Running Head: TYPE 2 DIABETES 1

Type 2 Diabetes: How to Avoid Becoming a Statistic

Breanna Wimbush

Ocean Lakes Math and Science Academy

Author’s Note

During my summer I completed a mentorship with Dr. Valerio Genta, a pathologist, at

Sentara Virginia Beach General Hospital. I then presented my lesson under the supervision of

Mrs. Domingo, a teacher, at Virginia Beach Middle School.

After graduation I plan to attend Virginia Wesleyan University and double major in

biology and religious studies. I then hope to go on to medical school and become a pathologist

myself.

I would like to thank Mrs. Graves, Dr. Genta, Mrs. Domingo, my mother and anyone else

who helped me complete the product and give me an amazing experience.

Feel free to contact Dr. Genta with the email vmgenta@sentara.com if you are interested

in a medical or pathology related project.

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Introduction

Sugar is everyone’s favorite sweetener and is practically in everything people consume.

However, as consumption of this sweetener increases so does an increasingly worrying problem.

Type 2 diabetes mellitus is a metabolic disorder, in which glucose is not taken from the blood

and into the body at a fast enough rate, producing hyperglycemia. Hyperglycemia occurs when

there is too much sugar in the bloodstream. The prevalence of this disorder has grown greatly

over time throughout the world and throughout the United States. In fact, globally, the number

of people diagnosed with diabetes has increased from 108 million in 1980 to 422 million in

2014. It is estimated that, collectively, type 1 and type 2 diabetes have been diagnosed in 8.5%

of the world’s population as of 2014; however, type 2 diabetes makes of 90%-95% of these

cases. Here, in the United States, 30.3 million Americans have diabetes (9.4% of the

population), but only 1.25 million of these Americans have type 1 diabetes (Diabetes Basics,

2017). Not only is the prevalence increasing across the all United States population, but it is also

increasing within young adults and teens. The number of teens with diabetes is not considered

significant, but the increase in the number of cases is. This has to do with the rise of obesity

within the United States.

When examining these statistics it is not hard to see why type 2 diabetes is a huge

problem and therefore, I wanted my senior project to focus primarily on the prevention of type 2

diabetes. Though, the statistics alone is not what influenced my decision. Throughout my

seventeen years of life I have met many people who have type 2 diabetes or have a risk of

developing the disorder. These people include my godmother and my grandmother. My

godmother is currently going through type 2 diabetes and, I have seen her prick her finger more

than once per day to check her blood sugar. My grandmother died when I was seven from
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congestive heart failure due to her diabetes. Because she had diabetes, my mother and I are also

at risk to one day develop the disease. That is, if we don’t maintain a healthy lifestyle. As a

result, the topic of diabetes is a very sad yet important issue to me.

As I began my journey into type 2 diabetes, I realized that I did not know very much

information. When I started this, I thought type 2 diabetes was fairly simple. Based on my

experience with the disorder and some light research, I figured type 2 diabetes was caused by a

mixture of mainly weight and some genetics. Essentially, I believed the, “if you get fat, you get

diabetes,” which turned out to be wrong. I quickly learned that type 2 diabetes was extremely

complicated. I also discovered that I had a lot of learning on my hands.

Before I started my project I came up with a series of questions to help me throughout my

journey to understand this topic so close to my heart. I had a main question followed by several

sub-questions. Each of these sub-questions were going to be written and answered on my blog

and would answer my main question. My main question was “What is type 2 diabetes mellitus

and how can it be prevented?” I had to make this question have two parts because as mentioned

before I wanted to focus on the prevention of diabetes. I chose a total of five sub-questions to

research and answer: “What are the causes of type 2 diabetes?”, “What are the signs and

symptoms of type two diabetes?”, “How is type 2 diabetes diagnosed?”, “Why is the prevalence

of type 2 diabetes increasing?”, and “How can type 2 diabetes be prevented?” While the last

question is exactly the same as the second part of my main question, my reasoning for leaving it

in the main question still stands; however, I cannot answer it without also making it a sub-

question. Now, I was ready to begin my journey.

The Story
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The beginning of my journey starts with the search of my mentor. It was somewhat of a

rocky start as I consider myself as a very independent person, and I don’t like to trouble other

people when asking for help. At first, I wanted to complete my mentorship at a pediatric care

facility, unfortunately that fell through, and I was going to have to find a new mentor. The only

problem was that I did not have any other connections. Fortunately, my junior year was nowhere

near being over yet, so there was still plenty of time to find a mentor. However, once again, I

don’t like asking for help, so it took a bit of time and pushing from my parents to ask the ever so

helpful Mrs. Graves for assistance.

Mrs. Graves ask me some questions about what I wanted my senior project to be based

on. My answer was diabetes. She presented me with a choice between two mentors. The first,

was going to give me more hands on work and the second was going to make me read a lot and

have multiple discussions about the reading. I ended up choosing the second mentor because I

felt that I would learn a lot more with him. This mentor’s name was Dr. Valerio Genta and he

was a pathologist at Sentara Virginia Beach General Hospital. I was really excited, not only

because I knew I was going to receive an in depth learning experience about diabetes, but I also

want to become a pathologist when I’m older. As a result, I was killing two birds with one stone,

I was going to learn more about diabetes and experience a part of my dream job.

As soon as I got home I emailed my soon-to-be mentor. To my surprise her responded in

under 10 minutes to my email (and this would be the case with every email I sent). He happily

agreed to be my mentor and we met a few days later after that email. During this meeting my

topic changed slightly, or rather it became more specific, instead of focusing on diabetes mellitus

as a whole, Dr. Genta suggested I only focus on type 2 diabetes. Which ended up being a very

good idea because I was overwhelmed by the information on type 2 diabetes alone. We talked
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for about an hour on how I planned to do things and what he did as a pathologist at the hospital.

He seemed extremely nice and very smart, but was sometimes hard to understand due to his

Italian accent.

My mentorship at the Sentara hospital did not start right away after our first meeting, in

fact, it started on July 2nd, 2018. On that day I got a real look in to how smart Dr. Genta was.

He knew a lot of information about many subjects, not just pathology or diabetes. On the first

day he assigned for me to read the beginning of a translation of Sidereus Nuncias by Galileo

Galilei. Sidereus Nuncias is a short astronomical treatise. It was written by Galileo to describe

his observations the Medicean Stars, which were later discovered to four moons of Jupiter. It

may seem strange that I read a piece about astronomy and Galileo. Wasn’t I supposed to be

learning about diabetes? What did this have to do with my senior project? The answer is that it

had nothing to do with my senior project itself. Astronomy is very different from pathology let

alone diabetes. However, I didn’t read the treatise because it was going to answer my questions

about type two diabetes, I read it because it would help me answer my questions about type 2

diabetes. Dr. Genta knew that I would have to do a lot of reading and look at graphs, he wanted

me to be able to document what I saw in an organized and methodical way. Just as Galileo did.

Also, Dr. Genta is a huge fan of Galileo.

After Dr. Genta and I discussed the methodology Galileo used to publish his findings, I

dove right into reading about type 2 diabetes. For the first couple of weeks I was given three

clinical chemistry books with their own sections on diabetes. The first textbook was TIETZ

Textbook of Clinical Chemistry and Molecular Diagnosis Fourth Edition, the second was

Clinical Chemistry Laboratory Management and Clinical Correlations, and the third was TIETZ

Fundamentals of Clinical Chemistry Fifth Edition. After I finished taking notes on one book we
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would discuss the content. I was allowed to ask questions and make sure my notes were correct.

I also had to update information in my book to make my notes accurate for today. Almost

everyday, I read, I took notes, and I discussed my reading. I became well versed in almost

everything dealing with type 2 diabetes, from the factors that correlate with type 2 diabetes to the

diagnosis of the disorder.

From these books I learned a lot of information. My favorite book was the third one.

This is because it best explained the information in a way I understood, even though it was

almost identical to the first book. This is because they were made by the same company. The

first book I described; however, was my least favorite because it had too much information and

not everything was explained in an easy to understand way, so the third book really helped clear

a lot of lingering questions up. I also had to do online research for these textbooks because not

all the information was accurate for today. I used the CDC website to update and confirm

information given to me in the textbooks.

For the remainder of this section I’m going to explain my findings based on the various

parts of type 2 diabetes, since each of my topic questions were explored in each textbook. So, I

will talk about the causes of type 2 diabetes, then the symptoms, then the diagnosis, then the

prevention, and then the increasing prevalence.

First, based on the reading there is no known direct cause of type 2 diabetes. However,

there are many factors that appear to contribute to the risk of developing type 2 diabetes. Before,

I discuss the factors, it is important to discuss two common defects found in type 2 diabetic

patients. Insulin resistance which is a decreased ability of insulin to act on peripheral tissues,

this is thought by many investigators to be the primary underlying pathological process, and

beta-cell dysfunction which is an inability of the pancreas to produce sufficient insulin to

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compensate for the insulin resistance (Carl A. Burtis, PhD, Edward R. Ashwood, MD and David

E. Bruns, MD, 2006). These are not causes of the disorder, but simply observable differences

between a healthy patient and one with type 2 diabetes. Because of these defects a person with

diabetes must take insulin shots; however, by maintaining a healthy lifestyle and monitoring

one’s sugar intake a diabetic patient can stop the insulin shots.

A factor of type 2 diabetes is weight. Weight also is most often confused as being a

cause of type 2 diabetes, but the relationship is very complex. While around 80% of patients

with type 2 diabetes are considered obese, only 10%-15% of the national obese population has

type 2 diabetes (Carl A. Burtis, PhD, Edward R. Ashwood, MD and David E. Bruns, MD, 2006).

So it is widely acknowledged that weight is a huge factor when determining the potential risk for

diabetes, but it is also obvious that it is not the only risk factor.

A second risk factor is genetics. The genetics playing into type 2 diabetes is also very

difficult for scientists to understand. It has been known as a “geneticists nightmare.” However,

the proof genetics play a role in determining one’s risk for developing this disorder are their. For

example, the concordance rate for type 2 diabetes in identical twins approaches 100%. Meaning

if one identical twin has type 2 diabetes the other one does too, especially in cases where there

are similar weights. Also, an obese person with one diabetic parent is ten times more likely to

have diabetes than an equally obese person with no diabetic family history (Carl A. Burtis, PhD,

Edward R. Ashwood, MD and David E. Bruns MD, 2006).

While weight and genetics are probably the biggest factors when determining the risk of

type 2 diabetes development, there are many others. Age is also a huge one, as most people with

the disorder then to be over 45 years old. However, as previously stated the prevalence in the

younger generation has increased and will be discussed late in this section. Gestational diabetes
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is also a large risk factor. Gestational diabetes occurs during pregnancy and mainly affects the

mother’s sugar levels; however, the child is more likely to become obese and develop type 2

diabetes and the mother is also more likely to develop type 2 diabetes later on life (Type 2

diabetes, 2019)

This risk interested me greatly because it my great grandmother on my mother’s side, Ila,

started my diabetic family history. However, as far as my mother knows there was no reason for

Ila to have type 2 diabetes as she was skinny and healthy. As a result, I developed my own

theory since learning about gestational diabetes, and that was that Ila had gestational diabetes.

This would explain why my grandmother always struggled with her weight and developed type 2

diabetes, and why Ila, a healthy woman, developed the disorder as well. Dr. Genta said that was

a reasonable hypothesis.

Alcohol is also a risk factor because alcohol damages the pancreas reducing its ability to

produce insulin (Dr. Genta, 2018). In fact someone I know, who is a young adult and very skinny

has type 2 diabetes which was caused from too much alcohol. He drank a little too much in

college and it practically destroyed his pancreas. Excessive drinking is probably one reason why

the prevalence of type 2 diabetes is increasing in the younger generation.

There are many signs and symptoms associated with type 2 diabetes. Increased hunger is

a very noticeable sign that someone may have type 2 diabetes. Without enough insulin to move

sugar into your cells, your muscles and organs don't get enough energy. This causes intense

hunger. A seemingly ironic and contradictory symptom is weight loss, but despite eating more

than usual to relieve hunger, you may lose weight. Because glucose can't be used as energy, fuel

is taken from muscles and fat. More calories are also lost when glucose leaves the body as

waste. A few other symptoms include fatigue, blurred vision, slow-healing, and areas of
Running Head: TYPE 2 DIABETES 9

darkened skin. Or a person may experience no symptoms at all, which is why it is important for

people to get their blood sugar checked at least once a year.

There are also four main tests doctors check to see if a person has type 2 diabetes. The

most modern test is the A1C test. This test is interesting because it does not show glucose levels,

it is based on the attachment of hemoglobin to glucose. To be diagnosed with diabetes the

patient’s A1C must be at least 6.5%. While this is the most modern way to test for glucose, it is

not the most common way because it does not diagnose diabetes as often. It also can report a

falsely increased or lowered result if the patient if of a certain heritage because different

ethnicities have different types of hemoglobin, or if the patient has kidney disease, liver disease,

or iron deficiency anemia (Rodney S. Markin, 2002).

The oral glucose tolerance test (OGTT), is one of the more common tests because is is

less likely to be affected by illness and stress which can influence the effectiveness of insulin

This test directly measures blood sugar levels after an eight hour fast and two hours after a

sugary drink is taken. It shows how well the insulin is eliminating the glucose from the patient’s

blood. To be diagnosed with diabetes the patient must have a blood sugar level of at least 200

mg/dL. It is inconvenient for the patient to fast and it is involves a morning appointment so that

the patient will not tempted to eat before the appointment. However, this test is more likely to

diagnose diabetes than the A1C test (Rodney S. Markin, 2002).

Another test is the Fasting Plasma Glucose test (FPG) and this test is very similar to the

OGTT as the patient has to fast before their appointment, but no sugary drink is needed. Also

FPG is the most common test used. This is because the test costs very little and is widely

available. However, this test is less likely to diagnose diabetes than the OGTT, but more likely
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to diagnose it than the A1C test. To be diagnosed with diabetes the patient must of have blood

sugar level of 126 mg/dL. This test is affected by illness or stress (Rodney S. Markin, 2002).

The last test is the Random (Casual) Plasma Glucose test (RPG). This test is almost

identical to the FPG, but no fast is necessary. This is because this test is only given to patients

that are experiencing extreme symptoms of diabetes. It is meant to diagnose diabetes quickly so

that the patient can get the necessary medication to curve the symptoms. When diabetes is

diagnosed the patient must have blood sugar level of at least 200 mg/dL and must show signs of

polyuria (increased urination), polydipsia (increased thirst), and weight loss. As a result, it isn’t

used very often(Rodney S. Markin, 2002).

Making healthy choices is the main way to prevent type 2 diabetes as there is no known

cure for the disorder. Doing three simple things can help prevent diabetes: Eat healthy, exercise

regularly, and maintain a healthy weight. If a person has type 2 diabetes, choosing a healthy

lifestyle can prevent or mitigate future complications and problems. Also, as previously

mentioned, because of this a person with type 2 diabetes may not always have to use an insulin

shot.

Eating healthy foods is the first step in preventing type 2 diabetes. Make an effort to

purchase foods lower in fat and calories, but higher in fiber. Focus on fruits, vegetables and

whole grains. While fruits may have lots of sugar, sugar is not the cause of diabetes, so while it is

important to keep track of blood sugar always, it is okay to eat sugar if you do not have diabetes.

Exercising is extremely important in addition to eat healthily. Aim for a minimum of 30

minutes of moderate physical activity a day. Research shows that for every 500 kcal your work

off your chances of developing type 2 diabetes decreases by 5%-7% (Carl A. Burtis and Edward

R. Ashwood, 2013).
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Losing excess pounds can mitigate or reduce your chances of developing type 2 diabetes.

If you're overweight, losing 7 percent of your body weight can significantly reduce the risk of

diabetes. About 60% To keep your weight in a healthy range, focus on permanent changes to

your eating and exercise habits (Carl A. Burtis and Edward R. Ashwood, 2013). There is also

oral medication that can be taken to help prevent diabetes from becoming severe. However,

maintaining the healthy lifestyle is essential even when taking the medication.

Now, the main reason diabetes has become an increasingly popular is because the

prevalence of the disorder is also increasing. While the prevalence of diabetes is unknown, the

CDC predicts, however, that 30.3 million people have diabetes in the United States which is

9.4% of the population. 90% of these people have type 2 diabetes. Over the past years the

number of cases have increased dramatically. In the 1950s only 1.5 million people were

diagnosed with diabetes. So what has been the cause of this drastic increase? Considering

weight has been linked as a factor contributing to diabetes, it is no wonder that the obesity

epidemic within the US has been correlated with this increase. The obesity epidemic has been

caused by an array of factors. Poor people tend to be more obese and with the more common

scenario of food deserts which involves the only food around is fast food and junk. Also with

increased technology it allows people to be lazier and work less hard to get tasks done.

Not only has the number of cases increased across the country, the number of cases

within teens and young adults has increased too. Though the number of cases is not significant

compared to the total number cases, the increase has been considered significant. This is

concurrent to the obesity epidemic as well, type 2 diabetes is becoming increasingly more

common in obese children and adolescents. Until a decade ago, type 2 diabetes accounted for

less than 3% of all cases of new-onset diabetes in adolescents. At present 45% of cases are
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attributed to it (D’Adamo, E., & Caprio, S. 2011). Meaning ten years ago, almost all cases of

diabetes in adolescents was most likely type 1 diabetes, but now type 1 diabetes accounts for a

little over half of the diabetic cases in adolescents.

Hence, it is easy to see that I received a lot of information while working with Dr. Genta.

I probably learned a lot more than I bargained for. However, this was one of the best

experiences of my life and I am extremely happy that I did choose the other mentor. I was able

to learn more about something that might affect me in the future and how I could possibly

prevent it from happening. I also showed my mother the information as a received it, since she is

more likely to develop type 2 diabetes than me.

My Product

After my mentorship with Dr. Genta I knew exactly what I wanted my product to be.

During my mentorship I realized I learned a lot of valuable information that needed to be shared

with others. As a result, I wanted to create a lesson plan that highlighted the importance of type

2 diabetes prevention. However, my problem was that I didn’t know who was the best group to

receive my information. I thought about adults; however, as time goes on it is harder to prevent

diabetes, and also I wanted to highlight the significance of in the increase in prevalence for the

younger generation. So, I turned my thoughts towards high school, but considering there were

high school teenagers out there with type 2 diabetes, I did not want to offend anyone, since I will

be talking about maintaining a healthy weight, exercising, and eat healthy. I thought these things

may make someone on the verge or with the disorder feel bad about themselves. Lastly, I

considered middle school students. They were old enough to understand the importance of type
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2 diabetes prevention, but young enough that none of them should have type 2 diabetes. They

seemed like the perfect group to present a lesson to about diabetes.

My lesson was devised into three main parts: a presentation through Google Slides, a

worksheet I created, and a Kahoot game to evaluate what they learned. For the presentation part

of my product I first explained what type 2 diabetes was and then went on to explain the factors.

Throughout the lesson I planned to ask question to help them get involved and make sure they

were paying attention. I then talked about the symptoms of type 2 diabetes as well as add a small

slide about long term complications. The reason I added this slide was so that they understood

type 2 diabetes was a very serious disorder and the issue was not to be taken lightly. The next

slide had to do with my main reason for teaching the lesson and that was for diabetes prevention.

I listed the three ways to prevent type 2 diabetes and verbally went more in depth with each way.

The next slide on the presentation asked the kids to create a meal and workout plan.

For the meal plan I used a MyPlate template because that is what the students use to give

examples of healthy eating. The goal was for them to list three healthy foods in each category,

that they could eat at meal time. On the back of the paper, I had them create an hour long

workout comprising of three exercises. The students were allowed to choose how long each

exercised lasted, but each workout had to be a total of at least 60 minutes. After both of these

sections were done I had the students read out examples of the foods they listed and the exercises

they chose.

The Kahoot game was very simple and only five questions long. These questions were:

“What is type 2 diabetes?” “What does insulin do?” “What is a major defect of type 2 diabetes?”

“Factors of type 2 diabetes,” and “What can be done to prevent type 2 diabetes?” I considered

making the Kahoot longer, but time was a large constraint for me, and I wanted to make sure the
Running Head: TYPE 2 DIABETES 14

information and worksheet were completed before moving on to the Kahoot. There is a lesson

plan in the appendix to show how the lesson in more detail.

My lesson was supposed to presented to the students of Virginia Beach Middle School’s

(VBMS) health and PE classes in November. Unfortunately this did not workout and I quickly

decided to present the lesson to four team of my travel volleyball club in December. Their

lesson involved the same presentation, but there was no worksheet and instead of a Kahoot there

was a Google Form that needed to be completed, with very similar questions. I also only had

thirty minutes to complete this lesson because each team had to get back to practice.

I also presented each group with an evaluation, the middle schoolers had a paper one and

the volleyball player’s evaluation was in the the Google Form.

My Results

I’ll start with results from the day that I presented my lesson with the volleyball players.

Overall, it went extremely well, but this was to be expected because I knew a lot of them. There

is not much to say about them because they were not very exciting. A few would ask questions,

but they mainly sat there and listened. After the lesson was finished they filled out the Google

Form. As I expected most of the players did extremely well with 97% of the players receiving a

four or three on the form. Eight students received a three; however, it appeared some errors

could have been caused carelessly, and I don’t believe a 75% on the quiz accurately reflects what

the student learned. However, once again I could not make the quiz longer, as I had a thirty

minute time constraint.

Most of the feedback from the players was positive, 97% of the students gave me a four

or five while only one gave me a three. There were no ones or twos given by the players.
Running Head: TYPE 2 DIABETES 15

However, I believe the students were slightly biased because many of them were friends, despite

this I did receive some good suggestions which would help me present to the middle school

students later on such as: talk slower and that the lesson was not engaging enough.

On the 22nd of January I presented to VBMS’s middle school students. I was very

nervous as I am not must of a public speaker, but I was also equally excited because I would be

sharing valuable information. I presented to three classes that day. The first class was extremely

quiet and small, they were a fantastic test run for the following classes. However, because they

were so quiet and mellow the lesson flew by extremely fast, no one wanted to ask questions.

About 86% of my responses were fours and five, but I had to void one response because the

student did nothing the whole class and gave me ones. I may have included the ones; however

he or she’s feedback for recommended improvements was “don’t teach it at all.” So her

evaluation did not accurately express how my lesson went. There was also almost each student

got a 100% on the Kahoot.

The next two classes were very similar. They were loud, excited, and rowdy. I also

recognized many of the students within the class and they recognized me since my mother is a

math teacher at VBMS. Both of these classes had almost, if not over 30 students. They were

extremely talkative but seemed eager to learn about the lesson. These classes also asked more

questions, which allowed the lesson to fill up it’s time constraint. After I finished the

presentation, the students filled out the worksheet, which took longer than expected. I don’t

remember my seventh grade classmates being so distracted and unwilling to do work. However,

after threatening them with no Kahoot the work was done a much faster pace. Most of the

students had reasonable answers for each section of the worksheet, but there were answers such a

bacon when they were supposed to each healthy foods, and unrealistic workouts. Many included
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doing burpees or push-ups for twenty minutes straight. The Kahoot game went very well in each

of these classes and they really seemed to enjoy it. For these classes it was recommended that I

give candy to the winners so that they had a larger incentive to win. It worked out nicely.

The evaluations for these classes did not work out as nicely. While the students seemed

to enjoy their time in the class much of the feedback included low scores. Unfortunately, it was

noticeable that some students just wanted to be a pain for the fun of it, so I don’t know which

low scores accurately represent what the student thought, or if they just gave me that for the heck

of it. About 14% of the total scores were ones and twos versus none in my previous lessons. I

did have to throw out a few low scores once again because it was obvious it did not reflect my

lesson accurately. One student gave me a one and two, and then proceeded to write in the

improvement section “I was very tired and did not pay attention, but I’m sure she did good.”

While it did give me a laugh, it needed to be thrown out. I also believe some of the positive

scores were biased in that the students like my mom so much, however most of the scores

received were not fours and fives, but mainly just fours. Though when looking at the

improvement section to see why I received a less than perfect score, the main response was to

make the Kahoot longer, which unfortunately was not possible due to time constraints or I would

have from the beginning.

Overall, I think this was a great experience for me and the students. It was definitely a

step out of my comfort zone as I do not generally enjoy public speaking. However, I very much

enjoyed this. I believe that I have accomplished tremendous personal growth because of this

senior project. I learned how to understand complicated information and ask meaningful and

thoughtful questions thanks to Dr. Genta. I also, learned how to speak in public better, which

will help me prepare for my presentation on my senior project.

Running Head: TYPE 2 DIABETES 17

One thing I could do better to work on is time management. I tended to be rushing to get

things done. Another improvement I could make about myself is to learn to ask for help when I

am rushing to get things done. Because whenever I asked for help even if it was just once,

everything seemed to be much more clear and run a lot smoother. In conclusion, I believe my

senior project was a huge success and I would not change any part of it.

References

Carl A. Burtis and Edward R. Ashwood (2013) TIETZ Fundamentals of Clinical Chemistry Fifth

Edition

Carl A. Burtis, PhD, Edward R. Ashwood, MD and David E. Bruns, MD (2006) TIETZ

Textbook of Clinical Chemistry and Molecular Diagnosis Fourth Edition

D’Adamo, E., & Caprio, S. (2011, May 01). Type 2 Diabetes in Youth: Epidemiology

and Pathophysiology. Retrieved from

http://care.diabetesjournals.org/content/34/Supplement_2/S161
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Diabetes Basics (2017, June 01). Retrieved from

https://www.cdc.gov/diabetes/basics/diabetes.html

Dr. Valerio Genta, personal communication (July 23rd, 2018)

Rodney S. Markin (2002) Clinical Chemistry Laboratory Management and Clinical

Correlations

Type 2 diabetes. (2019, January 09). Retrieved from

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-
20351193