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4 aspects of treating diabetes

Regulating: Diet, Weight, Exercises, Drugs

Symptoms of Diabetes

Thirst, Weight Loss, Hunger, Dry mouth, Increased urination, Blurred vision, Frequent infections, slow healing of cuts and bruises

Type 1 diabetes

insulin dependent diabetes; need insulin injections

Glucose units

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


most prominent adverse effect of injection

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

south asians

become diabetic sooner before anyone else

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

Fate of glucose in T2DM

stored as fat

Lifestyle modifications

exercise; Diet

pharmacological management

oral hypoglycemics; sulfonylureas; biguanides; alpha-glucosidase inhibitors; thiazolidinediones


increase insulin


increases insulin sensitivity


allows glucose to enter muscle cell

alpha-glucosidase inhibitors

makes you think your full; complex sugars persist for longer


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


harmful chemical released by fat


stimulates insulin secretion; suppresses glucagon secretion; slows gastric emptying; improves insulin sensitivity; reduces food intake; maintains ß cell function; can't get hypoglycemic

Two primary incretins

Glucagon-like peptide (GLP-1)

DPP-4 inhibitors

increases glucose uptake; decreased glucose output; controls blood glucose


tells you a history of glucose management; goal is to reduce HbA1C

when to use incretin therapy

A1C not at target with metformin + sulfonylureas; weight gain is of concern; Hypoglycemia is undesirable

complication (macrovascular)

coronary artery disease, peripheral vascular disease, cerbrovascular disease

complication (microvascular)

leading cause of blindness, kidney failure and amputations

take away message

1. Diabetes is a progressive disease
2. Most diabetics die of cardiovascular complications
3. Treatment of diabetes is a partnership
4. Insulin types 1 and 2
5. oral hypoglycemics (T2DM)

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