Everything about Diabetes (1)

Everything about Diabetes (1)

Types of diabetes:

• T1DM: Autoimmune disease on pancreatic β-cells leading to absolute insulin deficiency.
• T2DM: Peripheral insulin resistance or pancreatic β-cell dysfunction with pro-amylin accumulation.
• GDM: Impaired glucose tolerance diagnosed during pregnancy.
• PDM: T1DM or T2DM diagnosed prior to pregnancy with risk of maternal and/or congenital risks.
• DI: Hypotonic polyuria due to ADH-dysfunctions leading to persistent hyperglycemia.
• Primary CDI: Insufficient synthesis or secretion of ADH - idiopathic or autoimmune.
• Secondary CDI: Insufficient synthesis or secretion of ADH - brain tumor, surgery, etc.
• NDI: Hereditary or acquired ADH-receptor dysfunction in kidney.
• Pancreatogenic DM: Diabetes following pancreatectomy or conditions that destroy pancreatic endocrine islets (e.g., hemochromatosis, cystic fibrosis).
• Drug-induced diabetes: Excessive corticosteroid use (steroid diabetes).

Types of diabetes based on on-set:

• Neonatal diabetes: Persistent hyperglycemia in neonatal period (when T1DM persists for > 1 week).
• MODY: Autosomal dominant genetic β-cell dysfunction before 25 years of age with no obesity.
• MODY II: Glucokinase gene defect.
• MODY III: Hepatocyte nuclear factor-1-a gene defect.
• LADA: Late onset of T1DM (often mistaken for T2DM).

Typical hyperglycemic symptoms:

• Polydipsia (increased thirst).
• Polyuria (increased urination).
• Polyghagia (increased hunger).
• Unexplained weight loss.

Diagnostic criterias:

• Random blood glucose level > 200 mg/dL + hyperglycemic symptoms = DM.
• > 2 abnormal test results for hyperglycemia in asymptomatic individuals in 2 different days.
• FPG (fasting plasma glucose) level > 126 mg/L (7 mmol/L).
• OGTT (oral glucose tolerance test) level > 200 mg/L (11.1 mmol/L).
• Hemoglobin A1C > 6.5%

Treatment:

• T1DM: Insulin therapy.
• T2DM: Exercise + Diet + Noninsulin antidiabetics and/or insulin therapy.
• GDM: Regular exercise + Diet + Insulin therapy + Regular ultrasound to evaluate fetal development
• PDM: Exercise + Diet + Insulin therapy + Consider C-section if fetus weight is > 4,5 kg
• DI: Drink water + Low-sodium/protein diet
• Primary CDI: Intranasal desmopressin or chlorpropamide.
• Secondary CDI: Intranasal desmopressin or chlorpropamide.
• NDI: Treat underlying cause or  Stop giving causative agent + Thiazide diuretics + Indomethacin (NSAIDs).

Intranasal desmopressin is for CDI due to decreased hypothalmic secretion and chlorpropamide is for CDI due to decreased posterior pituitary secretion. Also, amiloride is indicated for patients with lithium-induced NDI who continue lithium therapy.

Comprehensive diabetes care:

• Weight reduction (exercise, weight loss drugs, or bariatric surgery)
• Balanced high-fiber diet
• Regular exercise
• Smoking cessation