BIOC33H3 Lecture Notes - Inhalable Insulin, Urinary Retention, Amylin
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Chapter 49: Diabetes Mellitus
Diabetes mellitus is a chronic multisystem disorder of glucose metabolism related to absent or
insufficient insulin supplies and/or poor utilization of the insulin that is available.
The two most common types of diabetes are classified as type 1 or type 2 diabetes mellitus.
Gestational diabetes, prediabetes, and secondary diabetes are other classifications of diabetes
commonly seen in clinical practice.
TYPE 1 DIABETES
Type 1 diabetes mellitus most often occurs in people who are under 30 years of age, with a peak
onset between ages 11 and 13, but can occur at any age.
Type 1 diabetes is the end result of a long-standing process where the body’s own T cells attack
and destroy pancreatic beta cells, which are the source of the body’s insulin.
Because the onset of type 1 diabetes is rapid, the initial manifestations are usually acute. The
classic symptoms are polyuria, polydipsia, and polyphagia.
The individual with type 1 diabetes requires a supply of insulin from an outside source
(exogenous insulin), such as an injection, in order to sustain life. Without insulin, the patient will
develop diabetic ketoacidosis (DKA), a life-threatening condition resulting in metabolic acidosis.
Prediabetes is a condition where blood glucose levels are higher than normal but not high
enough for a diagnosis of diabetes. Most people with prediabetes are at increased risk for
developing type 2 diabetes and if no preventive measures are taken, they will usually develop it
within 10 years.
Long-term damage to the body, especially the heart and blood vessels, may already be occurring
in patients with prediabetes.
TYPE 2 DIABETES
Type 2 diabetes mellitus is, by far, the most prevalent type of diabetes, accounting for over 90%
of patients with diabetes.
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In type 2 diabetes, the pancreas usually continues to produce some endogenous (self-made)
insulin. However, the insulin that is produced is either insufficient for the needs of the body
and/or is poorly used by the tissues.
The most important risk factors for developing type 2 diabetes are believed to be obesity,
specifically abdominal and visceral adiposity. Also, individuals with metabolic syndrome are at
an increased risk for the development of type 2 diabetes.
Some of the more common manifestations associated with type 2 diabetes include fatigue,
recurrent infections, recurrent vaginal yeast or monilia infections, prolonged wound healing,
and visual changes.
Gestational diabetes develops during pregnancy and is detected at 24 to 28 weeks of gestation,
usually following an oral glucose tolerance test.
Although most women with gestational diabetes will have normal glucose levels within 6 weeks
postpartum, their risk for developing type 2 diabetes in 5 to 10 years is increased.
A diagnosis of diabetes is based on one of three methods: (1) fasting plasma glucose level, (2)
random plasma glucose measurement, or (3) 2-hour oral glucose tolerance test.
The goals of diabetes management are to reduce symptoms, promote well-being, prevent acute
complications of hyperglycemia, and prevent or delay the onset and progression of long-term
complications. These goals are most likely to be met when the patient is able to maintain blood
glucose levels as near to normal as possible.
Exogenous (injected) insulin is needed when a patient has inadequate insulin to meet specific
Insulin is divided into two main categories: short-acting (bolus) and long-acting (basal) insulin.
Basal insulin is used to maintain a background level of insulin throughout the day and bolus
insulin is used at mealtime.
A variety of insulin regimens are recommended for patients depending on the needs of the
patient and their preference.
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