Session 10

DIABETES
Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose
levels. DM has several categories, including type 1, type 2, maturity-onset diabetes of the young
(MODY), gestational diabetes, neonatal diabetes, and secondary causes due to
endocrinopathies, steroid use, etc. The main subtypes of DM are type 1 diabetes mellitus
(T1DM) and type 2 diabetes mellitus (T2DM), which classically result from defective insulin
secretion (T1DM) and/or action (T2DM). T1DM presents in children or adolescents, while T2DM
is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to
poor lifestyle and dietary choices. The pathogenesis for T1DM and T2DM is drastically different,
and therefore each type has various etiologies, presentations, and treatments.

T1DM is characterized by the destruction of beta cells in the pancreas, typically secondary to an
autoimmune process. The result is the absolute destruction of beta cells, and consequentially,
insulin is absent or extremely low.
T2DM involves a more insidious onset where an imbalance between insulin levels and insulin
sensitivity causes a functional deficit of insulin. Insulin resistance is multifactorial but commonly
develops from obesity and aging.
Signs & Symptoms
During patient history, questions about family history, autoimmune diseases, and insulin-
resistant are critical to making the diagnosis of DM. It often presents asymptomatically, but
when symptoms develop, patients usually present with polyuria, polydipsia, and weight loss. On
physical examination of someone with hyperglycemia, poor skin turgor (from dehydration) and a
distinctive fruity odor of their breath (in patients with ketosis) may be present.
While T1DM and T2DM can present similarly, they can be distinguished based on clinical history
and examination. T2DM patients are typically overweight/obese and present with signs of
insulin resistance, including acanthosis nigricans, which are hyperpigmented, velvety patches on
the skin of the neck, axillary, or inguinal folds. Patients with a longer course of hyperglycemia
may have blurry vision, frequent yeast infections, numbness, or neuropathic pain.
Diagnosis
What tests are used to diagnose diabetes?
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Doctors use a variety of tests to diagnose diabetes and prediabetes. Your doctor may
recommend different tests depending on whether you have symptoms or not, or whether you
are pregnant.
Fasting plasma glucose test
The fasting plasma glucose (FPG) test measures your blood glucose level at a single point in time.
For the most reliable results, your doctor will give you the test in the morning after you have
fasted for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.
A1C test
It is a blood test that provides your average levels of blood glucose over the last 3 months. Other
names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated
hemoglobin test. You can eat and drink before this test.
Random plasma glucose test
Sometimes doctors use the random plasma glucose test to diagnose diabetes when you have
symptoms of diabetes and they do not want to wait until you have fasted for 8 hours. You may
have this blood test at any time.
Glucose challenge test
If you are pregnant, your doctor might test you for gestational diabetes with the glucose
challenge test. Another name for this test is the glucose screening test. In this test, a health care
professional will take a sample of your blood 1 hour after you drink a sweet liquid containing
glucose.
Oral glucose tolerance test
The oral glucose tolerance test (OGTT) helps doctors detect type 2 diabetes, prediabetes, and
gestational diabetes. Before the test, you will need to fast for at least 8 hours. A health care
professional will take a blood sample to measure your glucose level after fasting. Next, you will
drink a liquid that is high in sugar. Another blood sample is taken 2 hours later to check your
blood glucose level. If your blood glucose level is high, you may have diabetes.
Treatment
Treatments for type 1 and type 2 diabetes
Treatment for type 1 diabetes: involves insulin injections or the use of an insulin pump, frequent
blood sugar checks, and carbohydrate counting. For some people with type 1 diabetes, pancreas
transplant or islet cell transplant may be an option.
Treatment of type 2 diabetes: mostly involves lifestyle changes, monitoring of your blood sugar,
along with oral diabetes drugs, insulin or both.
Monitoring your blood sugar
Depending on your treatment plan, you may check and record your blood sugar as many as 4
times a day or more often if you're taking insulin. Careful blood sugar testing is the only way to
make sure that your blood sugar level remains within your target range.
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Risk Factors
Type 1: Known risk factors include:

• Family history: Having a parent, brother, or sister with type 1 diabetes.

• Age: You can get type 1 diabetes at any age, but it usually develops in children, teens,
or young adults.
Type 2: You’re at risk for type 2 diabetes if you:
• Have prediabetes.
• Are overweight.
• Are 45 years or older.
• Have a parent, brother, or sister with type 2 diabetes.
• Are physically active less than 3 times a week.
• Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby
who weighed over 9 pounds.
• Are an African American, Hispanic or Latino, American Indian, or Alaska Native person.
Some Pacific Islanders and Asian American people are also at higher risk.

THE ENDOCRINE SYSTEM