Diabetes Mellitus
- Diagnostic criteria
- FBS >126 mg/dl Most critical
- Random glucose >200 mg/dl with symptoms
- GTT ? indication
- Classification
- Type I
- Type II
- Insulin resistance
- Decreased insulin
- Secondary
- Gestational
- Chronic Pancreatitis
- Hemochromatosis
- Cushing's syndrome
- Pacreatectomy
- Impaired glucose tolerance
- Pathogenesis
- Type I
- Autoimmune destruction of beta cells
- Genetics
- Acute symptoms/ pathogenesis
- Urinary loss of glucose when blood glucose exceeds
renal threshold 180 mg/dl
- Loss of electrolytes and water with glucose
- Hyperosmolarity of serum, dehydration, hypovolemia
- Polyuria, thirst, polydypsia, polyphagia, loss of
weight, lack of energy
- Therapy
- Diet
- Estimate of caloric requirements
- Composition
- Balancing with Insulin administration
- Insulin
- Sources
- Types based on duration of action
- Complications of Insulin
- Hypoglycemia
- Lipodystrophy
- Allergic reactions
- Oral hypoglycemic agents
- Postprandial stimulation of endogenous insulin
- Decrease insulin resistance
- Delay carbohydrate absorption
- Exercise
- Type I
- Control of hyperglycemia
- Insulin / Diet and
exercise
- Long term complication
- "tight" control
- Low fat <30 percent
- Type II
- Diet
- Exercise
- Oral hypoglycemic agents
- Insulin
- Diabetic ketoacedosis
- Hyperglycemia / insulin
- Hyperosmolality, dehydration, hypovolemia , 6
liters of negative balance
- Ketosis
- Potassium shifts
- Avoid complications of therapy
- Correct precipitating factor
- Monitoring diabetic control
- Urinary glucose
- Blood glucose
- HbA1c
- Acute complications
- Diabetic ketoacidosis
- Non-ketotic hyperosmolar syndrome
- Chronic complications
- Microvascular disease
- Kidney
- Retina
- Non-proliferative
- Proliferative / Annual follow up / Laser
- Macrovascular disease
- Coronary artery
- Cerebrovascular disease
- Peripheral vascular disease
- Neuropathic
- Symmetrical peripheral neuropathy
- Mononeuropathy
- Foot ulcers
- Infections