Diabetes Mellitus

Diabetes Mellitus
? DM is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
? T2DM 90-95% of all cases of diabetes
? T1DM & other causes representing 5-10%
? Risk for microvascular complications(retinopathy, nephropathy, & neuropathy, and high risk for macrovascular disease
? T2DM is accompanied by HT (75%) & hyperlipidemia which considered a "cardiac risk equivalent" because of the excess risk for macrovascular disease, cardiovascular disease (CV) events, and mortality
Classifications
1. T1DM
? (<10%)a cellular-mediated autoimmune destruction of the beta (B) cells of the pancreas.
? The rate of destruction of cells is rapid in infants and children and slower in adults. Thus, the presentation in young people is often ketoacidosis, whereas older persons may have a longer symptomatic prodrome and may be diagnosed on the basis of hyperglycemia and positive autoantibodies.
? Severe insulin deficiency.
? Exogenous insulin is required to :
- control (BG) level, prevent (DKA), and preserve life.
- withheld insulin from T1DM, ketosis will develop in 8 -16 hrs
ketoacidosis in 12-24 hrs.
? Early, some insulin secretory capacity remains and the insulin requirement may be lower than expected (0.3- 0.4 units/kg).
? Tight control from onset shown to preserve the residual B-cell function and prevent or delay later complications.
? Latent autoimmune diabetes in adults (LADA) is characterized by mild to moderate hyperglycemia at presentation that often responds to noninsulin therapies but progresses over months to years to insulin dependency.