The following criteria may be used to diagnose DM
– FPG concentration (after 8 or more hours of no caloric intake) of 126 mg/dL or greater, or
– Plasma glucose concentration of 200 mg/dL or greater 2 hours after ingesting 75-g oral glucose load in the morning after an overnight fast of at least 8 hours, or
– Symptoms of uncontrolled hyperglycemia (eg, polyuria, polydipsia, polyphagia) and a random (casual, nonfasting) plasma glucose concentration of 200 mg/dL or greater, or
– A1C level of 6.5% or higher.
Q2. Classification of DM
DM represents a group of heterogeneous metabolic disorders that develop when insulin (WHAT IS INSULIN) secretion is insufficient to maintain normal plasma glucose levels.
1.T2DM is the most common form of DM, accountingfor more than 90% of cases. It is typically identified in patients older than 30 years who areoverweight or obese and/or have a positive family history, but do not have autoantibodies characteristic of type 1 DM (T1DM). Most persons with T2DM have evidence of insulin resistance (such as high triglycerides or low high-density lipoprotein cholesterol [HDL-C])
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2. T1DM is usually characterized by absolute insulin deficiency and may be confirmed by the presence of autoantibodies to glutamic acid decarboxylase, pancreatic islet b cells (tyrosine phosphatase IA-2), and/or insulin Some forms of T1DM have no evidence of autoimmunity and have been termed idiopathic. T1DM or monogenic DM can also occur in obese children and adolescents. Therefore, documenting the levels of insulin and C-peptide and the presence or absence of immune markers and obtaining a careful family history in addition to the clinical presentation may be useful in establishing the correct diagnosis, determining treatment, and helping to distinguish between T1DM and T2DM in children
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3. GDM is a condition in which women without previously diagnosed DM exhibit elevated plasma glucose
levels
4.Monogenic DM (formerly maturity-onset diabetes of the young)
Evaluation is recommended for any child with an atypical presentation, course, or response to therapy. Diagnostic likelihood is strengthened by a family history over 3 generations suggesting autosomal dominant inheritance. This type of DM can occur in the child before appearing in the parent or other relatives.
Q3.What causes type 2 diabetes?
T2DMis most often caused by cells becoming less sensitive to the hormone insulin. This phenomenon is called insulin resistance (WHAT IS INSULIN RESISTANCE). Insulin normally signals cells to grab up and use sugar( glucose) from the bloodstream, so if cells are not getting the message, glucose stays in the blood. But what makes cells ignore this critical message? While the exact causes remain unknown, it appears that having high levels of insulin in the blood for a prolonged period can alter the receiving mechanisms that many cells have for insulin (called insulin receptors) making them less able to respond to the signal.
So what makes insulin levels high in the first place? Unfortunately, scientists do not know exactly why this happens, but one thing is clear: obesity is a major factor. Several other risk factors are known including other preventable risk factors, like high blood pressure and some that are not preventable, like family history.
Type 2 diabetes can also occur when the pancreas produces only low levels of insulin. In this case, there is not enough insulin to signal body cells to take up sugar and the result is the same as insulin resistance.
Q4. How Can DM Be Prevented?T2DM can be prevented or at least delayed by intervening in persons who have prediabetes
1. Monitoring of patients with prediabetes to assess their glycemic status should include at least annual measurement of FPG and/or an oral glucose
tolerance test A1C should be for screening use only .
2.CVD risk factors (especially elevated blood pressure and/or dyslipidemia) and excessive weight should be addressed and monitored at regular intervals
3.Persons with prediabetes should modify their lifestyle,
including initial attempts to lose 5% to 10% of body weight if overweight or obese and participation in moderate physical activity (eg, walking) at least 150 minutes per week Organized programs with follow-up appear to benefit these efforts
4.In addition to lifestyle measures, metformin or perhaps thiazolidinediones (TZDs) should be considered for younger patients who are at moderate to high risk for developing DM; for patients with additional CVD risk factors including hypertension, dyslipidemia, or polycystic ovarian syndrome; for patients with a family history of DM in a first-degree relative; and/or for patients who are obese .
5.Obesity is a major risk factor for T2DM and for CVD. Lifestyle modification (primarily calorie reduction and appropriately prescribed physical activity) is the cornerstone in the control of obesity in T2DM .
Pharmacotherapy for weight loss may be considered when lifestyle modification fails to achieve the targeted goal in patients with T2DM and a body mass index greater than 27 kg/m2 .Consideration may be given to laparoscopic-assisted gastric banding in patients with T2DM who have a body mass index greater than 30 kg/m2 or Roux-en-Y gastric bypass for patients with a body mass index greater than 35 kg/m2 to achieve at least short-term weight reduction .Patients with T2DM who undergo Roux-en-Y gastric bypass must have meticulous metabolic postoperative follow-up because of a risk of vitamin and mineral deficiencies and hypoglycemia .
Q5.what are the Prediabetes Risk Factors Suggesting a Need for Screening?
Prediabetes Risk Factors Suggesting a Need for Screening are:
1.Family history of diabetes mellitus
2.Cardiovascular disease
3.Being overweight or obese
4.Sedentary lifestyle
5.Nonwhite ancestry
6.Previously identified impaired glucose tolerance, impaired fasting glucose, and/or metabolic syndrome
7.Hypertension
8.Increased levels of triglycerides, low concentrations of high-density lipoprotein cholesterol, or both
9.History of gestational diabetes mellitus
10.Delivery of a baby weighing more than 4 kg (9 lb)
11.Polycystic ovary syndrome
12.Antipsychotic therapy for schizophrenia and/or severe bipolar disease
Q6.are there any new drugs for diabetes
Yes,Exenatide is injected twice daily, can regerate the insulin producing pancreas, control glucose levels and also causes weight loss. It is a chemical derivative of GLP-1 (glucagon like peptide-1) which can improve insulin secretion and control body weight- side effects of exenatide include vomiting, nausea and a serious illness called pancreatitis which can cause damage to the pancreas.
The other drug, sitagliptin (januvia) which is a DPP-4 inhibitor,allows the GLP-1 produced by the body to increase, by blocking its degradation. This causes a modest but effective rise in GLP-1 levels- resulting in glucose control, but without any weight loss. Unlike exenatide, sitagliptin does not cause nausea. Both sitagliptin and exenatide are expensive, but are quite effective medications.now vildagliptin(jalra) and saxagliptin(onglyza)are new DPP-4 inhibitors .They are available in India.
7)HOW TO ADMINISTER INSULIN INJECTION
8) HOW TO USE INSULIN PEN
