Type 1 10% Autoimmune disease - lack of beta cell insulin production Not overweight, children/adolescents or age 50+ Insulin required! Type 2 90% Fattys!!! Insulin resistance - leads to lack of insulin Liver is straight churnin out some glucose since your fat ass has insulin resistance Hallmark Characteristics 1.) hyperglycemia 2.) alterations in lipid metabolism 3.) alterations in protein metabolism 3 Polys of Type 1 Diabetes 1.) polyuria - frequent peeing 2.) polydypsia - frequent drankin 3.) polyphagia - frequent hunger/eatin Diabetic Ketoacidosis Seen in Type 1 due to fat breakdown into ketone bodies for brain fuel... rare in type 2 due to SOME insulin Fasting Plasma Glucose Normal 125 mg/dl 8 hours of fasting and then you get tested :( A1C Normal 6.4% OGTT Normal 199 mg/dl 75 grams anhydrous glucose dissolved in water then you get tested 2 hours later... biiiiiitch Diagnostic Criteria Hypo or Hyperglycemia crisis and a random plasma glucose of 200 mg/dl IFG Impaired Fasting Glucose - inability of insulin to suppress hepatic glucose production aka gluconeogenesis due to insulin resistance IGT Impaired Glucose Tolerance - insufficient insulin release in the postprandial state Glycosylated Hemoglobin RBCs last 120 days, Covalent bonds with glucose Diabetic Complications Retinopathy - 15-40% after 5 years Nephropathy - 20-35% after 15 years Neuropathy - 50% after 25 years Cardiovascular disease due to increased lipid circulation and deposition ya bastard What is the typical blood glucose range? 70-130 mg/dl What is the minimum brain glucose requirement? 40-60 mg/dl **Glucose utilization in the brain is insulin independent** When does glucose make your pee taste like sugar? When you drink Mountain Dew like its your job. And when blood glucose is >180 mg/dl We already know what glucagon and insulin does soooo.... explain it to me then, ya wanka. MOA of Insulin on Muscle/Fat Insulin binds receptor Glut 4 vesicle fuses to cell membrane Glucose now has a means of getting in When insulin decreases, transporters are taken back up MOA for how a Beta cell secretes Insulin Talk it out, meow. Goals of therapy for Diabetics Coming back to this Insulin is cleared by the kidneys? Yep, it sure is. So you might want to not mess up a dose when someone is renally impaired, you soup sandwich. Daily Insulin Requirements Type 1 - initial dose - 0.3-0.5 units/kg honeymoon phase - 0.2-0.5 units/kg ketosis, illness, or growth - 1-1.5 units/kg Type 2 - with insulin resistance - 0.7-1.5 units/kg Note Dose: 1 unit = 45mcg How is insulin packaged as a hexamer? By zinc everybody! Diffusion is fastest with monomers though. Why is
Posted on: Wed, 21 Jan 2015 21:19:58 +0000