Symptoms

Type I Diabetes hyperglycemia owtloss

thirst polydipsia oelectrolytedisturbances

Betacelldestructionresultsinabsoluteinsulindeficiency urinationpolyuria
Autoimmunediseasemore riskofdevelopingothers

oridiopathic

Complications f
Diabeticketoacidosis

bloodtocompensateforsolids
pulledinto
ohyperosmolareffectHao

ketoacidosis macro vascularDiseases

orketones inbloodeurine

heart
coronary disease
operipheralvasculardisease oaso600Gic

cnoinsulinso a lot of ketone buildupacidosis

ocerebrovasculardisease

Microvascular Diseases

Hyperglycemic Hyperosmolar syndrome

retinopathy

nephropathy ohyperosmolareffect dehydration

noketonesadequateinsulinpreventingbuildup

Neuropathy o4002800

gic
oexcessivefluidlossfromhyperosmolareffect

Type II Diabetes

oprogressiveinsulinsecretorydefect w insulin resistance Bcellfailure

diabetesimpairedglucosehomeostasis
pre normalwoo

IFG t fastinggicabove
o 1Gtin plasma gic after sgcaoload
elevated

gestationaldiabetestemporarybutso75 chancewilldevelopintotype later 210 ofpregnancies

ogeneticfactorsenvironmental factorsintakeofexcessivecalories physicalinactivity

orobesityolderageraceethnicitypre diabetesfamilyhistoryPcosgestationaldiabetes 9lbsbb hypertension

AA LatinoNAasianamericanpacificislander

oHD Lass tri 2so BMI 25

initial insulinresistancebycells highglucoselevels releasesmoreinsulinhyper insulinemia

extrainsulindeclinesovertime

glucoselow

Cells
breakdown of Fat Protein

hyperglycemia
I
increaseketones

µ woodman
t I
acetone bream

givgose

glucose inurine

Urine ketoacidosis
inaffed
glucosuria ftioss

increased'tzoloss I
ketonesfiltered increasedNa polyphagia

polyuria filteredfrom

denyartation ketonuria blood urine

electrolyteimbalances moret

increased ketones nitrogen

in

thirst urine

polydipsia trivialoss

Diagnostictesting

Alc 6.5 prediabetes

FPG 126mgal duringoralglucosetolerancetest FPaloo12s

2npatisgoatt140199

2hPG 200mg al duringoralgic tolerancetest

Alcs 6.4
PG zoomglasthyperglycemicsymptoms
random

goals Anc 7or

preprandial
capillary gloso130mgdi
plasma
peakpostpranPG isomglal
 Strategies
Diabetic MNT
olowCHOdiets notreccomended
caloricamtofstarch
sugarsdonotincreaseglycemiamorethaniso
omonitortotal
gramsofCitoforglycemiccontrol consistentdaily
permealsnack

PlateMethod typellselderlyilliterateoverwhelmeddenialcognitivedifficultiesunlikelytomeasurefoodstomatch
toexchanges orlabels
Easy

goodforinsulin users
pump
notothergroups needtorecognizefoodsthathaveotto gramsserving
swlato
focusesonfood moreflexibilityoffoodchoices
Carbcounting portionsoffoodw iggat betterBGcontrolthanplatebutaccuratelikestheworryfreerigidityofgroups
n'ont'much
Exchangelists understands orhast imetolearn nottryingfortightestBGcontrol preferspresetfoodstold
mendedservingsizesforallfood
caloriebasedrecco etypes
groups

Countingtotalottonot
usedmuch
tightcontrolflexiblechoices
simpleharderthanplatethough
doesn'twant can'tlearnfoodgroupswantsflexibilityveryCitosensitivewillingtomeasure
food
boredw currentmealplan

ReducedCalorieSweetenerssugar alcohols etagatose

Nonnutritivesaccharinaspartameneotameace meke sucralose
sulfa

Fiber 25 30g day 7 13gsoluble forhearthealth

Protein normal 15 207keats

doesn'tslowabsorption
littletonoeffectonBGinwell pt
controlled

Fat 25 35 Kcals EtoH moderateants w foodcanhaveminimaleffect

saturated 27 I d women 1 2 dmen
notrans
omega3 putas
34d contributes to hyperglycemia ordelayed hypos

Glycemicindex notveryreliable

50gChofood to 50gstandardaltofood puregiewhitebread

M 55 70
omeasure increase in BGabove fastingBGlevels 2hrsafteringestion
70 High
GlycemicLoad calculated
bymultiplying Glbythe of in
the amt otto f
eachood ethentotalingthe antforeach
 improvesinsulin sensitivity
oreducesCVriskfactors
Physical Activity oimproveswell
being
maypreventDMin diabetic
pre

type I can t or t glucose

Hypohighintensity stresshormones tglucagon liver ketones

30minsstrenousunplanned
low fatburnlessinsulin
longes hyper extraglucagonrelease counterregulatoryhormones
fast ATPneed insulin hyporise

type II tglucose
noChoifnotoninsulinor secretagogues
noadjustmentforworkout somins
o
Tgicclearance during after BGcioomg start 15gCito
Tinsulinsensitivity
oinsulinorinsulinsecret
agoguestcan causehypo
regulatoryhormones thepatic
counter
gicoutput

Recco
mend

Frequent BG monitoringbeforeduring e after 730min

Reduce insulin or go
ingest IsCitoforevery3060minsover30minroutine

moderate strenousactivity 45 60mins trapidorshortactinginsulin l zu

needis 20 decreaseindailyinsulindose
prolongedvigorousexercisemay

150min week moderateaerobicactivity 3days

nomorethan 2daysrest

type II resistancetraining atleast2dweek

 Hypoglycemia

shakysweatypalpitations anxietyhunger

slowpoorconcentrationconfusiondisorientedslurredspeechirrationalbehaviorextremefatigueseizures Kyo

gice70 15gCHO la regular juice

6oz soda etc
retesttoisminsrepeatasneeded
eat winnexthr

Ketoacidosis

DawnPhenomenon
oincreased
glclevel4am8am
o need lessinsulin1am3am
ocaused
bydecreasedamtofinsulinavaiiblebedtimedoseusedup ORliveris makingmoreglucosein overnightfast
Treat Metformintellslivertomakelessgic
Moreinsulin
Differentinsulin slowerdifferentpeak

Somogyi Effect slingshot

middle of night hypoepisodefollowed rebound hyperglycemia in

otoomuchinsulinor nobedtime
by morning
snackwinsulin
obodyrespondsto hypo by
releasingglucagontoners thatbreakdownliverglycogenstores releaseGlo
reboundtohigherthannormal

Treatlessinsulin or bedtimesnack

lesscommon thanDawn morecommonintypeIs chronichappenseverymorning

too insulin
much
Longterm
vascular
macro
odyslipidemiasmallerdenserLDLs moreatherosclerotic
hypertension plaquebuildupw vasculardamage
microvascular
nephropathy gioaccumulatesinvesselwallglycated reducedbloodflownervedies

f
retinopathy
neuropathy
ogastro
paresis
eyeskidneyendothelium

healing
 Insulin
Rapid
Short
IntermediateNPH
Long
Mixtures short
intermediatewregular
acting

NPH aregular

Physiologicregimensmimicnaturalinsulinsecretion multipleinjectionsorpump

Flexibleamtofcao mealdetermineshowmuch
each

BestfortypeIs qualityoflife butrequiresknowledgeeatin

Use carbcounting totalgramCHOexchanges

Fixedregimens sameamt allday1everyday

premixedinsulin musthaveconsistentCHO consistenttime

Bestfornewlydiagnosed xiiteracytravels inconsistentschedule

Use platemethod

simplerequireslittleattire

injectableS

amylinagonists activatesamylinreceptors tglucagon gastric time tsatiety

emptying

wtloss
Gi

GLP 1agonist activatesG1P 1receptors insulinsecretionesatiety tgastricemptyingtimeeglucagonsecretion

wttoss
Gi CvPancreasthyroid
 OralMeds
Secretagogues

sulfonyureas closeKATPchannelsonBcellplasmamembrane t insulinsecretion

hypo
wtgain monitorrenal hepatictune

glinides closeKATP
channels onBcellplasma
membrane rinsulinsecretion
hypo
wtgain atriskofhypow hepaticinsufficiency

Insulinsensitizers

TLDs activatesnucleartranscriptionfactorPPARY y Ltinsulinsensitivity inmusclefat eliver

nohypo
outgain Cr edemaheartfailure Bonefractures

EnzymeInhibitors

DPP4inhibitorsinhibitsDPPaactivitywhich t Gtp ieGitlin lyftinsulinsecretion tglucagonsecretion

cretinspostprandial

nohypo
noweight
2 glucosidaseinhibitorsinhibitsintestinalaglucosidaseflowsintestinalCitodigestionabsorption
nohypo
noweight Glissues

Biguanides metformin activatesAMPkinase hepatic glcproduction

onohypo o Gl tBiz renalcontraindicationsnotwrenalinsufficiency
now