ILE I U2 D1 Flashcards
Type 1
Insulin deficient
Type 2
Insulin resistant
The American Diabetes Association Diabetes Expert Committee recommends a diagnosis of diabetes when one of three criteria is met
- Random plasma glucose of ≥ 200 mg/dL, + polydipsia, polyuria, unexplained weight loss
- Fasting plasma glucose of ≥ 126 mg/dL on AT LEAST 2 occasions
- Fasting plasma glucose of < 126 mg/dL, but a 75g 2 hr oral glucose tolerance test plasma glucose of ≥ 200 mg/dL
normoglycemia
appropriate glycemic control based on the patient’s comorbidities
BP control in diabetic patients reduces risk for
- retinopathy
- nephropathy
- cardiovascular risk
significant reductions in macrovascular complications may take
5-15 years
Short term reductions time-frame
<5 years
T1D therapy
Insulin
T2D therapy
Insulin (or other injectable anti-hyperglycemics) and metformin.
Multiple therapeutic agents required for T2D
thiazolidinediones (TZDs) MoA
Reduce (not stop) decline of beta cell function
Aggressive management of cadiovascular risk is required for patients with which type?
T2D
How do you prevent T1D?
Unknown
Alcohol consideration in D
Less than one drink per day for women
Less than two drinks per day for men
A drink = 12 oz beer, 5 oz glass wine, 1.5 oz distilled spirits
Na consideration for D
<2300 mg/day
consideration for sweeteners for D
non nutritional sweeteners “May be an acceptable substitute for nutritive sweetners”
Carb consideration for D
Type 1 diabetes: carbohydrate counting to dose insulin
▪ Type 2 diabetes: portion measurement to improve glycemic control
For diabetic patients, do you want a high or low glycemic index?
High!
Proteins consideration for D
15-30% of diet
Fat consideration for D
Limit calories from fat ▪ Polysaturated fats—”good fats” ▪ Monounsaturated fats—”good fats” ▪ Saturated fats---limit/avoid if/when possible ▪ Trans fats---AVOID if/when possible
The PLATE method is used when treating patients with which type of diabetes?
T2D
What are the 2 “bad” fats? Provide examples of each
- Saturated (lard, poultry skin, coconut oil, high fat meat)
- Trans (French fries, shortening, crackers, chips)
What are the 2 “good” fats? Provide examples of each
- Monounsaturated (Avocado, canola oil, nuts, peanut butter)
- Polyunsaturated (Salad dressing, corn oil, pumpkin seeds)
Diabetes definition
Group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
Long-term hyperglycemia is associated with what?
damage, dysfunction, and failure of the eyes, kidneys, nerves, heart, and blood vessels.
What causes T1D?
body’s immune system destroys pancreatic
beta cells, the only cells that make the insulin that regulates blood glucose
Risk factors for developing type I diabetes
autoimmune, genetic, or environmental
Types of T1D
- Immune-mediated (90%)
2. Idiopathic (10%)
Immune-mediated T1D
Auto-antibodies, Patients prone to other autoimmune disorders i.e. Graves disease,
Hashimotos thyroiditis, Addison, vitiligo, pernicious anemia.
Idiopathic T1D
No anti-bodies, no evidence of pancreatic beta cell autoimmunity
Symptoms of T1D
Symptoms of polyuria, polydipsia, rapid weight loss, ketonuria, keto-acidosis
T1D treatment
Healthy (eucaloric) diet and insulin
Islet cells can develop antibodies to (5)
This leads to T_D
- Insulin: decreases release and overall insulin expression 2. Proinsulin
- Glutamic acid decarboxylase
- Ganglioside antigens
- Tyrosine phosphatase
Leads to T1D
4 other disease states that lead to pancreatic cell destruction
a. Mumps virus
b. Coxsackievirus B4
c. Pancreatitis
d. Destructive cytotoxins and antibodies form sensitized immunocytes
Environmental toxins that lead to T1D
nitrosamines (R-N=O)
Food/drugs that lead to T1D
Early exposure to cow milk, immunosuppressive drugs
Polydipsia
Increased thirst
Polyuria
Increased urination
Macrophages release what in terms of beta cell death?
Cytokines and free radicals
T and B cells release what in terms of beta cell death?
Auto-antibodies
“Hallmarks” of T1D
- Auto-bodies
2. Beta cell destruction
Formerly IDDM
T1D