Any Endocrine folks here?

[Apollyon]

I don't think we have any endocrine fellows/attendings that regularly post on SDN. I have a question that I don't know the answer to:

I eat a lot of whatever I want - including tons of carbs - all the time. I'm 6', 190lbs, no weight change, no polyuria/polydipsia, no flu-like s/s, strong family hx of DM (I and II).

Had some routine bloods for residency, had an elevated random glucose (179), Cr 1.1, BUN 13.

So I had a fasting BGT and an HbA1c...155 and 6.7. Lucky me.

My question (finally) is...can you tax the pancreas and receptors so much, that they can't keep up with the glucose load? The fasting BGT goes against that, but, in the other time, can a constant, hardcore influx of glucose mess with the insulin axis?

Of course, I know, just exercise, and everything will get better (and eat more reasonably, blah, blah, blah ).

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[ckent]

Originally posted by Apollyon

My question (finally) is...can you tax the pancreas and receptors so much, that they can't keep up with the glucose load? The fasting BGT goes against that, but, in the other time, can a constant, hardcore influx of glucose mess with the insulin axis?

Of course, I know, just exercise, and everything will get better (and eat more reasonably, blah, blah, blah ).

That's the idea behind type II diabetes. In the beginning, you have elevated insulin levels, but your glucose receptors in your periphery (muscles, fat, liver) become insuline resistant. They become insulin resistant because they already have plenty of glucose and don't want anymore, so it takes more and more insulin to stimulate them. Later on, your pancreas "tires" out from producing so much glucose, that your insulin levels will ultimately drop. That's one of the reasons that a lot of late type-II diabetics ultimately become insulin-dependent diabetics, and theoretically, could enter DKA if they don't go into a hyperosmolar coma first I suppose. Anyways, I won't bore you with the type II diabetes talk since you are in medicine, but I would recommend speaking with a nutrionists and probably a personal trainer too if you can afford it. Our medical education is sorely lacking in the area of nutrition. Also, be sure to read up on some of the research regarding sulfonurea's and the glitathiazones. You'd be surprised on how "thin" their supporting data regarding their usage is and how a lot of people actually think that they are more harmful then helpful. Stick with metformin, diet and exercise. You know the long term prognosis of diabetes, it's not a pleasant one. Don't skip breakfast, but go light on lunch and dinner, and heavy on the fruits and vegtables. And no snacks, you have to have periods of fasting for your body to begin re-responding to insulin again.

 

[Apollyon]

Thanks for the info; it's what I suspected. Doing prelim IM in a city hospital, you get a LOT of DM - I and II. I've prescribed more Glucophage than you can shake a stick at...but none for me yet!

Thanks again. Say hi to Lana.

 

[ckent]

This is probably one of the best type II diabetes review articles that I've ever read:

http://care.diabetesjournals.org/cg...NDEX=0&sortspec=relevance&journalcode=diacare

For some reason, one of my cardiology prof's is going around preaching results that contradict this study. Just shows that you always have to do your own research.