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Diabetes: management and pathophysiology (T1DM (From autoantibodies…
Diabetes: management and pathophysiology
T1DM
From autoantibodies against islet cells or other components of the pathway
Usually younger onset; formerly known as 'insulin dependent'
There are genetic associations; may see family hx of autoimmune disorders
Investigations for autoAb and specific HLA haplotypes
Management starts with insulin therapy, and a combination of short acting/long acting insulins are used
Uncontrolled T1DM will lead to hyperglycaemia and DKA
T2DM
Can be from a multitude of causes but most commonly seen with metabolic syndrome. Some evidence of genetics but unclear
May alsobe predisposed by other endocrine abnodmalities
If uncontrolled, may present with nephrotic syndrome, diabetic retinopathies and peripheral neuropathies.
Diagnosis: using fasting blood glucose and HbA1c
Management: first line is metformin. Then may add in other classes. including secretagogues and GLP related drugs. When hard to control with hypoglycemic agents then may also use insulin
Mendelian Disorders
Single Gene disorders that may cause the lack of sensitivity to insulin or a lack of production to insulin
Usually have family history
Exocrine Pancreas
Disorders of exocrine pancreas, most typically pancreatic cancer, can cause destruction or transformation leading to diabetes
Gestational Diabetes