Type 2 diabetes Flashcards
DM and life expectancy
Approximately 65 to 80% of people with diabetes mellitus (DM) will die as a result of heart disease or stroke.
DM is a contributing factor in the deaths of approximately
41,500 Canadians each year.
Canadian adults with DM are twice as likely to die prematurely as people without DM.
Types of Diabetes
The two most common types
Type 1
Type 2
Other types
Gestational
Prediabetes
Secondary diabetes
how is insulin produced
Produced by beta cells in Islets of Langerhans
Released continuously into bloodstream in small increments with larger amounts released after food
Normal glucose level
Stabilizes glucose range to 4–6 mmol/L
function of Insulin
Facilitates glucose transport from bloodstream across cell membrane to cytoplasm of cell
Decreases glucose in the bloodstream
↑ Insulin after a meal
Stimulates storage of glucose as glycogen in liver and muscle
Inhibits gluconeogenesis
Enhances fat deposition
↑ Protein synthesis
Type 2 Diabetes Mellitus risk factors
over 35 years of age
High BMI
Genetic factors
Increased rate in people of Indigenous, Latin American, South Asian, Asian, or African descent
Individuals with hx of gestational diabetes
Individuals with metabolic syndrome
Sedentary lifestyle
Hypertension/dyslipidemia
4 factors thatdirecity cause high blood glucose DM2
1.) Insulin resistance
2.) Pacreas losing the ability to produce insulin
3.) Inapporatite glucose production from liver
4.) Alteration in the production of hormones and adipokines
Onset of DM2
Gradual onset
Person may go many years with undetected hyperglycemia
Clinical Manifestations of Type 2 Diabetes Mellitus
Nonspecific symptoms
May have classic symptoms of type 1
Fatigue
Recurrent infection
Recurrent vaginal yeast or monilia infection
Prolonged wound healing
Visual changes
4 main diagnostic findings for DM
A1C ≥6.5%
Fasting plasma glucose level ≥7 mmol/L
Random or casual plasma glucose measurement ≥11.1 mmol/L plus classic symptoms
2-hour oral glucose tolerance test (OGTT) level ≥11.1 mmol/L when a glucose load of 75 g is used
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The fasting plasma glucose (FPG) test, confirmed by repeat testing on another day, is the preferred method of diagnosis.
When the OGTT is used, the accuracy of test results depends on adequate patient preparation and attention to the many factors that may influence the outcome of such tests. For example, factors that can cause falsely elevated values include recent severe restrictions of dietary carbohydrate, acute illness, medications (e.g., contraceptives, corticosteroids), and restricted activity such as bed rest.
Hemoglobin A1C test
Recommended to be used as a diagnostic test
Useful in determining glycemic levels over time
Shows the amount of glucose attached to hemoglobin molecules over RBC lifespan
Approximately 120 days
Regular assessments required
Ideal goal
CDA ≤7.0%
Normal range is <6.0%
Normal A1C reduces risks of retinopathy, nephropathy, and neuropathy
Goals of diabetes management
Decrease symptoms
Promote well-being
Prevent acute complications
Delay onset and progression of long-term complications
Classes of Diabetes Oral Agents
Sulphonylureas
Meglitinides
Biguanides
Thiazolidinediones
DPP4-Inhibitors
Sulphonylureas
↑ Insulin production from pancreas
↓ Chance of prolonged hypoglycemia
Examples
Gliclazide (Diamicron, Diamicron MR)
Glimepiride (Amaryl)
Meglitinides
Increase insulin production from pancreas
Taken 30 minutes before each meal up to time of meal
Should not be taken if meal skipped
Example
Repaglinide (GlucoNorm)
