Diabetes Mellitus (DM)

Last updated 03.11.12

 

-  DM in Pregnancy

 

Definition

-  Chronic metabolic disease associated with elevated BSL

 

Features

-  Represents huge disease burden

-  Incidence of Type 2 increasing

-  Complications similar regardless of type

-  In Australia 85% DM2, 10% DM1

 

Classification

-  Type 1 DM

-  Type 2 DM

-  Gestational DM

 

DDx Type 1 vs 2

Type 1

Type 2

Age

<40yrs

>40yrs+/-

Weight

Thin

Obese

Present

DKA/ill

+/- S/S

Complications

4yrs+

At Dx

Family Hx

+/-

++

DKA

++

Rare

Insulin

++

+/-

 

Associated S/S

-  Hyperglycaemia

-  Classic triad

-  Polyuria, polydipsia, polyphagia

 

Complications

-  Similar regardless of type of DM

-  Microvascular

-  Nephropathy: microalbuminaemia

-  Retinopathy

-  Vitreous haemorrhage

-  Cataracts

-  Neuropathy

-  Peripheral

-   Glove & stocking paresthesia

-   Contributes to foot problems

-   Typically effects fingers when reaches knees

-   Light touch preserved

-   Pain, temp & vibration lost (spinothalamic)

-  Mononeuritis multiplex

-  Autonomic

-   Gastroparesis

-   Hypo-unawareness

-   Impotence

-   Postural hypotension

-  Macrovascular

-  AMI: esp silent infarcts (ANS neuropathy)

-  Stroke, PVD, CAD

-  Feet

-  Diabetic foot = ulcers: cellulitis, osteomyelitis, amputation

 

Mx

-  Targets

-  BSL fasting 4-8 mmol/L

-  HbA1c < 7%

-  Prevention & Mx of Hyperlipidaemia

-  Total Cholesterol <4 mmol/L

-  LDL < 2.0 mmol/L

-  HDL > 1 mmol/L

-  TGs < 2.0 mmol/L

-  BP < 130/80 mmHg

-  BMI < 25 kg/m(2)

-  Urinary albumin excretion

-  < 20 ug/min (timed overnight)

-  < 20 mg/L (spot)

-  < 3.5 mg/mmol (women)

-  < 2.5 mg/mmol (men)

-  Aspirin: prophylactic 75-325mg daily

-  Annual ECG

-  Diet

-  Exercise

- Smoking cessation

-  Podiatry: ulcers, neuropathy, shoes

- +/- Immunisation: influenza, pneumococcal

 

 

References