Overview of Diabetes Mellitus – Hyperglycemia

by Carlo Raj, MD

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    00:03 Welcome to the topic of diabetes mellitus.

    00:05 This is the prototype of your endocrine pancreas and what may then go wrong with it.

    00:11 Initially, we’ll go through in great detail the pathogenesis, we will describe in great detail type I and type II diabetes.

    00:19 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.

    00:31 I’ll walk you next into your complications and finally, a word or two about management of diabetes mellitus.

    00:43 Welcome to hyperglycemia.

    00:46 Diabetes mellitus itself is a chronic disease dealing with carbohydrates, fats and protein metabolism.

    00:54 The fact that the balance of insulin and glucagon in fact has been lost.

    01:01 Maybe there’s issue with a receptor causing or creating an environment of insulin resistance.

    01:09 In any case, your patient with diabetes mellitus will always have hyperglycemia.

    01:16 Therefore, you’ll do everything in your power to make sure that you’re able to prevent the glucose levels from rising to excessive levels.

    01:25 Importantly, you are responsible to be able to diagnose your patient with hyperglycemia.

    01:34 Any one of the three following criteria that you must be familiar with.

    01:40 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 importance.

    01:51 If you can then remember upon two separate occasions of finding random plasma glucose above 200 then perhaps you’re suspecting diabetes mellitus.

    02:04 Number two, the symptoms of diabetes… P, P, P… polyuria, polydipsia, polyphagia.

    02:15 All these glucose that’s in your circulation ends up in your renal, your nephron bringing about osmotic diuresis thus polyuria.

    02:25 All the urination is then making you feel thirsty… polydipsia.

    02:31 And thirdly, without proper uptake of glucose in your tissue, wow, you’re always feeling hungry… polyphagia.

    02:43 Third criteria, plasma glucose greater than 200 milligrams after consuming 75 grams of oral glucose in bowls of it, what does that even mean? Well, we’re getting into a topic called oral glucose tolerance test.

    03:03 Normally, what should happen when you consume glucose? You should be releasing insulin and, my goodness, two hours is physiologically reasonable amount of time for you to find your glucose levels starts dropping.

    03:21 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.

    03:37 Any one of the three criteria that I just walked you through in great detail is sufficient grounds to diagnose diabetes mellitus.

    03:47 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.

    04:08 And for you, if you find it to be above seven percent, you should be definitely thinking about and suspecting diabetes mellitus.

    04:17 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 day practice? This topic, and therefore, guaranteed you will have this in some way, shape or form on your step to pre-diabetes.

    04:44 What can you do to maybe perhaps predict that your patient is going to develop diabetes mellitus? Pre-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 your definition.

    05:02 Impaired glucose tolerance, what was the test that we used to confirm diabetes mellitus? Oral glucose tolerance test.

    05:10 What happened? 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.

    05:21 That has to be memorized.

    05:23 That means that insulin was not present to properly deal with the glucose.

    05:28 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.

    05:51 You can be pretty darn sure that your patient’s going to go into diabetes mellitus.

    05:56 Therefore, what do you do? You’re being preventive… welcome to medicine ha-ha, right? Because you want to do everything in your power to make sure if you prevent your patient from going into diabetes mellitus.

    06:09 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 fasting? 126.

    06:21 So, fasting glucose is between… well, below 126 to 125 and above 110… welcome to pre-diabetes.

    06:32 Impaired fasting glucose, fasting plasma glucose at 100 to 110.

    06:38 All these are very important factors and criteria that you’re paying attention to when you’re dealing with a patient pre-diabetic.

    06:47 And in the United States, metabolic syndrome X or metabolic X syndrome is an epidemic, isn’t it? 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.

    About the Lecture

    The lecture Overview of Diabetes Mellitus – Hyperglycemia by Carlo Raj, MD is from the course Pancreatic Disease & Diabetes.

    Included Quiz Questions

    1. Hyperglycemia
    2. Increased cortisol
    3. Hypercalcemia
    4. Uremia
    5. Increased fat deposition
    1. Symptoms of diabetes with a random glucose > 200 mg/dL
    2. Polyuria, polydipsia, and polyphagia with a random glucose > 100 mg/dL
    3. Plasma glucose > 200 mg/dL 24 hours after an oral glucose load
    4. Fasting glucose > 120 mg/dL on two separate occasions
    5. Random glucose > 300 mg/dL on one occasion
    1. 7%
    2. 5%
    3. 10%
    4. 3%
    5. 12%
    1. Fasting glucose of 110 mg/dL
    2. Fasting glucose of 90 mg/dL
    3. Plasma glucose of 125 mg/dL 2 hours after glucose load
    4. Fasting glucose of 60 mg/dL
    5. Plasma glucose of 210 mg/dL 2 hours after glucose load

    Author of lecture Overview of Diabetes Mellitus – Hyperglycemia

     Carlo Raj, MD

    Carlo Raj, MD

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