NS 3310 1st Edition Lecture 13Outline of Past LectureI. DiabetesII. Diagnosis of DiabetesOutline of Current LectureI. Glycosylated Hemoglobin (A1c)II. Progression of DiabetesCurrent LectureI. Glycosylated Hemoglobin (A1c)- Hemoglobin formed in new red blood cells enters circulation with minimal glycosylation- RBCs are freely permeable to glucose- Approximately 1% of total RBCs are formed and destroyed daily- Glycosylation of hemoglobin occurs at a rate dependent upon the prevailing blood glucose concentration- The percent of glycosylated hemoglobin reflects the mean blood glucose over the 120 day life span of the RBC- Normal A1c <6%, target A1c for diabetes <7%- A1c is used to judge quality of interval diabetes controlThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.- A1c can be used to reverse-calculate average blood sugar- Microvascular disease is correlated with A1cII. Progression of Diabetes- Normal> Insulin Resistance > Diabetes- Insulin Resistance is a subnormal biological response to normal insulin concentrations-Resistance to endogenous insulin: high serum insulin concentrations in association with blood glucose concentrations are normal or high. Compensatory hyperinsulinia may precede onset of hyperglycemia-Resistance to exogenous insulin: diabetic patients who require higher doses to prevent hyperglycemia-Biochemical markers: no validated test for measuring clinical insulin resistance currently- Insulin Resistance-Inherited target cell resistance: rare; due to insulin-receptor mutations-Secondary insulin resistance: type 2 diabetes mellitus, obesity, excess counterregulatoryhormones, immune-mediated, miscellaneous- Symptoms of IR: alopecia, skin tags, amenorrhea, hirsutism, obesity, muscle hypertrophy, hypertriglyceridemia- Metabolic Syndrome and fatty liver disease are diseases of IR- Type 2 Diabetes: beta-cell dysfunction caused by impaired insulin secretion, processing and function- Glucotoxicity: as blood glucose rises, insulin dysfunction worsens- Treatment of Type 2 Diabetes: improve insulin secretion, sensitivity, and