Diabetes mellitus diagnosis

If the patient has recently received a diagnosis of diabetes mellitus and has not received insulin or if the patient is known to have diabetes, the initial physical... 

If the diagnosis of diabetes mellitus is new, the nurse discusses the disease and methods of control... 

To reduce mortality, administration of an aldosterone antagonist, either eplerenone or spironolactone, should be considered within the first 2 weeks following MI in all patients who are already receiving an ACE inhibitor (or ARB) and have an EF of equal to or less than 40% and either heart failure symptoms or diagnosis of diabetes mellitus.3 Aldosterone plays an important role in heart failure and in MI because it promotes vascular and myocardial fibrosis, endothelial dysfunction, hypertension, left ventricular hypertrophy, sodium retention, potassium and magnesium loss, and arrhythmias. Aldosterone antagonists have been shown in experimental and human studies to attenuate these adverse effects.70 Spironolactone decreases all-cause mortality in patients with stable, severe heart failure.71... 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

Delivered a baby weighing greater than 9 lb (4.09 kg) or previous diagnosis of gestational diabetes mellitus... 

Either eplerenone or spironolactone should be considered within the first 2 weeks after MI to reduce mortality in all patients already receiving an ACE inhibitor who have LVEF <40% and either heart failure symptoms or a diagnosis of diabetes mellitus. The drugs are continued indefinitely. Example oral doses include the following ... 

Risk factors for TD include duration of antipsychotic therapy, higher dose, possibly cumulative dose, increasing age, occurrence of acute extrapyrami-dal symptoms, poor antipsychotic response, diagnosis of organic mental disorder, diabetes mellitus, mood disorders, and possibly female gender. 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

Uses of Specific Laboratory Tests to Discover, Confirm, and/or Exclude a Disease. Some tests can confirm the diagnosis of a disease (e.g., tissue histology from a broncho scopic biopsy to confirm lung cancer), but cannot be used to exclude the disease or discover the disease in routine screening. Other tests can be used both to confirm and to exclude the diagnosis of a disease (e.g., glucose tolerance test for diabetes mellitus), but are too inconvenient to be used to discover the disease in routine screening. The uses of each laboratory test to discover, confirm, or exclude a disease should be considered before a test is simply added to a clinical trial protocol. This ensures that the test is appropriate in the context of the planned clinical trial. 

Patients with type 1 diabetes mellitus make no insulin. The classic symptoms of Type 1 diabetes are excessive hunger, constant thirst, and frequent urination. Prior to the availability of exogenous insulin, a diagnosis of type 1 diabetes was a death sentence. The optimal therapy was to restrict food intake, usually to a few hundred calories a day. This extended life. However, toward the end, the only question was whether death would come as a consequence of the disease or through starvation. 

This is the basis of a story, probably apocryphal. A physician had been summoned to attend a family member who had collapsed. As soon as the physician entered die house, die family were stunned by die immediate diagnosis of diabetes mellitus by the physician, without even seeing die patient. The physician recognised the sweet smell of acetone. 

Mayfield J. (1998) Diagnosis and classification of diabetes mellitus New criteria. Am Fam Physician 58 1355-1362. 

Patients with leukemia often suffer from infections of the upper respiratory tract before the diagnosis of their haematologic malignancy is made. Chemotherapy for malignancy causes toxic stomatitis and superinfection with yeasts may follow. In patients with diabetes mellitus, malignant otitis externa and fungal sinusitis (mucormycosis) can be life-threatening. 

Diabetes mellitus causes about 50% of all patients being treated for End Stage Renal Disease (ESRD) in the USA and this is because the disease (type 2 disease) is pervasive. Recent studies have shown that the onset and progression of the disease can be ameliorated if treatment is instituted early on in the course of the disease. ESRD is the commonest complication of type 1 diabetes. A higher proportion of individuals with type 2 diabetes was found to have microalbuminuria and overt nephropathy shortly after the diagnosis of diabetes, because the diabetes had actually been present for many years before the diagnosis was made. There is a correlation between the degree of albuminuria and cardiovascular disease. 

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2003 26(Suppl l) S5-24. 

WHO Consultation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Geneva (Switzerland) World Health Organization Document Production Services 2006. Available from ... 

Julie Singer is a 55-year-old white woman who was admitted to the emergency department in acute distress. A previous physical examination showed hypertension and diabetes mellitus type 2. The patient s present medications include enalapril 40 mg, nifedipine 60 mg, and 100 U insulin. A physical examination revealed prominent ankle edema, a palpable spleen, and hepatomegaly. Chest radiography revealed diffuse cardiac enlargement and left ventricular hypertrophy. Based upon the history and clinical hndings, what is your diagnosis and what treatment do you recommend ... 

Unlabeled Uses Diagnosis of pheochromocytoma, opioid withdrawal, prevention of migraine headaches, treatment of diarrhea in diabetes mellitus, menopausal flushing... 

Diabetes mellitus is defined as an elevated blood glucose associated with absent or inadequate pancreatic insulin secretion, with or without concurrent impairment of insulin action. The disease states underlying the diagnosis of diabetes mellitus are now classified into four categories type 1, insulin-dependent diabetes) type 2, non-insulin-dependentdiabetes) type 3, other, and type 4, gestational diabetes mellitus (Expert Committee, 2003). 

---