Type 1 or Type 2 or...

1. Type 1 or Type 2 or...

2. Type 1 vs Type 2:How to Tell Them Apart

3. Proinsulin:Where Insulin Comes from Regular insulin has a strong tendency to self-associate into dimers. In the presence of zinc, three dimers form a hexamer, which is a very stable form of insulin. In insulin lispro, two amino acids at the carboxyl end of the B chain, normally proline and lysine at B-28 and B-29, respectively, are reversed in position. This change in the primary structure of the insulin molecule results in a decrease in the amount of self-association between two molecules of insulin. Although insulin lispro also exists at U-100 concentration as a hexamer, when injected subcutaneously the hexamers dissociate rapidly into monomeric insulin, leading to the marked increase in absorption rate of insulin lispro.Regular insulin has a strong tendency to self-associate into dimers. In the presence of zinc, three dimers form a hexamer, which is a very stable form of insulin. In insulin lispro, two amino acids at the carboxyl end of the B chain, normally proline and lysine at B-28 and B-29, respectively, are reversed in position. This change in the primary structure of the insulin molecule results in a decrease in the amount of self-association between two molecules of insulin. Although insulin lispro also exists at U-100 concentration as a hexamer, when injected subcutaneously the hexamers dissociate rapidly into monomeric insulin, leading to the marked increase in absorption rate of insulin lispro.

4. Proinsulin Processing Regular insulin has a strong tendency to self-associate into dimers. In the presence of zinc, three dimers form a hexamer, which is a very stable form of insulin. In insulin lispro, two amino acids at the carboxyl end of the B chain, normally proline and lysine at B-28 and B-29, respectively, are reversed in position. This change in the primary structure of the insulin molecule results in a decrease in the amount of self-association between two molecules of insulin. Although insulin lispro also exists at U-100 concentration as a hexamer, when injected subcutaneously the hexamers dissociate rapidly into monomeric insulin, leading to the marked increase in absorption rate of insulin lispro.Regular insulin has a strong tendency to self-associate into dimers. In the presence of zinc, three dimers form a hexamer, which is a very stable form of insulin. In insulin lispro, two amino acids at the carboxyl end of the B chain, normally proline and lysine at B-28 and B-29, respectively, are reversed in position. This change in the primary structure of the insulin molecule results in a decrease in the amount of self-association between two molecules of insulin. Although insulin lispro also exists at U-100 concentration as a hexamer, when injected subcutaneously the hexamers dissociate rapidly into monomeric insulin, leading to the marked increase in absorption rate of insulin lispro.

5. Insulin and C-Peptide Regular insulin has a strong tendency to self-associate into dimers. In the presence of zinc, three dimers form a hexamer, which is a very stable form of insulin. In insulin lispro, two amino acids at the carboxyl end of the B chain, normally proline and lysine at B-28 and B-29, respectively, are reversed in position. This change in the primary structure of the insulin molecule results in a decrease in the amount of self-association between two molecules of insulin. Although insulin lispro also exists at U-100 concentration as a hexamer, when injected subcutaneously the hexamers dissociate rapidly into monomeric insulin, leading to the marked increase in absorption rate of insulin lispro.Regular insulin has a strong tendency to self-associate into dimers. In the presence of zinc, three dimers form a hexamer, which is a very stable form of insulin. In insulin lispro, two amino acids at the carboxyl end of the B chain, normally proline and lysine at B-28 and B-29, respectively, are reversed in position. This change in the primary structure of the insulin molecule results in a decrease in the amount of self-association between two molecules of insulin. Although insulin lispro also exists at U-100 concentration as a hexamer, when injected subcutaneously the hexamers dissociate rapidly into monomeric insulin, leading to the marked increase in absorption rate of insulin lispro.

6. Type 1 vs Type 2:How to Tell Them Apart

7. Case Study #1 28 year-old Mexican American female was noted to have a random glucose of 125 mg/dL on a �chemistry panel� obtained as part of an annual health fair by her employer. No symptoms or prior history of abnormal glucose (screening OGTT during pregnancy 4 years ago was negative) PMH Negative Medications None FHx Mother and brother have type 2 diabetes Mother has a history of retinal laser treatments, proteinuria and foot ulcer This is a case of type 2 diabetes. The point is to discuss how to make the diagnosis or whether we need to make the diagnosis. Personally, I will suggest in this case that not making the diagnosis is appropriate. Diet and exercise to produce weight loss can reverse diabetes. Suggest using the technique of appealing to health of family � i.e. her child - by making lifestyle changes for the whole family. Suggest that avoiding the diagnosis of diabetes can reduce complications of buying health and life insurance in the future. Can discuss limitations of A1C to make diagnosis. Can discuss the lack of diagnostic criteria for hypertension (need two measurements as well). Can discuss smoking as a contributor to insulin resistance. Can discuss significance of family history of microvascular complications. Can discuss importance of asking about insurance status. This is a case of type 2 diabetes. The point is to discuss how to make the diagnosis or whether we need to make the diagnosis. Personally, I will suggest in this case that not making the diagnosis is appropriate. Diet and exercise to produce weight loss can reverse diabetes. Suggest using the technique of appealing to health of family � i.e. her child - by making lifestyle changes for the whole family. Suggest that avoiding the diagnosis of diabetes can reduce complications of buying health and life insurance in the future. Can discuss limitations of A1C to make diagnosis. Can discuss the lack of diagnostic criteria for hypertension (need two measurements as well). Can discuss smoking as a contributor to insulin resistance. Can discuss significance of family history of microvascular complications. Can discuss importance of asking about insurance status.

8. Case Study #1 Social Hx She has smoked 1ppd since age 19 years She and her husband own a convenience store They have two children, ages 4 and 6 years ROS Frequent yeast infections PE Height 64" � Weight 200 lb � BP 142/92, 92 Waist 38" � Skin tags � Trace edema Further exam normal Labs A1C 6.3% (normal 4-6%) 1-hour postprandial glucose 133 mg/dL This is a case of type 2 diabetes. The point is to discuss how to make the diagnosis or whether we need to make the diagnosis. Personally, I will suggest in this case that not making the diagnosis is appropriate. Diet and exercise to produce weight loss can reverse diabetes. Suggest using the technique of appealing to health of family � i.e. her child - by making lifestyle changes for the whole family. Suggest that avoiding the diagnosis of diabetes can reduce complications of buying health and life insurance in the future. Can discuss limitations of A1C to make diagnosis. Can discuss the lack of diagnostic criteria for hypertension (need two measurements as well). Can discuss smoking as a contributor to insulin resistance. Can discuss significance of family history of microvascular complications. Can discuss importance of asking about insurance status. This is a case of type 2 diabetes. The point is to discuss how to make the diagnosis or whether we need to make the diagnosis. Personally, I will suggest in this case that not making the diagnosis is appropriate. Diet and exercise to produce weight loss can reverse diabetes. Suggest using the technique of appealing to health of family � i.e. her child - by making lifestyle changes for the whole family. Suggest that avoiding the diagnosis of diabetes can reduce complications of buying health and life insurance in the future. Can discuss limitations of A1C to make diagnosis. Can discuss the lack of diagnostic criteria for hypertension (need two measurements as well). Can discuss smoking as a contributor to insulin resistance. Can discuss significance of family history of microvascular complications. Can discuss importance of asking about insurance status.

9. Case Study #2 32 year-old Caucasian female with a history of gestational diabetes presents for confirmation of pregnancy (LMP 10 weeks ago). Recent home pregnancy test was positive. Asymptomatic except for nocturia without dysuria or fatigue PMH She has two children, ages 3 years and 26 months Previous gestational diabetes requiring insulin therapy during both previous pregnancies Glucose tolerance test 6 weeks post-partum �normal� FHx No diabetes or vascular disease This is a case of type 1 diabetes. A small proportion of women with GDM will turn out to have slowly evolving type 1 diabetes. GDM is less common in Caucasians, those of normal body weight and without risk factors. Screening for diabetes should be performed annually in women with a history of GDM. Women with a history of GDM and with diabetes should always be counseled to seek evaluation prior to attempting to conceive.This is a case of type 1 diabetes. A small proportion of women with GDM will turn out to have slowly evolving type 1 diabetes. GDM is less common in Caucasians, those of normal body weight and without risk factors. Screening for diabetes should be performed annually in women with a history of GDM. Women with a history of GDM and with diabetes should always be counseled to seek evaluation prior to attempting to conceive.

10. Case Study #2 Social Hx No tobacco or EtOH Power-walks 30 minutes 5-7 days a week Follows standard nutritional guidelines Weight stable for past 4 years PE Height 64" � Weight 110 lb � BP 110/62, 66 Further exam negative Labs Urine beta-HCG positive A1C 9.4% Glucose 277 mg/dL (3 hr pc); yesterday at PCP 295 mg/dL (4h pc) This is a case of type 1 diabetes. A small proportion of women with GDM will turn out to have slowly evolving type 1 diabetes. GDM is less common in Caucasians, those of normal body weight and without risk factors. Screening for diabetes should be performed annually in women with a history of GDM. Women with a history of GDM and with diabetes should always be counseled to seek evaluation prior to attempting to conceive.This is a case of type 1 diabetes. A small proportion of women with GDM will turn out to have slowly evolving type 1 diabetes. GDM is less common in Caucasians, those of normal body weight and without risk factors. Screening for diabetes should be performed annually in women with a history of GDM. Women with a history of GDM and with diabetes should always be counseled to seek evaluation prior to attempting to conceive.

11. Case Study #3 78 year-old nursing home resident presents for evaluation of recurrent episodes of severe hypoglycemia. Diabetes diagnosed at age 65 years during routine insurance exam Current treatment includes insulin 70/30 14 units qam; glargine 10 units qhs and sulfonylurea Glucose logs (4-6 readings per day) reveal levels from 30�s to mid 500�s for past two weeks Severe hypoglycemia usually occurs during the afternoon or early morning The average measurement is 196 mg/dL (SD 130 mg/dL) PMH Otherwise unremarkable FHx No vascular disease This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture. This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture.

12. Case Study #3 Social Hx Denies tobacco or EtOH use PE Height 61" � Weight 98 lb BP 138/66, 82 � Further exam normal Labs A1C 8.6% Creatinine 1.3 Total Cholesterol 150 mg/dL HDL 70 mg/dL LDL 70 mg/dL Triglycerides 50 mg/dL This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture. This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture.