DIABETES MELLITUS

• Many people are unaware that they have diabetes, especially in its early stages when symptoms may not be present.
• There is no definite way to know if you have diabetes without undergoing blood tests to determine your blood glucose levels.
• See your doctor if you have symptoms of diabetes or if you are concerned about your diabetes risk.

Risk factors for type 1 diabetes are not as well understood as those for type 2 diabetes. Family history is a known risk factor for type 1 diabetes. Other risk factors can include having certain infections or diseases of the pancreas.

Risk factors for type 2 diabetes and prediabetes are many. The following can raise your risk of developing type 2 diabetes:

• Being obese or overweight
• High blood pressure
• Elevated levels of triglycerides and low levels of "good" cholesterol (HDL)
• Sedentary lifestyle
• Family history
• Increasing age
• Polycystic ovary syndrome
• Impaired glucose tolerance
• Insulin resistance
• Gestational diabetes during a pregnancy
• Ethnic background: Hispanic/Latino Americans, African-Americans, Native Americans, Asian-Americans, Pacific Islanders, and Alaska natives are at greater risk.

The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient.

• American Diabetes Association (ADA) Guidelines for Diabetes Screening and Diagnosis
• Screening Children for Type 2 Diabetes and Prediabetes

1. Severely elevated blood sugar levels due to an actual lack of insulin or a relative deficiency of insulin
2. Abnormally low blood sugar levels due to too much insulin or other glucose-lowering medications.

In patients with type 2 diabetes, stress, infection, and medications (such as corticosteroids) can also lead to severely elevated blood sugar levels. Accompanied by dehydration, severe blood sugar elevation in diabetic patients can lead to an increase in blood osmolality (hyperosmolar state). This condition can worsen and lead to coma (hyperosmolar coma). Hyperosmolar coma is most common in elderly diabetics.

Like diabetic ketoacidosis, a hyperosmolar coma is a medical emergency. Immediate treatment with intravenous fluid and insulin is important in reversing the hyperosmolar state.

Type I Diabetes is caused due to absence or insufficient production of insulin, hence it is essential to supply exogenous insulin. Without insulin, patients with type I diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA). Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death may result.

Diabetic ketoacidosis can be caused by infections, stress, or trauma, all of which may increase insulin requirements. In addition, missing doses of insulin is also an obvious risk factor for developing diabetic ketoacidosis.

These diabetes complications are related to blood vessel diseases and are generally classified into small vessel disease, such as those involving the eyes, kidneys and nerves (microvascular disease), and large vessel disease involving the heart and blood vessels (macrovascular disease). Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication).

• Diabetic Retinopathy Screening ADA Guidelines

Diabetic Kidney Disease (Nephropathy) Screening ADA Guidelines

Annually measure urinary albumin levels and eGFR in:

• Patients with type 1 diabetes with ≥ 5-year duration
• Patients with type 2 diabetes starting at diagnosis
• All patients with hypertension

Diabetic neuropathy:Diabetic neuropathy can also affect nerves to the stomach and intestines, causing nausea, weight loss, diarrhea, and other symptoms of gastroparesis (delayed emptying of food contents from the stomach into the intestines, due to ineffective contraction of the stomach muscles).

• Neuropathy Screening ADA Guidelines
• Foot Care Recommendations ADA Guidelines

• HbA1C, if the results are not available within the past 3 months
• If not performed/available within the past year
1. Fasting lipid profile, including total, LDL, and HDL cholesterol and triglycerides,
2. Liver function tests
3. Spot urinary albumin–to–creatinine ratio
4. Serum creatinine and estimated glomerular filtration rate
• Thyroid-stimulating hormone in patients with type 1 diabetes

*The comprehensive medical evaluation should ideally be done on the initial visit, although different components can be done as appropriate on follow-up visits