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Introduction to Endocrinology

{NB: Please read more details about Endocrinology in our Medicine Notes in the chapter Endocrine}

 

Diabetes Mellitus : Polyuria, polydipsia & polyphagia


Types:

 

Type I: Diabetes (B-cell destruction) (IDDM)

 

Type II: Diabetes

 

Other specific types

  1. Diseases of the exocrine pancreas
    1. Pancreatitis
    2. Cystic fibrosis
  2. Drugs
    1. Pentamidine
    2. Steroids        
    3. Dilantin
    4. Diazoxide
  3. Infections
    1. Mumps                
    2. Coxsackie virus B3 and B4
    3. Cytomegalovirus          
    4. Congenital rubella syndrome 

Type I DM - Autoimmune destruction of B cells

 

    - 95% - DR3 and/or DR4 antigens


Complications

 

Acute                 

  1. Diabetic ketoacidosis
  2. Hypoglycemia

Intermediate

  1. Lipoatrophy          
  2. Limited joint mobility
  3. Growth failure              
  4. Delay in sexual maturation

Chronic

  1. Retinopathy
  2. Nephropathy
  3. Renal failure is the most common cause of death in type I DM. Q
  4. Strong association between glycosylated hemoglobin & microalbuminuria.

Diagnosis

  1. Plasma glucose concentration £ 200 mg/dl on two separate occasions with symptoms of diabetes.
  2. Oral glucose tolerance test (OGTT) rarely needed.
  3. OGTT - oral glucose 1.75 gm/kg (maximum 75 gm)

Fasting - 126 mg/dl

 

2 hours - 200 mg/dl in two occasions

 

Specific therapeutic objective


Glycosylated hemoglobin – 3 monthly –8% or lower***
Q

  1. Diabetic Ketoacidosis
  2. Ketonuria                            
  3. Ketonemia
  4. Blood glucose > 250 mg/dl            
  5. Blood pH< 7.3      
  6. Serum bicarbonate < 20 mEq/l

Management

  1. Correction of dehydration with 0.9% saline 0.45% saline
  2. Insulin

Cerebral edema is a complication that may occur during therapy it is usually due to rapid correction of dehydration, hyperglycemia and hyper –osmolality Q





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