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Symptoms of Diabetes
Thirst, Weight Loss, Hunger, Dry mouth, Increased urination, Blurred vision, Frequent infections, slow healing of cuts and bruises
multiply or dive by 18;
Two types of secretions:
1. Secretes half of insulin as bolus after a meal
2. secretes other half gradually during the day and night (basal secretion)
Types of insulin to cover meals
rapid acting insulin: Clear
short acting insulin: clear
Intermediate acting: Cloudy
Long acting: Clear and colourless
Location of injection
absorption depends on location; Blood vessels vs. Fat content; abdomen injections are better than butt injections; Need to change the location of injection or allergic response may occur
Type 2 diabetes
insulin resistant; eventually end up insulin dependent; Insulin resistance ß cell dysfunction; obesity; No ketoacidosis;
Increased sugar -> increased insulin production all the time -> Down regulation of insulin receptors -> insulin doesn't do anything
progression of T2DM
predisposing factors -> Insulin resistance -> impaired glucose tolerance -> increased ß cell production of insulin -> ß cell exhaustion -> inadequate insulin for the degree of insulin resistance -> T2DM
oral hypoglycemics; sulfonylureas; biguanides; alpha-glucosidase inhibitors; thiazolidinediones
PPAR activators; induce production of peroxisomes that decrease fat from circulation; Fat is a major contributor to insulin resistance -> destroys ß cells
Peroxisome Proliferator Activator Receptors
nuclear receptors involved in expression of genes that regulate storage and catabolism of fats; PPARy; Peroxisomes have enzymes that breakdown fat and toxic substances
stimulates insulin secretion; suppresses glucagon secretion; slows gastric emptying; improves insulin sensitivity; reduces food intake; maintains ß cell function; can't get hypoglycemic
when to use incretin therapy
A1C not at target with metformin + sulfonylureas; weight gain is of concern; Hypoglycemia is undesirable
coronary artery disease, peripheral vascular disease, cerbrovascular disease
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