Which organs are responsible for ensuring that blood glucose levels are kept stable?
The pancreas and the liver.
2011 Standards of Care Classifications
Type 1 diabetes (results from β-cell destruction, usually leading to absolute insulin deficiency)
Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance)
Other specific types of diabetes due to other causes, e.g., genetic defects in β-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation)
Gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy that is not clearly overt diabetes)
Measuring Glucose Levels
–Requires blood sample
–Prick finger several times a day
–desired glucose levels are 70-110 mg/dl
–Measures glycosylated hemoglobin
–Glucose binds to hemoglobin A (for the life of the cell ~120 days)
–Evaluates the average amount of glucose in the blood over the last 2 to 3 months
2011 Criteria for the Diagnosing of Diabetes
A1C ≥6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*
FPG ≥126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h.
2-h plasma glucose ≥200 mg/dl (11.1 mmol/l) during an OGTT. The test should be performed as described by the World Health Organization, using
a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dl (11.1 mmol/l). Essentially, this test means that if you take a random blood glucose test and your blood sugars are greater than or equal to 200 mg/dl, you could be diagnosed with diabetes on the spot.
• When blood glucose levels are elevated
• Symptoms include:
• Blood glucose levels fall to low levels
• Stimulates stress in the body
–Get glucose on board (glucose tablets, candy)
–In an emergency use a glucagon kit which contains:
1 mg of freeze dried glucagon (vial)
1 mL of of reconstitution (syringe)
Combine glucagon and water immediately before use and discard any unused portion after injection.
Store at room temperature. Monitor for expiration date.
Alcohol and Diabetes
•Alcohol should be avoided in patients with
–Increases risks of low blood sugar
–Alcohol is a toxin
–The liver reacts to alcohol like a poison. It will clear it from the blood quickly. The liver won't produce any glucose again until it has taken care of the alcohol.
Type 1 Diabetes
•Results from the body's failure to produce
insulin (from the pancreas)
•5-10% of Americans
•Diagnosed in children or young adults (<20 yo)
–Polyuria: excessive urination
–Polyphagia: excessive hunger
–Polydipsia: excessive thirst
–Fruity breath (ketoacidosis)
Type 1.5 Diabetes
•Type 1 diabetes develops in someone older
–Must be >20 years old
–Thin—typically loss of weight over time
Type 2 Diabetes
•Most common form
•Often occurs later in life (~40+ years old)
•Some patients fail to make enough insulin
•Others make enough or too much insulin
–Cells won’t take up the insulin for use
–May be asymptomatic
•Diabetes while pregnant
•Affects 4% of all pregnant women
•Often goes away after the baby is born
•Small % continue to have diabetes after giving birth
•J.P. comes into your community pharmacy to purchase a glucometer. He tells you he was just diagnosed with diabetes.