Diabetes Mellitus Classifications

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Questions and Answers

Which type of diabetes typically presents with acute, classic, and severe symptoms?

Gestational Diabetes

Prediabetes

Type 2 Diabetes

Type 1 Diabetes (correct)

What is a common symptom of symptomatic hyperglycemia in type 1 diabetes?

Blurring of vision

Polyuria (correct)

Increased energy

Weight gain

Which of the following is NOT a common sign of asymptomatic hyperglycemia?

Weight loss (correct)

Hypertension

Pruritus vulvae

Loss of peripheral sensation

What is the renal threshold for glucose, which indicates when glucose appears in the urine?

180 mg/dl Signup and view all the answers

Which of the following conditions can lead to secondary diabetes mellitus?

Thiazide diuretics Signup and view all the answers

What percentage of type 2 diabetes cases are often undiagnosed?

10-20% Signup and view all the answers

Which test method is NOT a diagnostic tool for diabetes?

Urine testing for glucose Signup and view all the answers

Which of the following is a characteristic sign of insulin resistance?

Polycystic ovary syndrome Signup and view all the answers

What primarily characterizes Type 1 diabetes mellitus?

Autoimmune destruction of beta cells Signup and view all the answers

Which of the following is NOT a recognized factor contributing to Type 2 diabetes?

Congenital rubella infection Signup and view all the answers

What percentage of Type 2 diabetes cases are predominantly insulin resistant?

80% Signup and view all the answers

Which stage involves the activation of autoantibodies in Type 1 diabetes?

Stage III Signup and view all the answers

Gestational Diabetes Mellitus (GDM) falls under which classification of diabetes?

Primary Diabetes Mellitus Signup and view all the answers

Which of the following is a pancreatic defect associated with Type 2 diabetes?

Decreased insulin secretion Signup and view all the answers

What is the primary environmental factor proven to trigger Type 1 diabetes?

Congenital rubella Signup and view all the answers

Which of the following conditions would NOT cause secondary diabetes?

Obesity Signup and view all the answers

What is the primary characteristic of Hyperglycemic Hyperosmolar State (HHS)?

Severe hyperglycemia and hyperosmolality Signup and view all the answers

Which of the following is NOT a precipitating factor for HHS?

Excessive physical exercise Signup and view all the answers

In terms of clinical presentation, how do patients with HHS differ from those with DKA?

HHS patients display marked dehydration Signup and view all the answers

Which of the following laboratory findings is indicative of HHS?

Plasma glucose >600 mg/dl Signup and view all the answers

What is the first line treatment for managing severe HHS?

Fluid therapy Signup and view all the answers

Which of the following best explains the lack of significant ketosis in HHS?

Adequate insulin to prevent lipolysis Signup and view all the answers

Which symptom is more commonly seen in patients with HHS compared to DKA?

Focal neurological deficits Signup and view all the answers

How is effective serum osmolality calculated in the context of HHS?

2 [ serum Na+ (mEq/l) ] + glucose (mg/dl)/18 Signup and view all the answers

Which plasma glucose value indicates a diagnosis of gestational diabetes mellitus (GDM) for fasting levels?

92 mg/dL Signup and view all the answers

What is one condition that is NOT part of the low risk criteria for screening gestational diabetes mellitus?

Positive family history of diabetes Signup and view all the answers

What is an acceptable blood glucose diagnostic criterion for diabetes during the first trimester?

Random plasma glucose of 200 mg/dL Signup and view all the answers

Which hormone is NOT typically increased during diabetic ketoacidosis (DKA)?

Insulin Signup and view all the answers

What triad of symptoms characterizes diabetic ketoacidosis (DKA)?

Uncontrolled hyperglycemia, metabolic acidosis, ketosis Signup and view all the answers

What condition should clinicians investigate when DKA occurs in individuals with type 2 diabetes?

Search for a precipitating factor Signup and view all the answers

What is the significance of obtaining two abnormal test results in the absence of unequivocal hyperglycemia?

It is required for the diagnosis of diabetes mellitus. Signup and view all the answers

What is the recommended action for individuals with risk factors planning to become pregnant?

Screen for prediabetes or diabetes. Signup and view all the answers

What is the typical level of triglycerides in diabetic dyslipidemia?

More than 150 mg/dl Signup and view all the answers

Which drug class is considered the first-line therapy for lowering LDL-C?

HMG-CoA Reductase Inhibitors (statins) Signup and view all the answers

What is the recommended target level for LDL-C in patients with diabetes?

Less than 100 mg/dl Signup and view all the answers

What is a common manifestation of hypertension in Type 1 diabetic patients?

Diabetic nephropathy Signup and view all the answers

Which of the following is the best drug for increasing HDL levels?

Niacin Signup and view all the answers

What is the dosage range for aspirin therapy in diabetic patients with an increased cardiovascular risk?

75-162 mg/dl Signup and view all the answers

What condition often accompanies hypertension in Type 2 diabetic patients?

Obesity Signup and view all the answers

Which treatment options may be included in the management of hypertensive diabetic patients?

β-blockers and calcium channel blockers Signup and view all the answers

Study Notes

Classification of Diabetes Mellitus

Primary Diabetes Mellitus includes Type 1, Type 2, and Gestational Diabetes Mellitus (GDM).
Type 1 Diabetes is an autoimmune disorder resulting in β-cell destruction and insulin deficiency; associated with a genetic predisposition (HLA-DR3/DR4).
Type 2 Diabetes results from progressive loss of adequate insulin secretion; often characterized by:
- 80% with insulin resistance (typically obese).
- 20% with insulin secretory defects (often non-obese).
Secondary Diabetes arises from external conditions such as:
- Pancreatic diseases (e.g., pancreatitis, neoplasia, hemochromatosis).
- Endocrinopathies (e.g., acromegaly, Cushing's syndrome).
- Drug-induced effects (e.g., corticosteroids, thiazide diuretics).

Pathogenesis of Diabetes Mellitus

Type 1 Diabetes involves six stages:
- Genetic Susceptibility confirmed by HLA typing.
- Environmental Triggers like viral infections (e.g., congenital rubella).
- Immune Activation leading to autoimmune insulitis.
- Progressive Loss of insulin secretion occurs over time.
- Overt Diabetes develops after significant β-cell dysfunction.
- Endless Beta Cell Failure diagnosed by low insulin and C-peptide levels.
Type 2 Diabetes caused by combined insulin resistance and inadequate insulin secretion.
- Major risk factors include obesity, sedentary lifestyle, hypertension, and stress.
- Leads to defects in pancreatic insulin secretion and target tissue action.

Symptomatic Hyperglycemia

Acute Classic Symptoms:
- Polyuria: Excessive urination > 2.5 liters/day.
- Polydipsia: Increased thirst due to dehydration.
- Polyphagia: Increased hunger due to cellular starvation.
- Weight loss due to fluid loss and increased catabolism.
Subacute Presentation:
- Thirst, weight loss, lack of energy, blurred vision, balanitis.

Asymptomatic Hyperglycemia

Commonly identified in Type 2 Diabetes and Prediabetes.
May present during routine tests or chronic complications.
Signs can include pruritus, peripheral neuropathy, hypertension, and insulin resistance indicators.

Diagnosis of Diabetes Mellitus

One-third of cases remain undiagnosed; significant vascular complications may be present in 10-20% of cases.
Confirm diabetes via increased blood glucose levels or A1C.
Urine testing for glycosuria is not a diagnostic tool; requires blood glucose confirmation.

Gestational Diabetes Mellitus (GDM) Diagnosis

Criteria include:
- Fasting plasma glucose ≥ 92 mg/dL.
- 1-hour plasma glucose ≥ 180 mg/dL.
- 2-hour plasma glucose ≥ 153 mg/dL.
Screening recommended for high-risk pregnant women before 15 weeks of gestation.

Acute Diabetic Complications

Diabetic Ketoacidosis (DKA):
- Triad of hyperglycemia, high ketones, and metabolic acidosis.
- More common in Type 1 Diabetes but can occur in Type 2 under stress.
Hyperglycemic Hyperosmolar State (HHS):
- Severe hyperglycemia and dehydration without significant ketosis.
- Precipitated by infection, physical stress, or water intake restrictions.

Treatment Objectives for DKA

Goals include improving circulation, correcting electrolytes, providing insulin, and managing complications.
Fluid Therapy is the first line of treatment for volume replacement.

Diabetic Dyslipidemia

Characterized by increased triglycerides, low HDL, and possible increased small dense LDL particles.
Treatment targets include LDL levels < 100 mg/dL, with statins as first-line therapy for lowering LDL.

Hypertension and Diabetes

Hypertension linked to diabetes increases risks of nephropathy, retinopathy, and cardiovascular diseases.
Initial treatment goals for hypertensive diabetic patients target systolic at ≤ 130 mmHg and diastolic at ≤ 80 mmHg.
Common treatment options include ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics.

Antiplatelet Therapy Recommendations

Aspirin is recommended for primary and secondary prevention in diabetic patients at elevated cardiovascular risk.

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Description

Explore the different types of diabetes mellitus in this quiz. Learn about primary diabetes, including Type 1 and Type 2, and the various mechanisms behind these conditions. Additionally, discover the secondary forms of diabetes and their causes.