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Endocrine - Diabetes.docx

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Dalhousie University
NURS 2050
Cynthia Barkhouse Mckeen

Endocrine SystemDiabetesPathophysiologyClassification 1 Type I Result of pancreatic beta cell destructionNo beta cellsRequires insulin from the beginning usually develops as a childAutoimmune can also occur in adults2 Type II Ranges from insulin resistance with relatively little insulin deficiency to predominantly secretory defect with insulinResistanceInsulin resistance impaired insulin secretionhyperglycemiaGoals Of Treatment Promote effective safe cost effective use of meds 1 Preventdelay microvascular tingle sensation foot infections kidney damage eyes and macrovascular complications CVearlier you get tx the effects can be seen long term of decreased CV problems 2 Decreaseeliminate symptoms of hyperglycemiahypo 3 Target laboratory or selfmonitored markers for DM 4 Delay progression of beta cell decline 5 Improve insulin resistance 6 Reduce frequency of recurrent infections 7 Maintain quality of life and overall health 8 Decrease mortalityManagement 1 Glucose levels Diet and exercise Insulin Oral hypoglycemics 2 Lipid levels cholesterol3 Blood pressure 4 Lifestyle modifications Other risk factors smoking weight Recommended targets for glycemic controlA1CPreprandial PG 2 hour postprandial 70 longterm visual measurement4070 50100 Type 1 Average glucose over the past few months 5080 if A1C targets not being metbefore eating a Type 22hrs after eating a mealmeal Pancreas ReviewCell typeIslet Mass Secretatory products 20 Glucagon proglucagon Alpha 75 insulin cpeptide proinsulin Beta amylin 35 somatostatin Delta 1 gastrin G 1 pacreatic polypetide PP F cell PP cellInsulinproduced by the beta cells of islets of Langerhans stored as proinsulin Natural History if Type 2 DiabetesThis slide shows the evolution of diabetesGeneticsIGTDiabetesUncontrolledNote that before 0 before EnvironmentHyperglycemiaDX of Diabetes note the trend where BG is good the Postmeal PlasmaGlucoseinsulin resistance is building GlucoseFasting Glucosewhich leads to lower insulin 120 mgdLlevelsThis then leads to higher BG Relative BetaCellInsulin ResistanceFunctionAfter 0 decreasing ability of 100 the pancreas to make insulin Insulin Levelsnot producing as much 20 10 0 10 20 30insulin Years of Diabetes Adapted from the International Diabetes Centre IDC
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