Prediabetes

Now that I read my cards chapter and I got a few hours of sleep in at home, it's back to endo. I'm on the diabetes chapeter and some things to point out:

- Hepatic gluconeogenesis is responsible for fasting sugars that are too high according to Harrison's. But when I was working with the endocrinologists you also have to make sure a high fasting isn't from just drifting down from a high the night before.
- When insuling resistance increases in type 2 diabetics, the free fatty acid flux from adipocytes is incrased leading to higher levels of VLDL and free fatty acids. This can lead to NASH and abnormal transaminases leading to reduced HDL and increased small density LDL.
-Two severe forms of insuline resistance have been described in adults:
+ In type A, yound women present with severe hyperinsulinemia, obesity and features of hyperandrogenism. Patients have a defect in the insulin-signaling pathway.
+ In type B, middle-aged women have severe hyperinsulinemia, features of hyperandrogenism, and autoimmune disease. It is thought to be caused by autoantibodies to the insulin receptor. It can also cause intermittent hypoglycemia as the antibodies and block or stimulate the receptor.
- In regards to prediabetes, the ADA stated that metformin could be tried in patients at hight risk which include: age < 60, BMI > 35, family history of diabetes in a first-degree relative, elevated triglcerides, reduced HDL, hypertension or A1C <6%.