Diabetes mellitus: Symptoms, diagnosis, complications and treatment

Diabetes is a chronic medical condition characterized by high levels of blood sugar (glucose). This occurs either because the body doesn't produce enough insulin (a hormone that regulates blood sugar) or because the cells don't respond properly to the insulin that is produced. Insulin is necessary for the body to effectively use glucose as a source of energy.

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History for diabetes mellitus type 1 and 2: 

• Symptoms of hyperglycemia
• Thirst, dry mouth 
• Polyuria 
• Nocturia 
• Tiredness, fatigue, lethargy 
• Noticeable change in weight (usually weight loss) 
• Blurring of vision 
• Pruritus vulvae, balanitis (genital candidiasis) 
• Nausea; headache 
• Hyperphagia; predilection for sweet foods 
• Mood change, irritability, difficulty in concentrating, apathy 
• Family history

Physical examination for diabetes mellitus type 1 and 2

• BMI
• Retinal examination
• Orthostatic blood pressure
• Foot examination
• Peripheral pulses
• Insulin injection sites
• Peripheral neuropathy

Type 1 Vs Type 2 Diabetes mellitus DM

Table: Type 1 Vs Type 2 Diabetes mellitus DM

Insulin and insulin syringe

	Type 1	Type 2
Onset	Sudden	Gradual
Age at onset	Any (mostly young)	Mostly in adults
Body habitus	Thin or normal	Often obese
Ketoacidosis	Common	Rare
Autoantibodies	Usually +	Absent
Endogeneous insulin	Low or absent	Normal, decreased or increased
Concordance in identical twins	~ 50%	~90%
Prevalence	Less prevalent	More prevalent (~90-95% of US diabetics)
Biochemical	C-peptide disappears	C-peptide persists

Increased bloog glucose sugar level definition is called when 

Normal Blood Glucose

• FPG <100 mg/dL (5.6 mmol/L)
• Two-hour glucose during OGTT <140 mg/dL (7.8 mmol/L)

Categories of increased risk for diabetes:

• •Impaired fasting glucose(IFG) 
•  FPG between 100 and 125 mg/dL (5.6 to 6.9 mmol/L).
• •Impaired glucose tolerance(IGT)
• Two-hour - 75 g OGTT between 140 and 199 mg/dL (7.8 to 11.0 mmol/L).
• •A1C – Persons with 5.7 to 6.4 percent (39 to 46 mmol/mol

Diagnostic criteria of Diabetes mellitus

 1.    A1C ≥6.5 percent 

OR

2.     Fasting Plasma Glucose ≥126 mg/dL (7.0 mmol/L)

        (Fasting is defined as no caloric intake for at least eight hours.)

OR

3.     Two-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT. 

        (The test should be performed using a glucose load containing the equivalent of 75-gram                     anhydrous glucose dissolved in water.)

OR

4.     In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random                     plasma glucose ≥200 mg/dL (11.1 mmol/L).

Advice to patients with Impaired glucose tolerance

1. Have an increased risk both of progression to type 2 diabetes and of developing macrovascular disease
2. Advice lifestyle modification  reduces the risk of progression in IGT
3. Monitor annually by measurement of fasting blood glucose 
4. Other cardiovascular risk factors  treate aggressively

For Management of Diabetes mellitus Please refer to this link.

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