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  <head>
    <title>022-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Diabetes, energy metabolism, obesity, and emergencies">
      <outline text="Fed, fasting, and stress states">
        <outline text="Insulin dominates the fed state">
          <outline text="Adenosine triphosphate closes potassium channels"/>
          <outline text="Incretins amplify glucose-dependent secretion"/>
          <outline text="Promotes uptake, glycogen, lipid, protein, potassium entry"/>
          <outline text="Suppresses hepatic output, lipolysis, ketogenesis"/>
        </outline>
        <outline text="Glucagon rises as glucose and insulin fall">
          <outline text="Liver glycogen first, then gluconeogenesis"/>
          <outline text="Ketones fuel brain and muscle, spare protein"/>
        </outline>
        <outline text="Stress hormones oppose insulin action">
          <outline text="Expose limited beta-cell reserve"/>
          <outline text="Recurrent lows blunt warning, cause unawareness"/>
        </outline>
      </outline>
      <outline text="Diabetes classification and pathogenesis">
        <outline text="Type 1: immune beta-cell destruction">
          <outline text="Absolute insulin deficiency, insulin essential"/>
          <outline text="Autoantibodies classify but do not injure"/>
        </outline>
        <outline text="Type 2: resistance plus beta-cell dysfunction">
          <outline text="Compensation fails through gluco- and lipotoxicity"/>
          <outline text="Heterogeneous: resistance or secretory failure"/>
        </outline>
        <outline text="Monogenic, pancreatic, endocrine, drug, gestational"/>
        <outline text="Type changes treatment, inheritance, ketosis risk"/>
      </outline>
      <outline text="Diagnosis and monitoring">
        <outline text="Fasting glucose, tolerance test, glycated haemoglobin"/>
        <outline text="Confirm abnormal results unless clear"/>
        <outline text="Glycated haemoglobin misleads if red-cell lifespan alters"/>
        <outline text="Sensors show direction, variability, time in range"/>
        <outline text="Ketones in deficiency, illness, pregnancy, inhibitors"/>
      </outline>
      <outline text="Chronic tissue injury">
        <outline text="Hyperglycaemia damages microvessels">
          <outline text="Retinopathy: leakage, ischaemia, neovascularisation"/>
          <outline text="Kidney disease: albuminuria, filtration loss"/>
          <outline text="Sensory, painful, and autonomic neuropathy"/>
        </outline>
        <outline text="Accelerated atherosclerotic cardiovascular disease"/>
        <outline text="Foot ulcers from neuropathy, pressure, ischaemia"/>
        <outline text="Prevention goes beyond glucose treatment"/>
      </outline>
      <outline text="Glucose-lowering therapy">
        <outline text="Lifestyle foundations and individualised goals"/>
        <outline text="Metformin lowers hepatic output, little hypoglycaemia"/>
        <outline text="Sulfonylureas: hypoglycaemia and weight gain"/>
        <outline text="Thiazolidinediones: oedema, fractures, heart failure"/>
        <outline text="Glucagon-like peptide one agonists slow emptying, appetite"/>
        <outline text="Cotransporter two inhibitors: heart and kidney benefit">
          <outline text="Ketoacidosis without extreme hyperglycaemia"/>
        </outline>
        <outline text="Basal restrains fasting output, prandial covers meals"/>
      </outline>
      <outline text="Hypoglycaemia">
        <outline text="Usually insulin or secretagogue exposure"/>
        <outline text="Adrenergic warning versus neuroglycopenia"/>
        <outline text="Oral carbohydrate if able to swallow"/>
        <outline text="Intravenous glucose or glucagon if severely impaired"/>
        <outline text="Sulfonylurea lows may recur"/>
      </outline>
      <outline text="Diabetic ketoacidosis">
        <outline text="Insulin deficiency plus counter-regulatory excess">
          <outline text="Hyperglycaemia drives osmotic diuresis"/>
          <outline text="Ketones consume bicarbonate, high-gap acidosis"/>
          <outline text="Potassium shifts out, total stores depleted"/>
        </outline>
        <outline text="Glucose may be only moderately raised"/>
        <outline text="Fluid, insulin, potassium, then added glucose">
          <outline text="Continue insulin until ketosis resolves"/>
        </outline>
        <outline text="Seek infection, omitted insulin, infarction"/>
      </outline>
      <outline text="Hyperosmolar hyperglycaemic state">
        <outline text="Enough insulin to restrain major ketogenesis"/>
        <outline text="Osmotic diuresis causes water loss, hypertonicity"/>
        <outline text="Slower onset in older or vulnerable people"/>
        <outline text="Gradual fluid, cautious tonicity correction">
          <outline text="Rapid shifts worsen neurological injury"/>
        </outline>
        <outline text="Mixed presentations are common"/>
      </outline>
      <outline text="Obesity and metabolic dysfunction">
        <outline text="Leptin and hypothalamus integrate weight signals"/>
        <outline text="Weight loss raises hunger, lowers expenditure">
          <outline text="Biological resistance, not personal failure"/>
        </outline>
        <outline text="Visceral and ectopic fat drive complications"/>
        <outline text="Assess beyond body-mass index"/>
        <outline text="Combine diet, activity, drugs, selected surgery"/>
      </outline>
      <outline text="Dyslipidaemia and fatty liver">
        <outline text="Insulin resistance raises triglyceride-rich particles">
          <outline text="Lowers high-density lipoprotein cholesterol"/>
        </outline>
        <outline text="Statins cut synthesis, increase receptor clearance"/>
        <outline text="Steatotic liver disease from fat to cancer">
          <outline text="Normal aminotransferases despite fibrosis"/>
        </outline>
        <outline text="Weight, activity, lipids, alcohol, prevention"/>
      </outline>
    </outline>
  </body>
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