Page 261 - fourth year book

DIABETES MELLITUS

 Metformin therapy for prevention of type 2 diabetes should be
considered in those with pre-diabetes, especially in those with BMI >35

kg/m2, those aged <60 years, and women with prior gestational diabetes
mellitus.

 At least annual monitoring for the development of diabetes in those with
prediabetes is suggested.

 Screening for and treatment of modifiable risk factors for cardiovascular

disease is suggested.

 Technology-assisted tools including Internet-based social networks,

distance learning, DVD-based content, and mobile applications can be
useful elements of effective lifestyle modification to prevent diabetes. B

Pathophysiology:

Type 1

Individuals with Type 1 do not produce insulin. Without insulin,
muscle and adipose cells cannot access glucose to meet energy

requirements. Glucose production goes unopposed in the liver.
Glucagon is produced in response to the glucose deprivation of muscle

and adipose tissues, prompting glycogenolysis and gluconeogenesis.
Glucose levels rise in the blood.

The kidneys cannot absorb the ever-increasing glucose, so the

excess is excreted in the urine (polyuria). The brain, prompted by this
loss of fluid, signals thirst (polydypsia) and hunger (polyphagia). If this

process continues, stored fats are metabolized and transformed by the
liver into keto acids, which leads to lower pH levels and acidosis. The

drop in pH level and loss of ketones in urine signals the onset of
ketoacidosis.

Type 2:

In Type 2 there is interference with the body’s utilization of
available insulin. Insulin resistance is a decreased responsiveness to
sufficient concentration of insulin. The primary causes of insulin

230