Type 1 & Type 2 Diabetes Mellitus

Overview

The term diabetes mellitus (DM) describes as a group of metabolic disorders that are characterised by hyperglycaemia. It is divided broadly into type 1 & type 2 depending on the underlying cause.

Signs and Symptoms

Polyuria (too much urination), Polydipsia (constantly thirsty), Weight loss (50% of patients), Lethargy, Cachexia, Muscle wasting, Nail or skin infections, Dry mucous membranes, Poor skin turgor

Common Causes

Autoimmune, Non-autoimmune

Risk Factors

Family history, Genetic susceptibility, Ethnicity, Environmental agents eg. viruses, immunisation, diet, Autoimmune - associated with other autoimmune disorders e.g. Coeliac, Addison's Disease

Investigation Techniques

Fasting Plasma Glucose > 7.0 mmol/l, Plasma glucose > 11.1 mmol/l two hours following Oral Glucose Tolerance Test. (OGTT), Random plasma glucose >11.1 mmol/l ( in symptomatic patient), HBA1C > 48 mmol/mol. ( >6.5%)

Treatment and Prevention

Intensive therapy with insulin to achieve as close to normal glycaemic levels to reduce risk of long term complications, Patient education (Insulin dose adjustment and educate patient and family about management of hypoglycaemia), Regular glucose fingerprick monitoring, Needs regular diabetes review to assess glycaemic control & to look for evidence of long term complications, Check HBA1C to establish level of glycaemic control, Close involvement of diabetes day centre or nurses, Medi- alert bracelet for all diabetic patients, Dietician involvement for diabetic diet, Influenza & pneumococcal vaccinations, Smoking avoidance or cessation