DM

• Risk factors for diabetes mellitus


  • Obese
  • Genetics/family history
  • Pancreatic disease
  • Infection/illness that damage pancreas
• Type 1 Diabetes Mellitus (T1DM)


  • Younger age
  • Family history
  • Blurred vision, paresthesias, altered consciousness
  • Polyuria, polydipsia, weight loss with random plasma glucose ≥ 200 mg/dL
  • Plasma glucose ≥ 126 mg/dL after an overnight fast
  • Ketonemia, ketonuria, or both
  • Islet autoantibodies
• Type 2 Diabetes Mellitus (T2DM)


  • Asymptomatic to start
  • Hyperglycemic/hyperosmolar coma
  • Skin manifestations (itch, vaginitis, acanthosis nigricans, eruptive xanthomas)
  • Many patients are 40yo +/obese
  • Polyuria and polydipsia
  • Candidal vaginitis (initially)
  • HbA1C ≥ 6.5%
  • Hypertension, dyslipidemia, and atherosclerosis
• Pathophysiology of T1DM

  1. Beta cell destruction of islet B cells in pancreas

  2. Absolute insulin deficiency

  3. Hyperglycemia
• Pathophysiology of T2DM


  1. Insulin resistance with deficiency (insulin secretion problem)

  2. Immune cell loss and tissue insensitivity to insulin

  3. Resistance

  4. Beta cells function enough to prevent DKA but not hyperglycemia
• Lab tests for diabetes


  • Fasting plasma glucose
  • HbA1c
  • Urine glucose
  • Ketones (blood/urine) showing beta-hydroxybutyric acid
  • Oral glucose tolerance test
  • Self-monitor blood glucose
• Initiate medical therapy in new/established diabetics

  1. T1DM: Insulin injections daily, or pump

  2. T2DM: Diet (limit carbs, substitute calories with monounsaturated fats), Metformin, biguanide/DPP-4 inhibitor/GLP-1/GIP receptor agonist/SGLT2/sulfonylureas/thiazolidinediones
• Acute complications of diabetes


  • Hyperglycemia (thirst, polyuria, weight loss, blurry vision, random BG 200+)
  • Hypoglycemia (Neurogenic symptoms, Neuroglycopenic symptoms)
  • Diabetic ketoacidosis (DKA) (Hyperglycemia > 250 mg/dL, Metabolic acidosis with blood pH <7.3, Serum positive for ketones)
• Chronic complications of diabetes


  • Diabetic cataracts
  • Diabetic retinopathy
  • Glaucoma
  • Diabetic neuropathy (albuminuria, peripheral neuropathy, Charcot Arthropathy, Autonomic neuropathy)
  • Cardiovascular disease (heart disease, hypertension, peripheral vascular disease)
• Diabetes insipidus is characterized by excessive thirst and urination due to an inability to concentrate urine properly.