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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
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What are the predisposing factors for developing Type II diabetes?
- Excess food intake
- Physical inactivity
- Genetics can increase risk up to 6x
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What are the symptoms of hyperglycemia?
- Increased thirst
- HA
- Difficulty concentrating
- Blurred vision
- Frequent urination
- Fatigue
- Wt loss
- BG > 180 mg/dL
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How do you treat hyperglycemia?
Insulin (not too fast!)
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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)
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What are the symptoms of hypoglycemia?
- Shaky
- Dizzy
- Sweating
- Pale
- Confusion
- Sudden change of mood
- Clumsiness
- Seizure
- Difficulty paying attention
- Tingling around the mouth
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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
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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
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What is metabolic syndrome?
- High triglycerides
- Low HDL
- LDL - usually normal, but consists of small, dense, atherogenic LDL's
- Waist > 40 inches
- Insulin resistance
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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
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What are the test goals for Type II diabetes?
- Fasting blood sugar: 70-130
- Post prandial: <180
- A1c: <7%
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What is normal range of blood sugar?
70-110
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What blood sugar values determine a diagnosis of Type II diabetes?
- Fasting: 126 or higher
- Random: 200 or higher w/ sx
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What blood sugar values determine a diagnosis of pre-diabetes (metabolic syndrome)?
- Fasting: 101-125
- 2hr post glucose: 140-199
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What A1c value determines a diagnosis of pre-diabetes (metabolic syndrome)?
5.7-6.4%
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What A1c value determines a diagnosis of Type II diabetes?
6.5% or higher
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What is considered a normal A1c level?
< 5%
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Which is more directly correlated to A1c, microvascular or macrovascular complications?
microvascular (retinopathy, neuropathy, nephropathy)
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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)
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What is A1c a measure of?
- glycosylated hemoglobin
- a 3 month hx of consequences of high glucose levels
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