loss; exercise of 175 min/wk. behavioral therapy and group counseling.

1- prevent by using public health interventions

2- prevent complications of DM

3- prevent morbidity and mortality, decrease risk of developing more problems

1.attain and maintain optimal metabolic outcomes- ABC

 Prevent and treat chronic complications: modify nutrient intake

1. monitor blood glucose

 focus on carbs foods and portions and number of servings per meal

encourage pa

ust food records with blood glucose data

uses: type1 and type2 with insulin therapy, insulin pump

teach: count CHO grams, balance insulin and carb intake, read labels, advanced reference material

what is the distribution of kcal for dietarty strategies for DM pt.

kcal for individuals

40-50-c

30-40-f

20-p

30kcal/kg- normal

12-24kcal/kg

limit intake of simple sugars

3meals/day and snacks

limit sat fat to less than 7.

intake of trans fat should be minimized

loweer diet to <200mg/day

limit intake 

consume with food

no acute effect on bg but maybe the sugar with the alcohol may

no clear evidence of benefit from vitamin and mineral supp. 

chromium no clear evidence

-modest weight loss has been shown to improve insulin resistance.

low-carb, low fat has shown to reduce weight in short term

Pa and behavior modification are importnat components of weight loss

-weight loss medifications may be considered in treatment of overewieght and obese

-bariatric surgery can improve glycemia

reduced sodium and diet high in vegis and fruit.

modest weight loss

alpha glucosidase > low carb breakdown absorption

sulfonylureas meglitinides, ^ insulin secretion

biguanides lower glucose output and lower insulin resistance

what is the action of biguanides:

generic name

things to be careful about

metaformin

decrease hepatic glucose production, increases insulin uptake in muscle

decreases folate and vit. B absorption, avoid alcohol. take with meals to decrease GI distress.

incretin mimetics

generic form and function

exenatide

mimics glucose dependent insulin secretin, supresses alevated glucogon secretion, delays gastric emptying

sulfayurea agents: brand and mode of action

what do you need to avoid

glipizide: stimulates insulin secretion

avoid alcohol

.5-2.0% reductin for exersize

1.0-2.0 drugs

insulin 5%

rapid acting: o:15min duration: 3-5

short acting: o: 30-60 D: 5-8

intermediate acting, NPH: O:1-3hr 20D

long acting: Onset: 1hr during: 24hr

intermediate and short acting mixtures: mixtures

70-120mg/dL

less than 180mg/dL after food

3 or more injections or insulin pump

4 or more bg tests

frequent dietary instruction 

monthly visits 

integrated team care

less than 70mg.dL

too much insulin

mel skipping

exercise 

alcohol

hyperglycemia symptoms:

treatment

weakness fatigue, vomiting, drowsy, deep respirations, fruit odor to breath

over 200

adjust insulin 

increase fluids and electrolytes

imporves insulin sensetivity

lowers BG

uses Glycogenstores

increases release of FFA from adipose

avoid exercise is BG> 250mg/dl and ketones present

BG>300mg/dl

eat CHo if BG is less than 100

monitor bg before and after exercise

consume for CHO 

always keep CHO foods readily available 

glucose tolerance

weight maintance

CVD improvement

improved response to pharmacologic therapy

improved energy level