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WEEK 1: DIABETES

PATHOPHYSIOLOGY OF DIABETES
11/4/2013 4:37

TYPE 1

SWEDEN,
SCANDANAVIA

TYPE 2
PATHOPHYSIOLOGY
TYPE 1 1. Autoimmunity target Beta Cell
Destruction

1958
0.5% with DM
2009
6% with DM
Increase True Pandemically 70Million
(CHINA Highest)
Type 2
Highest Percentage due to
Obesity

TYPE 2

1. Insulin Resistance
2. Impaired Insulin Secretion
(Environment and Genes Influence)

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TYPES OF DIABETES
11/4/2013 5:10PM

GAD = Most sensitive all genetic test.

TAKE NOTE: TYPE 1?

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DIAGNOSIS OF DIABETES
11/4/2013 5:22 PM

2. Hyperosmolar = DM
Type 2 Complication
3. DKA = DM Type 1
Complication
4. Catabolic State
5. Infections Risk
LONG TERM
COMPLICATIONS

Microvascular
Complications:

1. (+) Exudates and


Bleeding

Takes about 5-10 years


with exposure wit
hyperglycemia =
Retinopathy.

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GLYCEMIC CONTROL AND OUTCOMES
11/4/2013 5:54PM

Silent Period of Kidney


Disease = 10-15 years
of Exposure to DM. (+)
Microabuminemia

SHORT TERM
COMPLICATIONS

1. Hypoglycemia =
Adrenergic Stimulation
effects
2. Neuroglycopenia =
Confusion/Seizure

1. Peripheral

Neuropathy
2. Autonomic
Neuropathy

RESULTS: INTENSIVE vs. CONVENTIONAL


CONTROL STUDIES.

1. 1993 big study in Las Vegas.


2. Relationship of Glucose vs. Progression
of Complications

The lower HgbA1c = Hypoglycemia Risk

This study is continuation of DCCT study after


9th year period.
NOTE:
1. Those Intensive Group = Maintained slightly
increased HgbA1c = Less Retinopathy
Progression
2. Those Conventional Group = had a lower
HgbA1c after 4 years but more Retinopathy
Progression.
GOOD CONTROL = LESS
CARDIOVASCULAR COMPLICATIONS
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PART 2 GLYCEMIC CONTROL OF DM
11/24/2013 6:25 PM

RESULTS:
SULFONYUREA-INSULIN GROUP = (+)
BENEFIT if 10 years maintained.
METFORMIN = ALSO GIVES MORE BENEFIT
10 years TREATMENT = GIVES BENEFIT
MORE.

1. EXPOSURE HIGH HgbA1c = MORE RISK


(TIME and CONCENTRATION)

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11/14/2013 6:48 PM

NOW: 2010

1990s HISTORY

1. Adding ORAL AGENTS 2 actions more


pronounced = MORE LOWER GLUCOSE.

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