Glycated Hg or A1C
Hg into which glucose has been incorporated, useful in looking at long term (previous 6-12 weeks) control. Less than 7% desired.
Diabetic ketoacidosis
Decrease in ketones (using muscle mass for energy, FFAs), Metabolic acidosis (Low Bicarb), T1
Long-term complications of diabetes mellitus
Retinopathy, cataracts, glaucoma, dizziness, syncope, cerebral infarct, hemorrhage, ischemic heart disease, MI, hypertension, diarrhea, constipation, bladder stasis and infection, ED, glomerulosclerosis, chronic kidney disease, peripheral vascular disease, gangrene, infections, abnormal sensory and motor function, foot ulcers, cellulitis
Function of Islets of Langerhans
Secrete hormones into the blood, composed of alpha, beta, and delta cells
Function of Insulin
Glucose transport into skeletal muscle/adipose tissue, increase glycogen synthesis, Decrease gluconeogenesis
Catecholamines and affect on blood glucose
Epi, NE, Help to maintain blood glucose levels during stress periods
GH affects on blood glucose
Increase protein synth in all cells, breakdown of FAs from adipose tissue, antagonizes effects of insulin
Glucocorticoid effects on blood glucose
Critical to survival during periods of fasting and starvation, stimulate gluconeogenesis by liver
Factors involved in dev of T1a
Genetic predisposition, hypothetical trigger event - environmental agent incites immune response, Immunologically mediated beta cell destruction
Type 1b diabetes
Idiopathic, small number of people most African or Asian, strongly inherited, episodic ketoacidosis with absolute insulin deficiency periods intermittently
Type 2 diabetes metabolic abnormalities
Impaired beta cell function and insulin secretion, peripheral insulin resistance, increased hepatic glucose production
Metabolic Syndrome
T2, Elevated triglycerides, low HDL, Increased BMI, increased waist circumference, increased BP, insulin resistance
Causes of Beta cell dysfunction in diabetes
Initial decrease in the beta cell mass, increased beta cell apoptosis/decreased regeneration, chronic hyperglycemia leading to beta cell desensitization (glucotoxicity), chronic elevation of FFAs causing beta cell toxicity (lipotoxicity), Amyloid deposition in beta cell can cause dysfunction
Characteristics of diabetic ketoacidosis
Hyperglycemia (>250 mg/dL), Low bicarb <15 mEq/L), Low pH <7.3, Ketonemia positive at 1:2 dilution, Moderate ketonuria