What are the diagnostic criteria for diabetes mellitus?
- Symptoms of diabetes and a a random glucose >=200mg/dl
- Fasting plasma glucose >= 126 mg/dl
- 2hr plasma glucose >=200mg/dl during an oral glucose tolerance test
- Hemoglobin A1c >= 6.5 (in adults)
What are clinical features of diabetes mellitus?
Polyuria, Polydypsia, Polyphagia
Ketoacidosis: abdominal pain, nausea, vomiting, mental status changes
Genital yeast infections
What is the pathophysiology of T1 DM?
Autoimmune destruction of pancreatic beta cells ( that secrete insulin)
--> Tcell mediated
--> Lymphocytic infiltration
What is the Two Hit Hypothesis?
Hypothesis of risk factors for T1 DM
Genetic Susceptibility to diabetes:
- assoc. w/HLA DR3/4, DQ2/8 alleles
- Viruses: congenital rubella
- Nutritional factors: early exposure to cow's milk and vit D deficiency
What are the biochemical criteria for Diabetic Ketoacidosis?
D = Hyperglycemia
K = Ketonemia or ketonuria
A = Venous pH <7.3 or HCO3 < 15mmol/L
What is the pathophysiology of Diabetic Ketoacidosis?
How is DKA treated?
1. Fluids: Only enough to reverse dehydration and replace ongoing losses (too much can lead to cerebral edema)
2. Insulin: To supress ketosis and reverse acidosis
3. Electrolytes: Replace profound Na and K losses
What are signs and symptoms of cerebral edema?
Sudden, persistent drop in HR
Change in sensorium
Fall in serum Na or failure to rise
What is the prayer sign?
Limited joint mobility due to uncontrolled diabetes
Fingers are unable to fully extend in a prayer position
- Associated with increased risk of retinopathy and nephropathy