What is the timeline for development of Type II diabetes?
- Approx. 10yrs before diagnosis:
- insulin resistance begins a gradual rise
- insulin production begins a gradual rise
- glucose levels are basically normal
- At diagnosis:
- insulin resistance has grown tremendously
- insulin production has grown substantially and has basically reached its peak so starts a descent
- glucose levels are beginning to rise more quickly
- Approx. 10yrs after diagnosis:
- insulin resistance has nearly maxed out so has leveled out
- insulin production is close to 0
- glucose levels are VERY high and still climbing steadily
What are the predisposing factors for developing Type II diabetes?
- Excess food intake
- Physical inactivity
- Genetics can increase risk up to 6x
What are the symptoms of hyperglycemia?
- Increased thirst
- Difficulty concentrating
- Blurred vision
- Frequent urination
- Wt loss
- BG > 180 mg/dL
How do you treat hyperglycemia?
Insulin (not too fast!)
What are the long term symptoms of hyperglycemia?
- Vaginal and Skin infections
- Slow-healing cuts and sores
- Decreased vision
- Nerve damage causing painful cold or insensitive feet, loss of hair on lower extremities, and/or erectile dysfunction
- Stomach and intestinal problems (chronic constipation or diarrhea)
What are the symptoms of hypoglycemia?
- Sudden change of mood
- Difficulty paying attention
- Tingling around the mouth
How do you treat hypoglycemia?
- Check blood glucose
- Sugar (15g of simple carbs: pop, candy bar, 1/2 cup of OJ, 4 glucose tabs, 5-10 lifesavers)
- Wait 15min and recheck blood glucose, then retreat as necessary
What is the role of insulin in the body?
- Glucose regulation:
- stimulates cells to take up glucose from the blood
- suppresses gluconeogenesis in the liver and gluconolysis
- Fat Storage:
- stores glucose as fat
- blocks lipolysis
What is metabolic syndrome?
- High triglycerides
- Low HDL
- LDL - usually normal, but consists of small, dense, atherogenic LDL's
- Waist > 40 inches
- Insulin resistance
How do you manage metabolic syndrome?
- Reducing BG is best way to lower triglycerides
- LIFESTYLE MODIFICATION!:
- goal of 7% wt loss
- 30 min of exercise 5d/wk
What are the test goals for Type II diabetes?
- Fasting blood sugar: 70-130
- Post prandial: <180
- A1c: <7%
What is normal range of blood sugar?
What blood sugar values determine a diagnosis of Type II diabetes?
- Fasting: 126 or higher
- Random: 200 or higher w/ sx
What blood sugar values determine a diagnosis of pre-diabetes (metabolic syndrome)?
- Fasting: 101-125
- 2hr post glucose: 140-199
What A1c value determines a diagnosis of pre-diabetes (metabolic syndrome)?
What A1c value determines a diagnosis of Type II diabetes?
6.5% or higher
What is considered a normal A1c level?
Which is more directly correlated to A1c, microvascular or macrovascular complications?
microvascular (retinopathy, neuropathy, nephropathy)
What can happen if your A1c is really high and you don't replace insulin?
weight loss! (no fat storage, no glucose going into the cells - you just pee it all out)
What is A1c a measure of?
- glycosylated hemoglobin
- a 3 month hx of consequences of high glucose levels