Diabetes Mellitus (Diabetes)

 Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert starches, sugar and other food into energy needed for daily life. At present the cause of diabetes is not quite known. Although both genetics and environmental factors such as lack of exercise, diet , and obesity seem to play roles.

There are three major types of diabetes:

- Type 1: it occurs usually in young subjects. In this disease the body does not produce any insulin. Therefore daily insulin injections are essential to stay alive. It accounts for 5 to 10 percent of diabetes

-   Type 2: it is a metabolic disorder resulting from the body’s inability to make enough, or  properly use , insulin. It accounts for 90 to 95 percent of diabetes. Type 2 diabetes is nearing epidemic  proportions, due to elderly, and a greater prevalence of obesity and sedentary lifestyles.

- Gestational diabetes mellitus Risk factors: marked obesity, personal history of gestational diabetes mellitus, glycosuria, or a strong family history of diabetes). A fasting plasma glucose level > 126 mg/dL (7.0 mmol/L) or a casual plasma glucose > 200 mg/dL (11.1 mmol/L) meets the threshold for the diagnosis of diabetes. If confirmed on a subsequent day it precludes the need for any glucose challenge such as 100-g or 75-g glucose load

Glucose load

 

100-g

75-g
Fasting
95 mg/dL
95
1-hour
180
180
2-hour
155
155
3-hour
140
-
The test should be done in the morning after a overnight fast of between 8 and 14 hours and after at least 3 days of unrestricted diet (> 150 grams of carbohydrates per day) and unlimited physical activity. The subject should remain seated and should not smoke throughout the test

 

Criteria for the diagnosis of diabetes mellitus 

Symptoms od diabetes1 plus casual2 plasma glucose concentration ≥ 200 mg/dL (11.1 mmol/L)

Fasting3 plasma glucose ≥ 126 mg/dL (7.0 mmol/L). The diagnosis must be confirmed

2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glusose tolerance test4 . The diagnosis must be confirmed.

1 polyuria, polydipsia, and unexplained weight loss

2Any time of day without regard to time since last meal

3No caloric intake for at lest 8 hours

4Glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water

 

Other categories 

Normal fasting glucose

Fasting plasma glucose < 110 mg/dL (6.1 mmol/L)

Impaired fasting glucose

Fasting plasma glucose ≥ 110 mg/dL and 126 mg/dL

Gestational diabetes mellitus

Fasting plasma glucose level > 126 mg/dL or a casual plasma glucose > 200 mg/dL

 Goals for patients with diabetes mellitus

 

q       Total cholesterol < 5.0 mmol/l (LDL cholesterol < 3 mmol/l)

q       Blood pressure < 130 mmHg systolic and < 80 mmHg diastolic (<125mmHg systolic and < 75 mmHg diastolic when there is proteinuria)

q       Optimal glycaemia control: HbA1c < 7%

  

Criteria for testing for diabetes in asymptomatic,

undiagnosed individuals

 

q       Testing for diabetes should be considered in all individuals at age 45 years and above, and, if normal, should be repeated at 3-year interval

q       Testing should be considered at a younger age or be carried out more frequentely in subjects who:

a.      Are obese (≥ 120% desirable body weight or a body mass index > 27 Kg/m2

b.      Have a first-degree relative with diabetes

c.      Are hypertensive (≥ 140/90 mmHg)

d.      Are members of a high-risk ethnic population (e.g.: Hispanic-American, Asian-American,  African-American, Pacific Islander)

e.      Have delivered a baby  weighing > 9 lb or have been diagnosed with gestional diabetes mellitus

f.        Have a high-density lipoprotein (HDL) cholesterol level < 35 mg/dL (0.9 mmol/L) and/or a triglyceride level > 250 mg/dL (2.82 mmol/L)

g.       On previous testing, had impaired glucose tolerance or impaired fasting glucose

 

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