Diabetes : Clinician's Desk Reference by David Leslie, Cecilia Lansang, Simon Coppack, Laurence

By David Leslie, Cecilia Lansang, Simon Coppack, Laurence Kennedy

The ebook explains the underlying pathophysiology of the affliction and covers intimately all its major varieties and problems. Separate chapters reflect on the diversity of therapies, including summaries of key medical trials. assurance additionally contains epidemiology and class, in addition to prognosis, screening, proscribing threat, and different facets of disorder administration and sufferer care. The booklet is illustrated all through by way of explanatory diagrams, graphs, tables, and pictures.

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Obesity/ insulin resistance genes Leptin; leptin receptor; PC1; POMC; PC4 receptor; Insulin receptor; PPAR-γ Associated conditions v In Western populations, type 2 diabetes usually forms part of a syndrome of morphological and metabolic abnormalities. Some of these associations are referred to as ‘metabolic syndrome’ (see p. 50). v The metabolic features of type 2 diabetes include fasting hyperinsulinemia, hyperglycemia, dyslipidemia, and high circulating concentrations of lactate, pyruvate, and glucogenic amino acids.

V Other independent risk factors for type 2 diabetes include lack of exercise, being born to a mother with gestational diabetes , being of exceptionally high or low birth weight. ȣ Low birth weight is postulated by the ‘Barker Hypothesis’ to predispose to diabetes and obesity by various mechanisms, including switching on ‘thrifty’ genes to counter the effects of intrauterine malnutrition. v Leaner patients with type 2 diabetes tend to show more severe insulin deficiency (and within this subgroup one typically finds LADA patients).

Cardiovascular disease is the major cause of death in patients who have had type 1 diabetes for over 30 years. Coronary artery disease Date of diagnosis 1950–1959 1960–1964 1965–1969 1970–1974 1975–1980 20 10 0 20 years 25 years Duration of follow-up 30 years 20 years 25 years Duration of follow-up 30 years Type 1 diabetes Insulin resistance v The normal relationship between insulin sensitivity relative to insulin secretion is disrupted in the ‘prediabetic’ phase, just as it is in type 2 diabetes.

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