DiabetesMellitus Zhao xiaojuan Introduction Diabetesmellitusisaheterogeneousgroupofmetabolicdiseasescharacterizedbyhyperglycemiaresultingfromdefectsininsulinsecretion insulinaction orboth Introduction Thechronichyperglycemiaofdiabetesisassociatedwithlong termdamage dysfunction andfailureofvariousorgans especiallytheeyes kidneys nerves heart andbloodvessels Symptoms PolyuriaPolydipsia thirst WeightlossWeaknessPolyphagiaBlurredvisionRecurrentinfectionImpairmentofgrowth Criteriafordiagnosisofdiabetes WHO1999 Symptomsofdiabetes Casualplasmaglucose 11 1mmol l 200mg dl OrFPG 7 0mmol l 126mg dl Or2 hPG 11 1mmol l DiagnosticCriteriaWHO1999 IGT FPG 7mmol L 2 hPG 7 8mmol Land 11 1mmol LIFG FPG 6 1mmol Land 7 0mmol L LaboratoryFindings UrinaryglucoseUrinaryketoneBloodglucose FPGand2 hPG HbA1candFA fructosamine OGTTInsulin CPreleasingtest Classification 1 Type1diabetes celldestruction usuallyleadingtoabsolutedeficiencyImmune mediateddiabetesIdiopathicdiabetesType2diabetesRangingfrompredominantlyinsulinresistancewithrelativeinsulindeficiencytopredominantlyaninsulinsecretorydefectwithinsulinresistance Classification 2 OtherspecifictypesofdiabetesDuetoothercauses e g geneticdefectsininsulinaction diseasesoftheexocrinepancreas drugorchemicalinducedGestationaldiabetesmellitus GDM diagnosedduringpregnancy Etiologicclassificationofdiabetesmellitus 1 I Type1diabetes celldestruction usuallyleadingtoabsoluteinsulindeficiency A immunemediatedB IdiopathicII Type2diabetes mayrangefrompredominantlyinsulinresistancewithrelativeinsulindeficiencytoapredominantlysecretorydefectwithinsulinresistance III OtherspecifictypesA geneticdefectsof cellfunction1 Chromosome12 HNF 1 MODY3 2 Chromosome7 glucokinase MODY2 3 Chromosome20 HNF 4 MODY1 4 MitochondrialDNA5 OthersB Geneticdefectsininsulinaction1 TypeAinsulinresistance2 Leprechaunism3 Rabson Mendenhallsyndrome4 Lipoatrophicdisease5 OthersC Diseasesoftheexocrinepancreas1 Pancreatitis2 Trauma pancreatectomy3 Neoplasia4 Cysticfibrosis5 Hemochromatosis6 Fibrocalculouspancreatopathy7 Others Etiologicclassificationofdiabetesmellitus 2 D Endocrinopathies1 Acromegaly2 Cushing ssyndrome3 Glucagonoma4 Pheochromocytoma5 Hyperthyroidism6 Somatostatinoma7 Aldosteronoma8 OthersE Drud orchemical induced1 Vacor2 Pentamidine3 Nicotinicacid4 Glucocorticoid5 Thyroidhormone6 Diazoxide7 adrenergicagonists8 Thiazides9 Dilantin10 Interferon11 OthersF Infections1 Congenitalrubella2 Cytomegalovirus3 Others Etiologicclassificationofdiabetesmellitus 3 G Uncommonformsofimmune mediateddiabetes1 Stiff man syndrome2 Anti insulinreceptorantibodies3 OthersH Othergeneticsyndromessometimesassociatedwithdiabetes1 Down ssyndrome2 Klinefelter ssyndrome3 Turner ssyndrome4 Wolfram ssyndrome5 Friedreich sataxia6 Huntington schorea7 Laurence moon Biedlsyndrome8 Myotonicdystrophy9 Porphyria10 Prader Willisyndrome11 OthersIV Gestationaldiabetesmellitus GDM Patientswithanyformofdiabetesmayrequireinsulintreatmentatsomestageoftheirdisease Suchuseofinsulindosenot ofitself classifythepatient Type1DM Generally 30yearsRapidonsetModeratetoseveresymptomsSignificantweightlossLeanKetonuriaorketo acidosisLowfastingorpost prandialC peptideImmunemarkers anti GAD ICA IA 2 Type2DM Generally 40yearsSlowlyonsetNotseveresymptomsObesityKetoacidosisseldomoccurNonketotichyperosmolarsyndromeNormalorelevatedC peptidelevelsGeneticpredisposition PathophysiologicalmodelfordevelopmentofobesityandT2DM Beta celldefect Intra uteringrowthretardation InsulinResistancegenes Obesitygenes InsulinResistance Intraabdominalobesity IGT T2DM Westernlifestyle Glucosetoxicity MetabolicInsulinResistance FFA 0 80 40 20 60 Year Disorderofglycemia etiologicaltypesclinicalstages Stages Types NormoglycemiaHyperglycemia Diabetesmellitus Type1Type2OtherspecifictypesGestationaldiabetes Normalglucosetolerance IGTand orIFG Notinsulinrequiring Insulinrequiringforcontrol Insulinrequiringforsurvival Acute life threateningconsequences HyperglycemiawithketoacidosisNonketotichyperosmolarsyndrome Microvascularcomplications RetinopathyNephropathyPeripheralneuropathyAutonomicneuropathy Macrovascularcomplications AtheroscleroticcardiovasculardiseasePeripheralvasculardiseasecerebrovasculardisease Others HypertensionAbnormalitiesoflipoproteinmetabolismPeriodontaldisease PotentialchroniccomplicationsofelevatedHbA1c good poor control RISK MicroalbuminuriaMildRetinopathyMildNeuropathy AlbuminuriaMacularEdemaProliferativeRetinopathyPeridontalDiseaseImpotenceGastroparesisDepression FootUlcersAnginaHeartAttackCoronaryBypassSurgeryStrokeBlindnessAmputationDialysisKidneyTransplant TheAimsofTreatment ReliefofhyperglycemicsymptomsCorrectionofhyperglycemia ketonuriaandhyperlipidemiaEstablishmentandmaintenanceofadesirablebodyweight andinchildrennormalgrowthanddevelopmentAvoidanceofacutemetabolicdisturbancePreventordelaytheonsetofthelong termcomplications Targetsforcontrol Management EssentialsofmanagementMonitoringofglucoselevelsFoodplanningPhysicalactivityTreatmentofhyperglycemia 2 MonitoringofGlucoseLevels B