Diabetes mellitus type diagnosis

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 ... 

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. 

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. 

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). 

Autoimmune polyglandular syndrome with progressive thyroid autoimmunity, type 1 diabetes mellitus, amenorrhea, and adrenal insufficiency has been reported in a 51-year-old woman treated with interferon alfa for chronic hepatitis C (545). Pancreas and pituitary gland autoantibodies, which were undetectable before interferon alfa treatment, were present at the time of diagnosis. After withdrawal, she recovered normal thyroid function, but was still insulin dependent with amenorrhea and adrenal insufficiency. 

Non-insulin-dependent diabetes mellitus (NIDDM), also known as late-onset or type II diabetes, affects over 12 million Americans, only about half of whom are aware of their disease (H6). Importantly, most diabetics have the disease for 4-7 years before it is diagnosed. About 50% of men and women aged 65-74 years demonstrate glucose intolerance (i.e., increased glucose levels but below that required for a definitive diagnosis) about 20% of these have NIDDM (C3, B16). NIDDM is a major cause of cardiovascular disease, stroke, renal failure, and blindness it is also associated with accelerated aging. 

Type-II diabetes may remain undetected for many years. In Europe and North America the ratio of undiagnosed to diagnosed cases may be as high as 1 1. Specific criteria have been adopted by WHO (1985a) for the diagnosis of Type-II diabetes mellitus. 

The ADA recommends initiation of complications monitoring at the time of diagnosis of diabetes mellitus. Current recommendations continue to advocate yearly dilated eye examinations in type 2 DM, and an initial eye exam in the first 3 to 5 years in type 1 DM, then yearly thereafter. Less frequent testing (every 2 to 3 years) can be implemented upon the advice of an eye care specialist. The feet should be examined and the blood pressure should be assessed at each visit. A urine test for microalhumin once yearly is appropriate. Yearly testing for lipid abnormalities, and more frequently if needed to achieve lipid goals, is recommended. 

The quantification of glucose is a prerequisite for the diagnosis and therapy of patients suffering from disorders in their carbohydrate metabolism that are mainly caused by diabetes mellitus. In type I diabetes, the jS-cells have been destroyed, leading to a severe insulin deficiency. In type II diabetes, enough insulin may be available, but there is an insulin resistance in the target organs. 

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