DM2

• Classic symptoms of hyperglycemia

  • Polyuria
  • Polydipsia
  • Nocturia
  • Weight loss (weight loss is prominent in type 1, infrequent in type 2)
• Polyuria

  Due to osmotic diuresis that occurs when blood glucose levels exceed the renal tubular resorptive capacity (the renal threshold)
• Fluid and electrolyte losses

  Stimulate thirst
• Weight loss

  Caused by fluid depletion and breakdown of fat and muscle secondary to insulin deficiency
• Other symptoms

  • Visual blurring
  • Genital thrush
  • Lethargy
  • Skin sepsis
  • Frequent candida infections
• May present with complications, ex: retinopathy
• Other causes of diabetes

  • Gestational diabetes
  • Drugs: steroids, anti-HIV drugs, antipsychotics, thiazides
  • Pancreatic: pancreatitis, surgery, trauma, cancer, hemochromatosis, CF
  • Endocrine disorders (Cushing, acromegaly, pheochromocytoma, hyperthyroidism)
  • Genetic/chromosomal syndromes, e.g. Down and Turner
  • Others: congenital lipodystrophy, glycogen storage diseases, iron overload in thalassemia
• Types of diabetes

  • Type 1
  • Type 2
  • MODY
  • LADA
• Type 1 diabetes

  • Age: Younger (usually <30 years)
  • Progression: Rapid (days/weeks)
  • Weight: Normal
  • Heredity: HLA DR3 or DR4 in >90%
  • Autoantibodies: Present
  • Clinical: Complete insulin deficiency
  • May develop ketoacidosis
• Type 2 diabetes

  • Age: Older (>25 years)
  • Progression: Slow (years)
  • Weight: Overweight or obese
  • Heredity: No HLA links, 50% concordance in identical twins
  • Autoantibodies: Absent
  • Clinical: Partial insulin deficiency, insulin resistance
  • May develop hyperosmolar state
• MODY

  • Age: < 25
  • Progression: Slow
  • Weight: Normal
  • Heredity: Autosomal dominant, Family history of DM in 2-3 generations
  • Autoantibodies: Absent
  • Clinical: Insulin secretion varies
  • Ketosis is rare
• LADA

  • Age: >30
  • Progression: Months/years
  • Weight: Normal
  • Heredity: Low HLA links, 30-50% concordance in identical twins
  • Autoantibodies: Present
  • Clinical: Insulin secretion varies
  • May develop ketoacidosis
• 1. peptide

  • Eventual disappearance in Type 1
  • Persists in Type 2
  • Variable in MODY and LADA