Etiology
A disorder of glucose metabolism related to absence or deficient insulin supply or poor utilization of insulin. |
Pathophysiology
Factors |
Type 1 |
Type 2 |
Primary defect |
Absent or minimal insulin production due to autoimmune process |
Insulin resistance, decreased insulin production and alteration in production of adipokines |
Age |
Common in young people but can occur at any age |
Greater than 35 but can occur at any age |
Type of onset |
Abrupt signs and symptoms |
Insidious and can go undiagnosed for years |
Nutritional Status |
Thin, normal and Obese |
Obese oe normal |
Symptoms |
Thirst, Polyuria, Polyphagia, Fatigue, Weight loss |
Frequently none, fatigue, recurrent infections |
Insulin |
Required for all |
Some |
Summary of Diabetes Mellitus
Prediabetes
AKA Impaired glucose tolerance or impaired fasting glucose |
Noted when fasting glucose is higher than normal but lower than DM. |
Usually do not have symptoms however, the A1c should be tested regularly |
Reducing risk by eating healthy, maintaining a healthy weight and exercising regularly |
Secondary Diabetes
DM caused by another medical condition or a treatment of a medical condition. |
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Type 1 Diabetes Mellitus
This occurs from the gradual destruction of pancreatic beta cells by an autoimmune process either directly or indirectly. |
It can either be Type 1a (immune) or Type 1b (idiopathic) |
Manifestations occur when the pancreas can no longer produce insulin which justifies the abrupt onset. |
The classic symptoms are polydipsia, polyuria and polyphagia |
Outside supply of insulin is required or diabetic ketoacidosis can be developed |
Other symptoms include weakness and fatigue and change in visual acuity. |
Polydipsia is as a result of osmotic concentration of glucose in the body.
Polyphagia is caused by cellular malnourishment from lack of energy which means the cells do not get glucose to convert to ATP.
Weight loss occurs the body turns to other sources such as fat and protein for strength.
Weakness and fatigue from energy loss
Diagnostics Studies
Glycalated Hemoglobin A1c greater than or equals to 6.5% |
Fasting blood glucose level greater than or equals to 7.0 mmol/L |
Random plasma glucose greater than or equal to 11.1 mmol/L |
Two hour plasma glucose in a 75G OGTT greater than or equal to 11.1mmol/L |
*A1c test indicates the level of glucose over a particular time. It should be done every 3-6 months.
Gestational Diabetes
Occurs during pregnancy. |
Detected between 24 and 28 weeks of pregnancy, |
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Type 2 DM
Most powerful risk factor is obesity. |
Endogenous insulin is still produced by the body. However, the insulin is either insufficient, poorly utilized or both. |
There are four major factors that play a role in the development of DM2. |
1. Insulin resistance as a result of unreceptive receptors, insufficient receptors or both. Both hyperglycaemia and hyperinsulinemia occurs as the body tries to decrease glucose by increasing insulin production, |
2. A significant decrease in the ability of the pancreas to produce insulin. |
3. Inappropriate glucose production by the liver which leads to increased glucagon production which stimulates the glucose production in liver. In total increasing sugar level. |
4. Alteration hormones and cytokines production by adipose tissues. |
Onset of disease is gradual. |
Diabetic ketoacidosis complication can be prevented with a sufficient endogenous supply. However osmotic and electrolyte loss can become severe and cause hyperosmolar and hyperglycaemic state. |
Manifestations Nonspecific and not limited to fatigue, recurrent infections, prolonged wound healing, visual acuity changes, and painful neuropathy of the feet. |
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