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Diabetes Mellitus

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  1. See Also
    1. Diabetes Mellitus Glucose Management
    2. Type I Diabetes Mellitus
    3. Type II Diabetes Mellitus
    4. Insulin Resistance Syndrome
    5. Diabetes Mellitus Education
  2. Definition
    1. Metabolic disorder of carbohydrate economy
    2. Deficiency of pancreatic beta cell Insulin secretion
    3. Resistance to Insulin effect peripherally
  3. Epidemiology (U.S. statistics for 2004 per ADA)
    1. Prevalence
      1. Type I Diabetes Mellitus: 750,000
      2. Type II Diabetes Mellitus: 13 million
      3. Gestational Diabetes: 135,000
      4. Undiagnosed with diabetes: 5.2 million
    2. Incidence
      1. Type 1: 30,000 new cases per year
      2. Type 2: 850,000 new cases per year
      3. Gestational Diabetes Mellitus: 4% of all pregnancies
      4. Fastest growing groups
        1. Ages 30 to 39 years
        2. Type II Diabetes in children
  4. Types
    1. Type I Diabetes Mellitus
      1. Juvenile Diabetes Mellitus
      2. Insulin Dependent Diabetes Mellitus (IDDM)
    2. Type II Diabetes Mellitus
      1. Adult onset Diabetes Mellitus
      2. Non-Insulin Dependent Diabetes Mellitus (NIDDM)
      3. Pediatric Type II Diabetes Mellitus (Pediatric NIDDM)
      4. Maturity onset Diabetes of youth (MODY)
  5. Symptoms
    1. Classic (75% of cases of Type I Diabetes Mellitus)
      1. Polyuria or nocturia
      2. Polydipsia
      3. Unexplained Weight Loss
    2. Other symptoms
      1. Increased appetite
      2. Blurred vision
      3. Frequent Urinary Tract Infections
      4. Frequent yeast infections
      5. Fatigue
      6. Dry or pruritic skin
      7. Numbness or tingling in the extremities
  6. Diagnostic Criteria
    1. Random Serum Glucose
      1. Serum Glucose over 200 mg/dl with symptoms
    2. Fasting Serum Glucose
      1. Serum Glucose exceeds 126 mg/dl on 2 different days
    3. Postprandial Glucose (2 hours post meal)
      1. Serum Glucose over 200 mg/dl
      2. Precedes fasting glucose increase
      3. More predictive of Diabetes Mellitus Complications
    4. Casual Plasma Glucose (random glucose)
      1. Same criteria as postprandial glucose
    5. Oral Glucose Tolerance Test (OGGT)
      1. Two hour Glucose Tolerance Test (75 gram) >200 mg/dl
      2. Consider in patients with Insulin Resistance
        1. Patients with pre-diabetes to qualify for education
  7. Other monitoring
    1. Home Serum Glucose monitoring
      1. Over 50% of values should fall in target range
  8. Management: Severe Hyperglycemia at diagnosis
    1. Start Insulin at onset if severe hyperglycemia
    2. Criteria
      1. Blood Glucose >300 mg/dl
      2. Hemoglobin A1C >9.0
    3. Protocol based on Urine Ketones
      1. Urine Ketones positive
        1. Evaluate for Diabetic Ketoacidosis
        2. Check Metabolic panel and Serum Ketones
      2. Urine Ketones negative
        1. Type I vs Type II is not critical initially
          1. Both get Insulin at this hyperglycemia level
          2. Type II suspected
            1. Consider adding Metformin
            2. Insulin can likely be weaned later
              1. Glucose toxicity causes low Insulin level
              2. Endogenous Insulin will later normalize
        2. Start Lantus Insulin at 10 units SQ today
          1. Low risk of Hypoglycemia
        3. Teach glucose testing, Insulin injection today
          1. Formal Diabetic Education within 1 week
          2. Consider endocrinology consultation later
        4. Give prescriptions today
          1. Meter, strips, lancets, Insulin, syringes
  9. Management: Initial Education
    1. Key Topics
      1. See Diabetes Mellitus Glucose Management
      2. See Diabetes Mellitus Education
    2. Type specific Diabetes Information
      1. See Type I Diabetes Mellitus
      2. See Type II Diabetes Mellitus
    3. Adjunctive Management
      1. See Hypertension in Diabetes Mellitus
      2. See Coronary Artery Disease Prevention in Diabetes
      3. Tobacco Cessation
      4. Weight loss
      5. Aspirin in all diabetic patients
      6. Consider ACE Inhibitor in all diabetic patients
        1. Use low dose (2.5 to 5 mg) in normotensive patient
      7. Lipid disorders
        1. See Coronary Artery Disease Prevention in Diabetes
        2. See Low Fat Diet
        3. See AntiHyperlipidemic

Diabetes Mellitus (C0011849)

Definition (MSH)A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.
Definition (CSP)heterogeneous group of disorders that share glucose intolerance in common.
Definition (NCI)(dye-a-BEE-teez) A disease in which the body does not properly control the amount of sugar in the blood. As a result, the level of sugar in the blood is too high. This disease occurs when the body does not produce enough insulin or does not use it properly.
Definition (NCI)Type 2 diabetes, characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Adipocytes secrete a unique signalling molecule, which was named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.
ConceptsDisease or Syndrome (T047)
ICD9250, 250.0
BasqueDIABETES MELITUSA
DanishDiabetes mellitus
DutchDiabetes mellitus
EnglishDiabetes, Diabetes Mellitus
FinnishSOKERITAUTI
FrenchDiabete sucre
GermanDiabetes mellitus
Hebrewsukeret
Hungariandiabetes mellitus
ItalianDiabete mellito
NorwegianSUKKERSYKE/DIABETES MELLITUS
PortugueseDiabetes mellitus
Spanishdiabetes mellitus, diabetes sacarina
SwedishDIABETES MELLITUS/SOCKERSJUKA
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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