Diabetes mellitus: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Diabetes mellitus}} | |||
{{CMG}}; {{AE}}{{MehdiP}} | |||
{{CMG}}; {{AE}} | |||
{{SK}} Diabetes; DM | {{SK}} Diabetes; DM | ||
== | ==Overview== | ||
Diabetes mellitus (DM) refers to a spectrum of disorders with different metabolic changes that result in hyperglycemia as a common feature. It is caused by interaction of environmental agents in a genetically susceptible person. The metabolic disarrangement that may result in hyperglycemia will define the pathologic feature of each types of DM. Decreased insulin secretion, insulin resistance, decreased glucose utilization and increased glucose production are the main metabolic dysregulations that are known to cause hyperglycemia. Hyperglycemia may cause secondary changes in metabolic arrangement in different systems and it can involve every organ systems. DM is the leading cause of end-stage renal disease (ESRD), nontraumatic lower extremity amputations, and adult blindness worldwide and, early diagnosis and treatment can result in significant decrease in mortality and morbidity. The incidence of Diabetes has been increasing constantly. According to WHO reports 346 million people worldwide have diabetes and it is projected to double by 2030. It's prevalence is more in developed countries but the death occurring due to it is commoner in developing world. The prevalence of Diabetes type 2 is commoner than type 1 diabetes. Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include macrovascular (Coronary heart disease, peripheral arterial disease and cerebrovascular disease), microvascular (retinopathy, neuropathy and nephropathy) and other organ involvement (gastrointestinal, genitourinary, dermatologic, infectious, cataracts, glaucoma, periodontal disease and hearing loss). The main goals of treatment are: | |||
#Eliminate hyperglycemic symptoms | |||
#Control the long term complications | |||
== | #Improve the patient's quality of life | ||
==Classification== | |||
Diabetes mellitus is classified in to 3 types based on pathogenic process that lead to hyperglycemia. | |||
*[[Diabetes mellitus type 1]] | |||
*[[Diabetes mellitus type 2]] | |||
*[[Gestational diabetes]] | |||
==Differential diagnosis== | |||
== | |||
==[[Diabetes mellitus | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center | ||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Disease | |||
==[[Diabetes mellitus | ! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;"|History and symptoms | ||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;"|Laboratory findings | |||
==[[Diabetes | ! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Additional findings | ||
|- | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Polyuria | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Polydipsia | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Polyphagia | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Weight loss | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Weight gain | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Serum glucose | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Urinary Glucose | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Urine PH | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Serum Sodium | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Urinary Glucose | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|24 hrs cortisol level | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|C-peptide level | |||
!align="center" style="background:#4479BA; color: #FFFFFF;"|Serum glucagon | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diabetes mellitus type 1|Type 1 Diabetes mellitus]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''''↑''''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Auto antibodies present ([[GAD65|Anti GAD-65]] and anti insulin anti bodies) | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diabetes mellitus type 2|Type 2 Diabetes mellitus]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Acanthosis nigricans]] | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[MODY]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Psychogenic polydipsia]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diabetes insipidus]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Transient [[hyperglycemia]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |In hospitalized patients especially in [[ICU]] and [[CCU]] | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Steroid]] therapy | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Acanthosis nigricans|Acanthosis nigricans,]] | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[RTA|RTA 1]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypokalemia]], [[nephrolithiasis]] | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Glucagonoma]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Necrolytic migratory erythema]] | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cushing's syndrome|Cushing syndrome]] | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |✔ | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑''' | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal | |||
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Moon face]], [[obesity]], [[buffalo hump]], easy [[Bruising|bruisibility]] | |||
|} | |||
==Diagnosis== | ==Diagnosis== | ||
==References== | |||
Revision as of 19:55, 7 March 2017
Diabetes mellitus Main page |
Patient Information |
---|
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Synonyms and keywords: Diabetes; DM
Overview
Diabetes mellitus (DM) refers to a spectrum of disorders with different metabolic changes that result in hyperglycemia as a common feature. It is caused by interaction of environmental agents in a genetically susceptible person. The metabolic disarrangement that may result in hyperglycemia will define the pathologic feature of each types of DM. Decreased insulin secretion, insulin resistance, decreased glucose utilization and increased glucose production are the main metabolic dysregulations that are known to cause hyperglycemia. Hyperglycemia may cause secondary changes in metabolic arrangement in different systems and it can involve every organ systems. DM is the leading cause of end-stage renal disease (ESRD), nontraumatic lower extremity amputations, and adult blindness worldwide and, early diagnosis and treatment can result in significant decrease in mortality and morbidity. The incidence of Diabetes has been increasing constantly. According to WHO reports 346 million people worldwide have diabetes and it is projected to double by 2030. It's prevalence is more in developed countries but the death occurring due to it is commoner in developing world. The prevalence of Diabetes type 2 is commoner than type 1 diabetes. Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include macrovascular (Coronary heart disease, peripheral arterial disease and cerebrovascular disease), microvascular (retinopathy, neuropathy and nephropathy) and other organ involvement (gastrointestinal, genitourinary, dermatologic, infectious, cataracts, glaucoma, periodontal disease and hearing loss). The main goals of treatment are:
- Eliminate hyperglycemic symptoms
- Control the long term complications
- Improve the patient's quality of life
Classification
Diabetes mellitus is classified in to 3 types based on pathogenic process that lead to hyperglycemia.
Differential diagnosis
Disease | History and symptoms | Laboratory findings | Additional findings | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Polyuria | Polydipsia | Polyphagia | Weight loss | Weight gain | Serum glucose | Urinary Glucose | Urine PH | Serum Sodium | Urinary Glucose | 24 hrs cortisol level | C-peptide level | Serum glucagon | ||
Type 1 Diabetes mellitus | ✔ | ✔ | ✔ | ✔ | - | ↑ | ↑ | Normal | Normal | N/↑ | Normal | ↓ | Normal | Auto antibodies present (Anti GAD-65 and anti insulin anti bodies) |
Type 2 Diabetes mellitus | ✔ | ✔ | ✔ | ✔ | - | ↑ | ↑ | Normal | Normal | ↑ | Normal | Normal | ↑ | Acanthosis nigricans |
MODY | ✔ | ✔ | ✔ | - | ✔ | ↑ | ↑ | Normal | Normal | ↑ | Normal | Normal | N | - |
Psychogenic polydipsia | ✔ | ✔ | - | - | - | Normal | Normal | Normal | ↓ | Normal | Normal | Normal | Normal | - |
Diabetes insipidus | ✔ | ✔ | - | - | - | Normal | Normal | Normal | ↑ | Normal | Normal | Normal | Normal | - |
Transient hyperglycemia | - | - | - | - | - | ↑ | ↑ | Normal | Normal | ↑ | Normal | Normal | N/↑ | In hospitalized patients especially in ICU and CCU |
Steroid therapy | ✔ | - | - | - | ✔ | ↑ | ↑ | Normal | Normal | ↑ | ↑ | N/↑ | N/↑ | Acanthosis nigricans, |
RTA 1 | - | - | - | ✔ | - | Normal | Normal | ↑ | Normal | ↑ | Normal | Normal | Normal | Hypokalemia, nephrolithiasis |
Glucagonoma | - | - | - | - | - | ↑ | Normal | Normal | Normal | - | Normal | Normal | ↑ | Necrolytic migratory erythema |
Cushing syndrome | - | - | - | - | ✔ | ↑ | - | Normal | ↓ | N/↑ | ↑ | Normal | Normal | Moon face, obesity, buffalo hump, easy bruisibility |