PET3932 – SECTION 2QUIZ 4 STUDY GUIDEDiabetes Mellitus (**Read ACSM book p.278 – 284; Bb Diabetes Med handout) Diabetes Mellitus (DM):  A group of metabolic diseases characterized by an elevated blood glucose concentration (i.e., hyperglycemia) as a result of defects in insulin secretion and/or inability to use insulin.  7 % of the U.S. population has DM Absolute or insufficient amount of insulin Pancreas isn’t producing insulin Insulin is needed as a carrier to take blood from plasma to the muscles Glucose can’t be carried without insulin Hyperglycemia à classic sign of diabetes à elevated blood glucose Type 1 Diabetes (5 – 10% of all cases) Most often caused by autoimmune destruction of the insulin producing β cells of the pancreas. Primary characteristics: absolute insulin deficiency and a high propensity for ketoacidosis. Need insulin for survival (their pancreas doesn’t or hardly produces any insulin) Glucose in urine à need to take insulin on a regular basis Symptomology: Unexpected/unexplained weight loss à can’t use glucose as an energy source à use protein/fat instead Tired/irritable Frequent thirst & urination Glucose in urine If a Type 1 has no insulin, plasma glucose increases b/c it can’t get into the muscles. Body’s natural mechanism à dilute large amounts of glucose…this is why diabetics get thirsty & urinate a lot…their body tells them to intake water to dilute the glucose & then rid it by urinating… except the problem doesn’t resolve itself this way. Type 2 Diabetes (90% of all cases) Caused by insulin-resistant skeletal muscle, adipose tissue, and liver combined with an insulin secretory defect. Common feature: excess body fat with fat distributed in the upper body (i.e., abdominal or central obesity) à these can also cause progression towards prediabetes. They have receptor sites on their muscle that can’t receive insulin/glucose Especially true for them: body uses protein/fat as energy source instead of glucose If a Type 2 isn’t on insulin, then they will respond the same way as any other person in terms of glucose levels. (“normal” people get shaky/tired/irritable when they haven’t eaten) For a Type 2, receptor sites are still open, so exercise can help them be more receptive. Prediabetes:  Individuals are at very high risk to develop diabetes as the capacity of the β cells to hypersecreteinsulin diminishes over time and becomes insufficient to restrain elevations in blood glucose. a condition characterized by: Elevated blood glucose in response to dietary carbohydrate, termed impaired glucose tolerance (IGT) and/or Elevated blood glucose in the fasting state, termed impaired fasting glucose (IFG) HbA1c (glycated hemoglobin) à test used to look at plasma glucose concentration control over 2 – 3 months (long-term glycemic control). For diabetic, treatment goal is < 6.5 (7)% glucose … so if they’re HbA1c is > 7%, they probably have diabetes. For non-diabetic, goal is 4-6 % glucose IGT (Impaired Glucose Tolerance) or IR (Insulin Resistance) Diagnostic Criteria: (p. 279, table 10.5) Diagnosed with OGTT (Oral Glucose Tolerance Test) à drink it; body should take glucose levels back to normal in 2 hrs if they do not have IGT or IR. (this test isn’t used that often) Prediabetes (on way to diabetes) à 140 – 199 mg/dL Diabetes à ≥ 200 mg/dL IFG (Impaired Fasting Glucose) Diagnostic Criteria: (p.279, table 10.5)  Test that most physicians use. Prediabetes à 100 – 125 mg/dL So < 100 mg/dL is good…this would indicate a normal IFG. Diabetes à ≥ 126 mg/dL Goals for fasting plasma glucose (IFG) levels: Diabetic treatment goal à ≤ 130 mg/dL Diabetic post-meal goal à < 180 mg/dL Hyperglycemia à impaired fasting glucose > 125 mg/dL or a casual glucose (taken anytime) >200 mg/dL WITH symptoms. (notice that this is the same criteria for DM…casual glucose MUST have symptoms included.. patient might have just eaten a dozen donuts so their glucose level might be through the roof, but that doesn’t mean they have hyperglycemia b/c they don’t have any symptoms...*review symptoms from above for diabetes).  Casual glucose levels is that which is measured at any time. Develops gradually over time if the patient can’t take insulin (due to economic needs, etc.) Symptoms of hyperglycemia include: Polyuria, fatigue, weakness, increased thirst, and acetone breath (the “fruity” breath that Dr. Kasper described it as). Hypoglycemia à blood glucose level < 70 mg/dL Is any rapid drop in glucose (happens suddenly) Caused by too much insulin and/or exercise Take glucose tablet or eat fast-acting carb Symptoms include: Shakiness, weakness, abnormal sweating, nervousness, anxiety, tingling of the mouth and fingers, and hunger. The fundamental goal for the management of DM: Glycemic control using diet, exercise, and, in many cases, medications such as insulin or oral hypoglycemic agents. Oral glucose drug (antidiabetes medications) (p.2 of handout) Most work on receptor sites (type 2) so they’ll except insulin Don’t have large effect on sudden drops in glucose Don’t interfere with HR, BP, EKG results, etc. Most of these are taken 1 – 3 times a day with a meal. These are the antidiabetes medications: Sulfonylurea: stimulates beta cells to release more insulin Meglitinide: works with similar action to sulfonylureas Nateglinide: works with similar action to sulfonylureas Biguanide: sensitizes the body to the insulin already present Thiazolidinedione: helps insulin work better in muscle and fat; lowers insulin resistance Alpha-glucose inhibitor: slows or blocks the breakdown of starches and certain sugars; action slows the rise in blood sugar levels following a meal.  Taking insulin à pancreas is still putting out insulin (working hard), but gets to a point where it stops à individual hasn’t been able to control glucose level (through exercise & diet) à glucose level is “out of control” àdon’t technicallyyy need it for survival like a type 1 patient b/c they’ve made certain lifestyle decisions, but if they don’t make changes, obviously they need it to survive. Exercise will allow a Type 1 or 2 patient to take less insulin b/c… Insulin acts like