Diabetes Mellitus

Normal Blood Sugar
>/7 mmol/L
Random >/11.1 mmol/L
on two occassions if no symptoms

Impaired glucose tolearance or impaired fasting glucose: between normal and diabetes.

Classification of abnormal blood sugar:

• Type I DM - Autoimmune or idiopathic
• Type II DM
• Other specific types: disease of pancreas, infection, genetic defects, drug induced
• Gestational

Anti-GAD antibodies are present in 80 % of Type I DM.

LADA - Latent Autoimmune Diabetes in Adult

• 2 - 12 % of all cases of adult diabetes
• Usually > 30 years old
• Non-obese
• Initially diet controlled but within months to years require oral agents and then progression to insulin dependency.
• Eventually develop weight loss, ketosis, unstable BGLs and diminished C-peptide reserve.
• Presence of autoantibodies in adults with diabetes
• Increased frequency of HLA-DR3 and -DR4 as in T1DM. However, also increased HLA-DR2 which is strongly protective against childhood T1DM.

MODY - Maturity onset diabetes of Young
Diagnostic Criteria

1. Onset before age 25
2. Correction of fasting hyperglycemia without insulin for at least 2 yrs following diagnosis
3. Non-ketotic disease
4. Autosomal dominant mode inheritance

All result from insulin deficiency
Recognised molecular etiology involves genes expressed in the B cell.
All are transcription factor mutations involved in regulation of insulin gene transcription except for MODY 2.

MODY 3 and 4 are most common.

What is aetiology of insulin resistance?
Obesity
Adiponectin - high in thin people
FFA
TNF, etc.

Insulin resistance may be an inflammatory state.

Metabolic Syndrome - definition

• Central obesity defined as waist circumference more than 94 cm in europid man and more than 80 cm in europid women.
• plus any two of the following four factors:

1. Raised TG level >/ 1.7 mmol/L or specific treatment of this abnormality.
2. Reduced HDL cholesterol <>
3. Rasied Blood Pressure: systolic BP >/130 or diastolic BP >/85 mmHg or treatment of previously diagnosed hypertension
4. Raised fasting plasma glucose >5.6 mmol/L or previously diagnosed Type II DM

Prevention of T2DM
5% reduction in BW
150 minutes exercise a week
Metformin
Acarbose
Rosiglitazone - not sustained when drug is stopped.

HbA1c
Target <7% style="font-weight: bold;">

Treatment of IDDM
Commonest regimes - basal bolus