Diagnosis of diabetes mellitus

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... 

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 ... 

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. 

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

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). 

Quantitative insulin determination (Yalow et al. 1959) is useful for the diagnosis of diabetes mellitus and for monitoring therapy. 

An OGTT is rarely necessary for the diagnosis of diabetes mellitus and is not recommended by the ADA for routine clinical use. It continues to be recommended in a limited fashion by the and its use remains contentious. The... 

NDDG. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes 1979 28 1039-57. 

Taylor R, Zimmet P. Limitation of fasting plasma glucose for the diagnosis of diabetes mellitus. Diabetes Care 1981 4 556-8. 

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. 

Glucose tolerance declines with age even in the absence of diabetes mellitus. and the renal threshold for glucose rises. These observations can make the diagnosis of diabetes mellitus difUcult in an elderly patient. 

As is common in these circumstances the boy had consumed a large amount of relined carbohydrate—two cans of soft drinks, a Jam doughnut and in excess of 2(H) g of assorted sweets over the preeeeding 2 hours. Thus, it is to be expected that the blood glucose would be high and a diagnosis of diabetes mellitus should not be made. 

The diagnosis of diabetes mellitus must be made with care since it has Car-reaching medical and social consequences. A number of biochemical tests are used in association w ith clinical assessment both for the initial diagnosis of this condition and the long-term monitoring of patients,... 

The World Health Organization has published guidelines for the diagnosis of diabetes mellitus on the basis of blood glucose results and the response to an oral gluco.se load. These are shown in Table I and arc further discussed below. 

Plasma insulin. Insulin measurements can lead to the diagnosis or exclusion of insulinoma. They play no part in the diagnosis of diabetes mellitus. 

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