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 hemochromatosis,
maybe Cushing, resulting in hyperglycemia.
I’ll walk you next into your complications and finally in order to about management of diabetes mellitus.
Welcome to hyperglycemia.
Diabetes Mellitus itself is a chronic disease dealing with carbohydrates, fats, and protein metabolism,
the fact that the balance of insulin and glucagon in fact has been lost.
Maybe there’s an issue with the 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 levels.
Importantly, you are responsible to be able to diagnose your patient with hyperglycemia.
In order for the diagnosis of diabetes mellitus to be made, you need at least one of the following criteria.
First, fasting glucose equal to or greater than 126 mg/dl -
fasting means that the patient should not have received any food for at least 8 hours.
Secondly, plasma glucose level of at least 200 mg/dl after an oral glucose tolerance test.
During this test the patient has to ingest 75 grams of glucose dissolved in water
and his plasma glucose is measured two hours after that.
A value of equal to or greater than 200 is indicative of diabetes.
Third, a level of glycosylated hemoglobin of at least 6.5%,
and finally, a random plasma glucose of at least 200 mg/dl in a patient with classic symptoms of hyperglycemia.
It is important to mention that if the patient does not present with the symptomatology indicative of hyperglycemia
for example, polyuria, polyphagia, polydipsia; and fulfills anyone of the criteria that we just discussed,
a second measurement of the same or different test is necessary in order to make the diagnosis.
Now let’s move on to pre-diabetes.
A patient is considered to have pre-diabetes if they have high glucose levels
but they do not fulfill the criteria in order for the diagnosis of diabetes to be made.
In order for a patient to be considered pre-diabetic, they must fulfill at least one of the following criteria as you can see in the slide.
A patient is considered to have impaired fasting glucose if their levels of fasting plasma glucose are between 100 and 125 mg/dl.
Remember normal levels of fasting plasma glucose are below 100 and levels above 125 are indicative of diabetes.
In between values are characteristic of impaired fasting glucose.
A patient is considered to have impaired glucose tolerance if two hours after ingestion of 75 grams of glucose
their plasma glucose levels are between 140 and 199 mg/dl.
Normal people should have levels below 140, whereas, diabetics has above 200.
If patients have between 140 and 199, they have impaired glucose tolerance.
Patients are also considered to have pre-diabetes if their glycosylated hemoglobin is between 5.7 and 6.4%.
Patients with pre-diabetes have increased cardiovascular risk and increased risk for developing diabetes mellitus.
As you can understand, the risk is greater with greater values of glucose or glycosylated hemoglobin.
All of these are very important factors and criteria that you're paying attention to when you're dealing with the patient, pre-diabetic.
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.