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DIABETES MELLITUS (DM type I (due to autoimmune destruction of beta…
DIABETES MELLITUS
DM type I
due to autoimmune destruction of beta-pancreatic cells
always needs insulin
commonly occurs <30 yr
no obesity associated
weak genetic predisposition
associated with HLA-DR3 and -DR4
severe glucose intolerance
high insulin sensitivity
ketoacidosis is common
DM type II
due to resistance to insulin or progressive pancreatic beta-cell failure
insulin treatment is necesary sometimes
commonly occurs >40 yr
associated with obesity
strong genetic predisposition
mild to moderate glucose intolerance
low insulin sensitivity
ketoacidosis is rare
Acute manifestations
Polydipsia
Polyuria
Polyphagia
Weight loss
DKA in type 1
Hyperosmolar coma in type 2
Diagnosis
HbA1c ≥6.5%
Fasting plasma glucose ≥126 mg/dL
2-hour oral glucose tolerance test ≥200 mg/dL
Chronic complications
Nonenzymatic glycation
Small vessel disease
Retinopathy
Hemorrhage
Exudates
Microaneurysms
Vessel proliferation
Glaucoma
Neuropathy
Nephropathy
Kimmelstiel-Wilson nodules
Chronic kidney failure
Arteriolosclerosis
Hypertension
Chronic kidney failure
Osmotic damage
Neuropathy
Motor
Sensory
Autonomic
Cataracts
Gerardo Lopez Diaz