PART 16: Endocrinology and Metabolism
SECTION 1 Endocrinology
344 Diabetes Mellitus
 | Figure 344-1 Spectrum of glucose homeostasis and diabetes mellitus (DM). The spectrum from normal glucose tolerance to diabetes in type 1 DM, type 2 DM, other specific types of diabetes, and gestational DM is shown from left to right. In most types of DM, the individual traverses from normal glucose... |
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 | Figure 344-2 Worldwide prevalence of diabetes mellitus. Comparative prevalence (%) of estimates of diabetes (20–79 years), 2010. (Used with permission from IDF Diabetes Atlas, the International Diabetes Federation, 2009.) |
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 | Figure 344-3 Relationship of diabetes-specific complication and glucose tolerance. This figure shows the incidence of retinopathy in Pima Indians as a function of the fasting plasma glucose (FPG), the 2-h plasma glucose after a 75-g oral glucose challenge (2-h PG), or the A1C. Note that the incidence... |
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 | Figure 344-4 Mechanisms of glucose-stimulated insulin secretion and abnormalities in diabetes. Glucose and other nutrients regulate insulin secretion by the pancreatic beta cell. Glucose is transported by a glucose transporter (GLUT1 in humans, GLUT2 in rodents); subsequent glucose metabolism by the... |
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 | Figure 344-5 Insulin signal transduction pathway in skeletal muscle. The insulin receptor has intrinsic tyrosine kinase activity and interacts with insulin receptor substrates (IRS and Shc) proteins. A number of "docking" proteins bind to these cellular proteins and initiate the metabolic actions of... |
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 | Figure 344-6 Temporal model for development of type 1 diabetes. Individuals with a genetic predisposition are exposed to an immunologic trigger that initiates an autoimmune process, resulting in a gradual decline in beta cell mass. The downward slope of the beta cell mass varies among individuals and... |
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 | Figure 344-7 Metabolic changes during the development of type 2 diabetes mellitus (DM). Insulin secretion and insulin sensitivity are related, and as an individual becomes more insulin resistant (by moving from point A to point B), insulin secretion increases. A failure to compensate by increasing the... |
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 | Figure 344-8 Relationship of glycemic control and diabetes duration to diabetic retinopathy. The progression of retinopathy in individuals in the Diabetes Control and Complications Trial is graphed as a function of the length of follow-up with different curves for different A1C values. |
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 | Figure 344-9 Diabetic retinopathy results in scattered hemorrhages, yellow exudates, and neovascularization. This patient has neovascular vessels proliferating from the optic disc, requiring urgent panretinal laser photocoagulation. |
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 | Figure 344-10 Time course of development of diabetic nephropathy. The relationship of time from onset of diabetes, the glomerular filtration rate (GFR), and the serum creatinine are shown. (Adapted from RA DeFranzo, in Therapy for Diabetes Mellitus and Related Disorders, 3rd ed.... |
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 | Figure 344-11 Screening for microalbuminuria should be performed in patients with type 1 diabetes for ≥5 years, in patients with type 2 diabetes, and during pregnancy. Non-diabetes-related conditions that might increase microalbuminuria are urinary tract infection, hematuria, heart failure, febrile... |
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 | Figure 344-12 Representative insulin regimens for the treatment of diabetes. For each panel, the y-axis shows the amount of insulin effect and the x-axis shows the time of day. B, breakfast; L, lunch; S, supper; HS, bedtime; CSII, continuous... |
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 | Figure 344-13 Essential elements in comprehensive diabetes care of type 2 diabetes. |
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 | Figure 344-14 Glycemic management of type 2 diabetes. See text for discussion of treatment of severe hyperglycemia or symptomatic hyperglycemia. Agents that can be combined with metformin include insulin secretagogues, thiazolidinediones, α-glucosidase inhibitors, DPP-IV inhibitors, and GLP-1... |
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