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diabetes (risk factors (non-modifiable (gentic preponderance (Type 1: HLA…
diabetes
risk factors
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modifiable
smoking, increased fat in diet, high BSL, inadequate control of BP and lipids.
complications
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acute
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infections: skin (follicular infections, boils from staph) superficial fungal infections, cellulitis and erysipelas, oral and genital mucosa. candida , kidney pyelonephritis from recurrent UTIs complicated by papillary necrosis.
clinical presentation
type 1
child or adolescent, weight loss, ketoacidosis, polyuria, polydipsia, polyphagia
type 2
Adults, asymptomatic, increased insulin secretion, polyuria or polydipsia maybe, hyperosmolar non-ketotic coma.
Casues
type 1
Autoimmune (triggered by virus?), physical pancreatic disease, hypersecretion of insulin antagonist hormones.
type 2
45 yrs, ethnicity, obesity, sedentary lifestyle, gestational diabetes, hyperlipidaemia, PCOS, Hypertension
Treatment
type 1
diet and exercise, long acting insulin and short acting after meals. if DKA insulin given with dextrose and fluids for K shift.
type 2
Diet and exercise, oral hypoglycaemic agent, 1st line biguinide, 2nd line: sulphonylureas, meglitinides, 3rd line insulin, extra: statin therapy
Management:
multidisciplinary: educator, GP, podiatrist, opthalmologist,
foot checks, blood sugar and lipid monitoring, dilated eye exams
Pthogenesis
type 1
Autoimmune destuction of B-cells islets of langerhans, = abolute insulin deficiency. histopathology: lymphocytic infiltrate in the islets
type 2
Insulin resistance of target cells impairment of the function of the receptors, relative deficiency of plasma insulin eventually results in exhaustion and atrophy of B cells and amylin deposition.
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