Read e-book online Diabetes : Clinician's Desk Reference PDF

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While there is good understanding of the natural history and treatment approach for type 2 diabetes, this is less so for secondary diabetes. Occasionally, the secondary diabetes may be significantly improved by treating the primary condition. 50 43 Ethnic minorites in England (2004). All minority ethnic groups, except Irish, have a higher standardized risk of (doctordiagnosed) diabetes compared to the general population, with Pakistani women being particularly vulnerable. 48 v In most patients with type 2 diabetes, the pattern Type 2 diabetes of inheritance suggests a polygenic disorder, with an important role for environmental factors (44) such as obesity and a low level of exercise.

There may be greater incidence of ovarian cancer and mortality, as implied by at least one study. ȣ Recent papers have questioned whether the use of an insulin analog, glargine insulin, could be associated with an excess risk of breast cancer, but this observation requires confirmation in larger, prospective studies and the current recommendation is that clinicians should be cautious but continue use of this therapy, much as before. Cardiovascular disease is the major cause of death in patients who have had type 1 diabetes for over 30 years.

V When insulin binds to the extracellular domain of the α subunit of the insulin receptor, an enzyme (tyrosine kinase) on the the intracellular domain of the β subunit is activated; the signal is thus transferred across the membrane. Activation of other intracellular enzymes follows (25). v After activation, the insulin–receptor complex is internalized by endocytosis. The receptor is later recycled to the cell surface. Internalization of the insulin receptor is important (and possibly essential) for insulin signals to reach the nucleus and influence cell growth and protein synthesis.

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