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A 36-year-old female lawyer is diagnosed with diabetes mellitus when her…
A 36-year-old female lawyer is diagnosed with diabetes mellitus when her fasting blood glucose on an annual health screening comes back 12mmol/L
Type I
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Blood glucose rather than A1C should be used to diagnose acute onset of type 1 diabetes in individuals with symptoms of hyperglycemia
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islet cell autoantibodies and autoanti- bodies to insulin, GAD (GAD65), the ty- rosine phosphatases IA-2 and IA-2b, and ZnT8. Type 1 diabetes is defined by one or more of these autoimmune markers
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Treatment
Insulin therapy
- Multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or CSII therapy.
- Match prandial insulin to carbohy- drate intake, premeal blood glucose, and anticipated physical activity.
- Formostpatients(especiallythoseat elevated risk of hypoglycemia), use insulin analogs.
- For patients with frequent nocturnal hypoglycemia, recurrent severe hy- poglycemia, and/or hypoglycemia unawareness, a sensor-augmented low glucose threshold suspend pump may be considered.
Pramlintide
delays gastric emptying, blunts pancreatic secretion of glucagon, and enhances satiety
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T2DM
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fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriat
- Casual plasma glucose ≥11.1 mmol/l
- Fasting plasma glucose ≥7.0 mmol/l
- 2-hour post-challenge plasma glucose ≥11.1 mmol/l
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Treatment
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Insulin therapy
newly diagnosed type 2 diabetes and markedly symptomatic and/or elevated blood glucose levels or A1C
3 months still no improvement - add 2nd agent - GLP-1 receptor agonist, or basal insulin
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Long-acting sulphonylureas e.g., chlorpropamide and glibenclamide, carry a high risk of hypoglycaemia and are not recommended
When glycaemic control is not achieved despite the addition of basal insulin to oral agents, discontinuing sulphonylureas and switching to premixed twice daily or basal-bolus insulin regimens becomes necessary. However, metformin and α-glucosidase inhibitors may still be used in conjunction with exogenous insulin to attenuate the insulin dose
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Others
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drug induced
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thiazide diuretics, and atypical antipsychotics
Diagnostic tests
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HbA1c
For patients with an abnormal hemoglobin but normal red blood cell turnover, such as those with the sickle cell trait, an A1C assay without interference from abnormal hemoglobins should be used
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