Diabetes Mellitus
Evaluation
General—includes many diseases of abnormal carbohydrate metabolism with resultant hyperglycemia
Diagnostic criteria (use any of the following, but results must be confirmed on a separate day)
Nonfasting blood sugar (BS) ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b564685c698da69790df8700473c62ab4}/ID(AB1-M10)”>>200 mg per dL = diabetes mellitus (DM)
Fasting blood sugar (FBS) or fasting plasma glucose (FPG)
Normal = <A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<100 mg per dL
Clinical—polyphagia, polydipsia, polyuria, nocturia, weight loss, fatigue, and blurred vision
Epidemiology—approximately 25 million Americans have DM (diagnosed and undiagnosed combined)
Pathology—pancreatic β-cell destruction (through autoimmune attack or idiopathic) results in a decrease in insulin.
Epidemiology—5% to 10% of all cases of DM; occurs at low incidence level throughout adulthood.
Risk factors
Family history (particularly, a first-degree relative with DM type I)
Susceptibility predominantly rests with human leucocyte antigen (HLA) genotypes DR and DQ
Race (white, particularly those from northern Europe)
Management theory
Concepts as gleaned from the Diabetes Control and Complications Trial (DCCT)
Any decrease in HbA1c is associated with a decrease in relative risk of complications (microvascular [retinopathy, nephropathy, and neuropathy] and likely macrovascular).
Intensive management should be implemented once DM is diagnosed.
Hypoglycemia (→ cognitive impairment) is a limiting step in managing DM.
Management components
Insulin
Types (see Table 2.21.1)
Basal-bolus insulin therapy approach uses multiple daily injections or an insulin pump.
“Basal” supply of insulin allows the presence of a low level of insulin through the day, and is provided by intermediate, long, or very long-acting preparations given qhs or BID.
“Bolus” supply of insulin is needed to cover the expected rise in blood glucose after a meal, and is provided by the rapid or fast-acting preparations, given before meals and based on carbohydrate counting in grams or as determined by a sliding scale.
Determining insulin dosage by the Rule of Thirds (when dosage is unknown)
Nutritional planning
Tailor to the needs/preferences of the patient to improve compliance.
Consistency in meal planning can help in obtaining glycemic targets.
Complex carbohydrates and monounsaturated fat should only be 60% to 70% of energy intake.
Microvascular complications of DM type I
Diabetic nephropathy
Epidemiology—most common cause of renal failure in the developed world
Phases
Microalbuminuria—urinary albumin excretion 20 to 200 μg per dayRelated posts:
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