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category archive listing Category Archives: CFRD Facts

“Normal” blood glucose levels

I think this will be very helpful for those who suspect they may have diabetes.  I stole it from my Continuous Glucose Monitor class:
Target values from the American Diabetes Association (ADA)/American Association of Clinical Endocrinologists (AACE)
Fasting/before-meal glucose: 90 mg/dL to 130 mg/dL (5.0 mmol/L to 7.2 mmol/L) (ADA);
<110 mg/dL (6.1 mmol/L) [...]

CFRD Fact #14

Complications of CFRD (poorly controlled):
Infections due to decreased white blood cell count phagocystosis.

Phagocystosis is the ability to encourage white blood cells to destroy bacteria.

Increased viscosity of mucus secretions with hyperglycemia and dehydration.

Dehydration is caused by the body trying to flush the excess blood glucose out in the urine.

Increased protein catabolism with CF [...]

CFRD Fact #13

Genotype is predictive of pancreatic status:
Delta F508 (the most common genetic defect in Cystic Fibrosis) homozygous genotype is associated with pancreatic insufficiency in nearly all patients.
This genotype is also at higher risk for CFRD.

CFRD Fact #12

How might early diabetes cause CF clinical decline? It is currently unknown, but here are some theories:

Insulin Deficiency

Insulin is an anabolic hormone which promotes conservation of body protein, fat and carbohydrate stores.

Malnutrition and protein catabolism are clearly associated with death in CF.

CFRD Fact #11

The American Diabetes Association (ADA) classifies CFRD under “other specific types of diabetes” involving diseases of the exocrine pancreas. CFRD shares some features of type 1 and type 2 diabetes but has important clinical distinctions that make its medical treatment and medical nutritional therapy (MNT) unique.

CFRD Fact #10

Weight loss and decline in pulmonary function began 4-6 years before the onset of diabetes.
After two years of insulin therapy,weight returned to levels seen six years earlier and the decline in pulmonary function stabilized.
This suggests a cause and effect relationship between clinical decline and the pre-diabetic state.
Lanng, Diabetic mellitus in Cystic Fibrosis: effect of [...]

CFRD Fact #9

Median Survival Rates in CFRD:
Clinical data was collected at the Minnesota CF Center between 1987 - 2002 from 1,081 Cystic patients with 123 patients having CFRD.

Total Cohort

47.0 Years

Women with Diabetes

30.7 Years

Women without Diabetes

47.0 Years

Men with Diabetes

47.4 Years

Men without Diabetes

49.5 Years

“CONCLUSIONS—Female subjects with CFRD have a remarkably poorer prognosis compared with all male subjects [...]

CFRD Fact #8

Interesting tidbits about CFRD:
Diabetic ketoacidosis (DKA) is rare. (I would love some more info on this).
Pancreatic insufficiency associated with CFRD.
A1c levels may underestimate abnormal glucose metabolism. (would love more info on this too). So far I have only found that there is an increased red cell turnover, causing a “diluted” A1c [...]

CFRD Fact #7

Autoimmune induced insulin deficiency is the cause of type 1 diabetes.
Insulin deficiency in CFRD is due to scarring and destruction of the pancreatic islet cells and their beta cells (the insulin producers).

CFRD is not associated with the autoimmune process and the autoantibodies seen in Type 1 diabetes
Scarring (fibrosis) occurs due to thickened mucus [...]

CFRD Fact #6

Not Type 1 or Type 2
CFRD is most like type 2 diabetes, BUT requires insulin treatment like type 1 diabetes rather than diet and oral therapy like type 2.
Reasoning:

Caloric intake needs to be maintained to meet metabolic demands of CF
Oral medications used in type 2 diabetes can not be used in CF

Major side effects may [...]