DIABETES MELLITUS

• The duration of action of short-acting insulin can be extended by the addition of protamine and zinc.
• Intermediate acting, long acting, and ultra-long acting insulins have a slower onset and last for longer periods.
• The duration of action of a particular type of insulin varies from one patient to another and needs to be assessed individually.
• Modified "depot" insulins are cloudy preparations.
• Insulin should be kept in the refrigerator or at room temperature for a maximum of 1 month.
• Ultra-short acting insulin has a rapid onset and short duration of action.
• Short acting insulin examples include regular insulin, soluble insulin, neutral insulin, and semilente.
• Short/rapid acting insulin has a relatively rapid onset and short duration of action.
• Ultra-short acting insulin examples include Lispro, Glulisine, and Aspart insulin.
• Genetic disorders associated with diabetes include Down's syndrome, Huntington's chorea, Myotonic dystrophy, and Turner's syndrome.
• During the honeymoon period, newly diagnosed individuals with diabetes may experience relative insulin deficiency and may require exogenous insulin.
• Type 1 diabetes is formerly known as insulin-dependent diabetes and accounts for 10% of cases.
• Type 1 diabetes is usually diagnosed in childhood or early adulthood.
• Oral hypoglycemic agents are not effective in lowering blood glucose levels in type 1 diabetes.
• Gestational diabetes mellitus (GDM) occurs during pregnancy and resolves after delivery.
• Endocrinopathies associated with diabetes include acromegaly, Cushing's syndrome, Phaechromocytoma, Somatostatinoma, and Aldosteronoma.
• The pathogenesis of type 1 diabetes involves phases of antibody production, impaired glucose tolerance, and abnormal fasting blood sugar.
• Drugs that can induce diabetes include nicotinic acid (niacin), beta blockers, thyroid hormone, diazoxide, beta-adrenergic agonists, thiazides, phenytoin, protease inhibitors, and immunosuppressive drugs.
• Type 1 diabetes is caused by beta-cell destruction and absolute deficiency of insulin.
• Infectious causes of diabetes include congenital rubella and cytomegalovirus.
• Other specific types of diabetes include maturity onset diabetes of the young (MODY) and type A insulin resistance.
• The causes of type 1 diabetes include genetic predisposition, viral infection, and autoimmune attacks.
• Patients with type 1 diabetes require insulin for survival and are at risk of developing ketoacidosis.
• The Somogyi effect is when a low blood glucose in the late evening causes a rebound effect leading to hyperglycemia in the early morning
• mmol/L (200 mg/dl) is the blood glucose level after a glucose load of 75 g in 300 ml of water during an oral glucose tolerance test
• HbA1c > 6.5% (48 mmol/mol) is considered diagnostic of diabetes
• Insulin analogs are created by modifying the human insulin molecule to alter absorption rates, duration, and time to action.
• Insulin requirements may be increased by pregnancy, infection, stress, trauma, and puberty, while they may be decreased in patients with renal or hepatic impairment and certain endocrine disorders.
• Indications for insulin use include Type 1 DM patients, patients with ketoacidosis, Type 2 DM patients when other methods have failed, pregnant women with Type 2 DM, and hyperglycemic emergencies.
• Mixtures of insulin preparations may be required and appropriate combinations have to be determined for each individual patient.
• Insulin preparations can be classified into types based on their duration and onset of action.
• The aim of insulin therapy is to achieve glycemic control, reduce the risk of complications, and maintain plasma glucose levels within a specific range.
• Clinical features of type 2 diabetes include polydipsia, polyuria, polyphagia, visual blurring, oral and genital thrush, muscle cramps, lethargy, peripheral neuropathy, postural hypotension, and various eye and leg complications.
• Diagnosis of diabetes is made based on symptoms and specific blood glucose levels.
• Diabetes insipidus and diabetes mellitus can be differentiated by examining the patient's urine output and blood glucose levels.
• Management of hypoglycemia involves rapid IV administration of glucose or PO/NG tube administration of concentrated sugar solution.
• The natural history of type 2 diabetes includes stages of insulin resistance, increased insulin secretion, impaired glucose tolerance, and overt diabetes.
• HHS (Hyperosmolar Hyperglycemic State) can cause coma due to high glucose and electrolyte imbalances causing osmotic shifts in the brain, as well as shock from fluid loss.
• Early clinical manifestations of hypoglycemia include cold sweat, tremor, hunger, or palpitations.
• Increased production of non-esterified fatty acids in obesity leads to insulin resistance in peripheral organs and increased gluconeogenesis in the liver.