By Ian N. Scobie
Diabetes mellitus is an exceptionally universal sickness that's achieving epidemic proportions because of significant raises within the prevalence of weight problems and the propensity for a sedentary existence. the necessity for physicians to familiarize themselves with all varieties of diabetes is vital and the Atlas of Diabetes Mellitus is going a ways towards making the duty more straightforward for either certified physicians and people in education.
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Extra resources for Atlas of Diabetes Mellitus, Third Edition (Encyclopedia of Visual Medicine)
Sulfonylureas have a tendency to produce weight gain, although any intervention that improves diabetic control in a patient following an isocaloric diet would be expected to result in such an effect. Metformin Metformin lowers plasma glucose by inhibiting hepatic glucose production and increasing the sensitivity of peripheral tissue to insulin. It does not usually cause hypoglycemia but, as it is renally excreted, it should not be used in patients with renal impairment. Gastrointestinal side-effects are common and include diarrhea, anorexia, dyspepsia and a metallic taste in the mouth.
Note the brown color of the pancreas compared with the surrounding fat. Normal pancreas tissue appears pale. The smaller piece of pancreas has been stained with Prussian blue to show the presence of iron deposits Figure 38 Hemochromatosis. Hemosiderin deposits in this low-power view of pancreas are stained blue. Note the accumulation of iron in the endocrine cells of the islet (center) as well as in the acinar cells of the exocrine pancreas. Prussian blue staining Figure 39 The characteristic histologic abnormality in type 2 diabetes mellitus (DM) is amyloid deposition in the islets, which is significant in around two-thirds of cases.
One simple and popular approach is to give a subcutaneous injection of an intermediate or long-acting insulin (NPH, insulin glargine or insulin detemir) before bed with the object of normalizing the pre-breakfast blood glucose. g. Human Mixtard 30, NovoMix 30 (Novo Nordisk) or Humalog Mix 25 (Eli Lilly)) given before or at breakfast and the evening meal according to insulin type. Finally, and especially in the context of severe insulin deficiency, insulin may be administered in a basal bolus regimen, as for type 1 DM patients, with short-acting insulin given with each meal accompanied by an injection of a longer-acting insulin before bed.