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Diabetes

Diabetes Mellitus is defined as a group of metabolic disorders which are characterized by elevated blood glucose and disordered insulin metabolism. Insulin is an anabolic hormone which is secreted by the pancreas which causes the cells to take up glucose, or sugar from the blood to store as glycogen in the liver and muscle. This inhibits the use of fat as energy. In a non-diabetic, when blood glucose levels are high, insulin is released which stimulates the liver and muscles to uptake glucose which normalizes the blood sugar. When blood sugar is low, glucagon is released and glycogen is broken down in order to balanced the blood sugar.

Type 1 Diabetes is the insulin dependent form of diabetes which is caused by a lack of insulin being secreted by the beta cells in the pancreas. In type 1 diabetes, the pancreas gradually loses its ability to synthesize insulin resulting in high blood sugar or hyperglycemia, polydipsia (excessive thirst), polyuria (exxcessive urination), polyphagia (excessive hunger) and fruity breath.

Type 2 Diabetes is the Non-Insulin Dependent which is the most common form of diabetes. It has a slow, asymptomatic onset and is related to obesity, genetics, ethnicity and lifestyle. It is characterized by insulin resistance, rather than a lack of insulin. The pancreas secretes insulin but the cells become desensitized and do not take up the glucose so it accumulates in the blood. Signs of Type 2 Diabetes include hyperglycemia, polyuria, polydypsia, weight loss, polyphagia, hypertension, hyperlipidemia, high triglycerides, and low HDL cholesterol.

Gestational Diabetes is when a glucose intolerance develops during pregnancy, usually in the second or third trimester. The placenta makes hormones that cause insulin resistance and women without gestational diabetes will double or triple their insulin production to overcome this but this is not the case in women with Gestational Diabetes. Risks of Gestational Diabetes include high BMI, inactivity, older age, family history and birth defects in the child.

Common laboratory assessments used to evaluate diabetes are urinalysis, random or fasting glucose, postprandial glucose and Hemoglobin A1C which reflects the individuals glucose control over the past 3 months. The lower the Hemoglobin A1C, the lower the risk of long term complications.

Hemoglobin A1C- reflects glucose control over last 2-3 mos- glucose attaches to amino acids on hemoglobin molecule. The higher the glucos in the blood, the more hemoglobin gets glycate. Normal=4-6%, lower HbA1C, the lower the risk of long term complications

Diabetic Ketoacidosis is a combination of ketosis which is a cataboli state, acidosis & hyperglycemia. This is generally how type 1 Diabetes is diagnosed. The cells are unable to take up glucose so the body begins to break down fat to make ketones which build up in the blood and lowers the pH. This is known as ketosis. Signs of Diabetic Ketoacidosis include lack of appetite, vomiting, blurry vision, trouble breathing, sleepiness, intense thirst, dry mouth, and frequent urination and can lead to coma or death if left untreated. Diabetic Ketoacidosis is treated with hydration and the replacement of electrolytes & insulin infusion.

Macrovascular complications of Diabetes include stroke or heart attack. Cardiovascular disease is the leading cause of death in diabetes and is due to dyslipidemia, hypertension, and obesity. Microvascular complications of diabetes include eye damage, kidney damage, impotence and trouble passing urine. Nephropathy is also a microvascular complication which is characterized by high blood pressure and hyperglycemia which damage the nephrons in the kidneys which ultimately leads to renal failure. Retinopathy is associated with diabetic blindness and is when the blood vessels in the retinas are damaged because of chronic high glucose & high blood pressure.

Nervous system complications include neuropathy or nerve damage, ischemic heart disease and gastroparesis which is delayed gastric emptying or the inability to empty the bladder. Peripheral neuropathy results in a dulled perception in limbs, risk of ulcers and amputations (especially in lower extremities and feet) and the constant dull perception that something hurts.

Treating diabetes relies on the self management of blood glucose with regular blood sugar testing with a glucometer and keeping records. The goal is to reduce the incidence of nephropathy, retinopathy and neuropathy. Blood pressure control, improved lipids, weight management, consuming healthy, balanced meals and physical activity are also important. Regular medical care and oral medications and insulin as needed cannot be ignored.

The goal is for blood sugar to stay under 100 mg/dL before a meal and 200 mg/dL after a meal. To do this, diabetics can use insulin as a drug in order to balance blood sugar levels. In a healthy person, the pancrease is constantly sending out a basal amount of insulin and a bolus amount with every meal, using insulin drugs, the goal is to mimic this. Syringes and pens are the most common form because they go right into the blood. Insulin pumps are also available and allow you to secrete and appropriate amount of insulin when you know you are going to consume carbohydrates.

Oral Antidiabetic drugs can be used in the treatment of Type 2 Diabetes to improve insulin secretion, reduce glucose production in the liver, improve the use of glucose by tissues and delay carbohydrate absorption. Other diabetes drugs include Dipeptidyl-peptidase 4 (DPP-4) inhibitors which are taken orally and generally do not cause weight gain but can inflame the pancreas; Glucagon-like peptide 1 (GLP-1) agonists which are taken through a syringe and can result in weight loss and nausea and Meglitinides which are taken orally and work quickly.

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