Welcome to the topic of diabetes mellitus.
This is the prototype of your endocrine pancreas
and what may then go wrong with it.
Initially, we’ll go through in great detail
the pathogenesis, we will describe in great
detail type I and type II diabetes.
I’ll walk you through secondary diabetes,
meaning to say that, well, was there something
else going on with your patient such as haemochromatosis,
maybe Cushing’s resulting in hyperglycemia.
I’ll walk you next into your complications
and finally, a word or two about management
of diabetes mellitus.
Welcome to hyperglycemia.
Diabetes mellitus itself is a chronic disease
dealing with carbohydrates, fats and protein
The fact that the balance of insulin and glucagon
in fact has been lost.
Maybe there’s issue with a receptor causing
or creating an environment of insulin resistance.
In any case, your patient with diabetes mellitus
will always have hyperglycemia.
Therefore, you’ll do everything in your
power to make sure that you’re able to prevent
the glucose levels from rising to excessive
Importantly, you are responsible to be able
to diagnose your patient with hyperglycemia.
Any one of the three following criteria that
you must be familiar with.
You wake up in the morning fasting glucose
and you find your fasting glucose to be above
126 milligrams per decilitre if… is of outmost
If you can then remember upon two separate
occasions of finding random plasma glucose
above 200 then perhaps you’re suspecting
Number two, the symptoms of diabetes…
P, P, P… polyuria, polydipsia, polyphagia.
All these glucose that’s in your circulation
ends up in your renal, your nephron bringing
about osmotic diuresis thus polyuria.
All the urination is then making you feel
And thirdly, without proper uptake of glucose
in your tissue, wow, you’re always feeling
Third criteria, plasma glucose greater than
200 milligrams after consuming 75 grams of
oral glucose in bowls of it, what does that
Well, we’re getting into a topic called
oral glucose tolerance test.
Normally, what should happen when you consume
You should be releasing insulin and, my goodness,
two hours is physiologically reasonable amount
of time for you to find your glucose levels
If that does not occur and you find your glucose
levels to be above 200 after consuming 75
grams of glucose, then you know that your
patient probably has diabetes mellitus.
Any one of the three criteria that I just
walked you through in great detail is sufficient
grounds to diagnose diabetes mellitus.
What is it to have HbA1C not currently part
of the diagnostic criteria, but you can imagine
the HbA1C would be elevated and that HbA1C
would mean that the glucose is bound to haemoglobin
for a period of the lifespan of an RBC.
And for you, if you find it to be above seven
percent, you should be definitely thinking
about and suspecting diabetes mellitus.
Pause… if what we just talked about was
all part of diagnostic criteria or in the
process of diagnosing diabetes mellitus, what
do you think is more important in current
This topic, and therefore, guaranteed you
will have this in some way, shape or form
on your step to pre-diabetes.
What can you do to maybe perhaps predict that
your patient is going to develop diabetes
In all the same concepts that we’ve already
dealt with, but let’s go into this a little
bit further and make sure that you secure
Impaired glucose tolerance, what was the test
that we used to confirm diabetes mellitus?
Oral glucose tolerance test.
75 grams of bowls of glucose that was taken,
two hours later you still find glucose levels
to be high at 200 milligrams per decilitre.
That has to be memorized.
That means that insulin was not present to
properly deal with the glucose.
If it’s pre-diabetic, impaired glucose,
look at this now, after two hour period of
75 grams of glucose being taken, you find
that the plasma glucose is between, well,
definitely above 126 and 140, but below 200
and 199… this is pre-diabetic.
You can be pretty darn sure that your patient’s
going to go into diabetes mellitus.
Therefore, what do you do?
You’re being preventive… welcome to medicine
Because you want to do everything in your
power to make sure if you prevent your patient
from going into diabetes mellitus.
Or you find your fasting plasma glucose to
be above 110, let me ask you a question, what
do you need to confirm diabetes mellitus on
So, fasting glucose is between… well, below
126 to 125 and above 110… welcome to pre-diabetes.
Impaired fasting glucose, fasting plasma glucose
at 100 to 110.
All these are very important factors and criteria
that you’re paying attention to when you’re
dealing with a patient pre-diabetic.
And in the United States, metabolic syndrome
X or metabolic X syndrome is an epidemic,
Obesity is an epidemic and when we talk about
metabolic syndrome, you’re talking about
an obese individual probably, probably suffering
from hyperglycemia and most likely pre-diabetic,
in fact, probably diabetic.