Diabetes Mellitus

Definição

A diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus) é uma patologia do metabolismo dos hidratos de carbono. Geralmente ocorre em indivíduos com predisposição genética e caracteriza-se pela produção inadequada de insulina ou resistência à ação da insulina no pâncreas, resultando em hiperglicemia e sequelas patológicas a longo prazo.

Epidemiologia

Tipo 1

• Afetados cerca de 1,6 milhões de indivíduos nos Estados Unidos em 2018
• Normalmente com apresentação na infância ou idade adulta (< 25 anos)
• 5%–10% de todos os diabéticos
• Apresenta um forte viés etário, racial e geográfico:
  • Diagnosticada mais MAIS Androgen Insensitivity Syndrome frequentemente entre os 4 e os 6 anos, com um 2.º pico no início da adolescência
  • Maior densidade geográfica na Finlândia e na Sardenha
  • Nos Estados Unidos, maior predominância em crianças e adolescentes brancos não hispânicos
• Predisposição genética

Tipo 2

• Em 2017, a prevalência mundial estimada foi de 425 milhões de pessoas
• Geralmente com apresentação em idades > 40 anos, mas pode ser mais MAIS Androgen Insensitivity Syndrome precoce
• 90%–95% dos diabéticos
• Prevalência estimada de 10,5% nos Estados Unidos (e 27% em americanos > 65 anos)
• Incidência muito maior em nativos americanos, negros, hispânicos, asiático-americanos e indivíduos das ilhas do Pacífico

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional

• Ocorre em 5%–7% das gestações nos Estados Unidos
• As prevalências étnicas e geográficas são semelhantes às da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2
• Nos Estados Unidos, prevalência elevada em mulheres afro-americanas, hispano-americanas, nativas americanas, das ilhas do Pacífico e do sul ou este asiático
• Aumento da incidência de diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus não gestacional numa fase posterior da vida

Fatores de risco:

• Hemoglobina A_1c ≥ 5,7% ou elevação da glicemia em jejum antes da gravidez
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional em gravidez anterior
• ≥ 110% do peso corporal ideal ou IMC (peso em quilogramas a dividir pelo quadrado da altura em metros) > 30 durante a gestação
• Ganho excessivo de peso durante a 1.ª metade da gestação
• História familiar de DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
• Glicose na urina na 1.ª consulta pré-natal
• Filhos anteriores ≥ 4 kg ao nascimento
• Perfil lipídico alterado
• Síndrome do ovário poliquístico (SOP)
• Uso de glicocorticóides
• Gravidez múltipla (gemelar, trigemelar, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).)

Latent Autoimmune Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus in Adults ( LADA LADA Autoimmune diabetes in adults with slowly progressive pancreatic beta cell failure and the presence of circulating autoantibodies to pancreatic islets cell antigens. Diabetes Mellitus, pela sigla em inglês)

• Com apresentação na idade adulta: > 25 anos
• 2%–12% da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2 na população adulta

Maturity Onset Diabetes of the Young Maturity Onset Diabetes of The Young Diabetes Mellitus ( MODY MODY Diabetes Mellitus, pela sigla em inglês)

• Afeta 1%–5% de todos os pacientes com diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus
• Sem predileção étnica

Etiologia

Tipo 1

• Destruição autoimune das células β pancreáticas por anticorpos anti descarboxilase do ácido glutâmico ( GAD GAD Generalized anxiety disorder (GAD) is a common mental condition defined by excessive, uncontrollable worrying causing distress and occurring frequently for at least 6 months. Generalized anxiety disorder is more common in women. Clinical presentation includes fatigue, low concentration, restlessness, irritability, and sleep disturbance. Generalized Anxiety Disorder, pela sigla em inglês) provocando défice de insulina
• Associação com HLA (HLA-DQ, HLA-DR3 e HLA-DR4 HLA-DR4 Goodpasture Syndrome)
• Associação com outras doenças autoimunes

Tipo 2

• Causada por resistência à insulina
• Défice relativo de insulina
• Forte associação familiar/componente genético

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional

• Etiologia pouco clara, mas não autoimune
• Aumento da secreção de insulina, mas não em quantidade suficiente para manter os níveis de glicose normais
• Diminuição da sensibilidade à insulina

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo LADA LADA Autoimmune diabetes in adults with slowly progressive pancreatic beta cell failure and the presence of circulating autoantibodies to pancreatic islets cell antigens. Diabetes Mellitus

• Semelhante à diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1, está associada a genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure do complexo HLA
• Obesidade e outros fatores de risco que provocam resistência à insulina

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo MODY MODY Diabetes Mellitus

• Transmissão autossómica dominante
• 14 subtipos distintos
• Mecanismos envolvidos:
  • Regulação da transcrição disfuncional
  • Enzimas metabólicas alteradas
  • Desdobramento proteico
  • Canais iónicos disfuncionais
  • Compromisso da transdução de sinal

Fisiopatologia

Tipo 1

• Destruição imunomediada por células T das células produtoras de insulina dos ilhéus pancreáticos
• Autoanticorpos (nem sempre detetáveis):
  • Anticorpos GAD GAD Generalized anxiety disorder (GAD) is a common mental condition defined by excessive, uncontrollable worrying causing distress and occurring frequently for at least 6 months. Generalized anxiety disorder is more common in women. Clinical presentation includes fatigue, low concentration, restlessness, irritability, and sleep disturbance. Generalized Anxiety Disorder:
    • Apresentam como alvo as células β pancreáticas produtoras de insulina
    • Destruição autoimune de 80%–90% das células
    • Provocam défice de insulina e hiperglicemia.
  • Anticorpos citoplasmáticos anti células dos ilhéus pancreáticos ( ICA ICA Diabetes Mellitus, pela sigla em inglês)
  • Anticorpos anti insulinoma-2 (IA-2, pela sigla em inglês)
  • Anticorpos anti insulina (IAA, pela sigla em inglês)
  • Anticorpos anti transportador do zinco 8 (ZnT8, pela sigla em inglês)
• Os pacientes apresentam produção autónoma de insulina mínima ou nula:
  • Requerem reposição de insulina em todos os momentos para tratamento da hiperglicemia
  • A ausência de suplementação com insulina provoca:
    • Cetoacidose diabética (CAD) (pode ser fatal)
    • Complicações crónicas da diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus

Tipo 2

A DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2 caracteriza-se pelo défice relativo de insulina e diminuição da sensibilidade à insulina.

• Défice relativo de insulina:
  • A secreção de insulina pelas células β requer o transporte de glicose para dentro da célula
  • Mediado pelo transportador de glicose 2 (GLUT-2, pela sigla em inglês)
  • A obesidade e uma dieta hiperlipídica podem afetar este transporte, causando diminuição da secreção de insulina
• Resistência periférica à insulina:
  • Com uma ingestão constante de glicose, existe uma necessidade constante de insulina.
  • A hiperinsulinemia provoca diminuição da sensibilidade dos recetores de insulina no fígado, músculo e células do tecido adiposo.
  • A regulação negativa dos recetores causa um círculo vicioso de altos níveis de insulina.
• Mecanismos adicionais:
  • A diminuição da sensibilidade hepática à insulina provoca um défice de inibição da glicogenólise e da gliconeogénese
  • A hiperglicemia pode prejudicar a função das células β pancreáticas e exacerbar a resistência à insulina.
  • A necessidade elevada de insulina e a produção excessiva de enzimas pancreáticas provocam acumulação de pró-amilina e apoptose pancreática.
  • Falência progressiva das células β pancreáticas

Existem vários efeitos da hiperglicemia crónica:

• Níveis elevados de glicose sérica (> 180 mg/dL) excedem o limiar renal causando:
  • Glicosúria
  • Aumento da pressão osmótica urinária, provocando poliúria
  • Desidratação, causando polidipsia
• Défice de glicose intracelular, provocando polifagia
• Complicações crónicas da diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional

• Disfunção das células β no contexto de resistência à insulina (semelhante à DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2)
• É provável que esta disfunção já esteja presente antes da conceção; o stress da gravidez desmascara e agrava a condição.
• Efeitos da hiperglicemia materna na gravidez:
  • Aumento do risco de pré-eclâmpsia
  • Aumento do risco de complicações no parto por distócia de ombros
• Efeitos da hiperglicemia materna no desenvolvimento fetal:
  • Aumento do risco de hipoglicemia pós-natal
  • Aumento do risco de feto grande para a idade gestacional

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo LADA LADA Autoimmune diabetes in adults with slowly progressive pancreatic beta cell failure and the presence of circulating autoantibodies to pancreatic islets cell antigens. Diabetes Mellitus

• Processo autoimune (semelhante à DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1)
• Destruição mediada por autoanticorpos anti células β (especialmente GAD GAD Generalized anxiety disorder (GAD) is a common mental condition defined by excessive, uncontrollable worrying causing distress and occurring frequently for at least 6 months. Generalized anxiety disorder is more common in women. Clinical presentation includes fatigue, low concentration, restlessness, irritability, and sleep disturbance. Generalized Anxiety Disorder)
• Processo lento e progressivo
  • Geralmente os pacientes não são dependentes de insulina na apresentação
  • Os fármacos orais perdem efeito rapidamente
  • Eventualmente apresentarão necessidade de insulina

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo MODY MODY Diabetes Mellitus

• Defeitos genéticos que conduzem a défice na deteção de glicose e secreção de insulina
• Mutações no fator nuclear 4 alfa do hepatócito (HNF4A, pela sigla em inglês) são a causa de 10% dos casos de MODY MODY Diabetes Mellitus.

Apresentação Clínica

Tipo 1

CAD:

A DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1 apresenta-se geralmente em contexto de urgência com CAD:

• Frequentemente precipitada por uma condição sugestiva (e.g., doença vírica, trauma, stress emocional)
• Depressão do estado de consciência
• Dor abdominal
• Vómitos
• Hálito frutado cetónico

Hiperglicemia:

A DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1 também pode apresentar sintomas clássicos de hiperglicemia:

• Polidipsia
• Polifagia
• Poliúria (pode apresentar-se como enurese e noctúria em crianças)
• Perda de peso
• Visão turva

Tipo 2

A DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2 apresenta um início gradual, permanecendo assintomática por vários anos:

• Níveis elevados de glicose frequentemente detetados em testes Testes Gonadal Hormones de rastreio previamente ao início dos sintomas
• Pode apresentar sintomas clássicos de hiperglicemia, como na DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1
• Por vezes, diagnosticada em contexto de síndrome hiperglicémico hiperosmolar ou com sinais de complicações a longo prazo antes de um diagnóstico estabelecido
• Raramente, com CAD presente
• Sintomas inespecíficos causados pela hiperglicemia:
  • Fadiga
  • Mal-estar
  • Anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa
  • Amenorreia
  • Disfunção erétil
  • Cefaleia
  • Visão turva
  • Cãibras musculares
  • Desidratação
• Manifestações cutâneas:
  • Celulite recorrente ou infeções fúngicas
  • Défice ou atraso na cicatrização de feridas
  • Prurido generalizado
  • Acantose nigricans: placas aveludadas hiperpigmentadas na pele da axila, pescoço ou entre os dedos

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional

• A maioria dos casos são detetados previamente ao início dos sintomas, no contexto do rastreio universal durante a gestação nos Estados Unidos
• Geralmente no 2.º ou 3.º trimestres
• Sintomas não tratados semelhantes aos da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo LADA LADA Autoimmune diabetes in adults with slowly progressive pancreatic beta cell failure and the presence of circulating autoantibodies to pancreatic islets cell antigens. Diabetes Mellitus

• Sintomas inespecíficos semelhantes aos da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2:
  • Fadiga
  • Mal-estar
  • Anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo MODY MODY Diabetes Mellitus

• Pacientes em idade jovem, geralmente não obesos: muitas vezes diagnosticados erradamente com DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1
• Não resistente à insulina:
  • Distinguir da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2 pode ser um desafio
  • Sintomas característicos de resistência à insulina (e.g., acantose nigricans) frequentemente ausentes

Diagnóstico

O diagnóstico de diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus baseia-se na presença de hiperglicemia inadequada no contexto de sintomas clínicos suspeitos.

Tipo 1

• A análise de urina pode revelar microalbuminúria, glicosúria ou corpos cetónicos
• Autoanticorpos associados à DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus (anti-GAD65, anti-ICA, anti-IA-2)
• Peptídeo-C
  • Níveis baixos indicam défice de insulina ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1)
  • Níveis elevados indicam resistência à insulina ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2)

Tipo 2

• Rastreio recomendado em:
  • Indivíduos > 45 anos sem fatores de risco
  • Indivíduos 35 – 70 anos com excesso de peso ou obesos
  • Indivíduos mais MAIS Androgen Insensitivity Syndrome jovens se fatores de risco presentes
  • Situações particulares nas quais deve ser ponderado o rastreio:
    • Mulheres com história de diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional
    • Indivíduos que iniciam terapêutica antirretroviral para o HIV HIV Anti-HIV Drugs
    • Familiar de primeiro grau com diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
• Critérios de diagnóstico: (qualquer 1 dos seguintes)
  • Glicose plasmática em jejum (> 8 horas) ≥ 126 mg/dL (pré-diabetes: 100–125)
  • Glicose plasmática ≥ 200 mg/dL 2 horas após a ingestão de 75 g de glicose (prova de tolerância oral à glicose (PTOG)) (pré-diabetes: 140–199)
  • Hemoglobina A_1c (HbA_1c ) ≥ 6,5% (pré-diabetes: 5,7–6,4)
  • Glicose plasmática ocasional ≥ 200 mg/dL em paciente com sintomas clássicos

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional

A prova de tolerância oral à glicose está recomendada entre a 24.ª e a 28.ª semanas de gestação. Consideram-se resultados alterados, se:

• Glicemia em jejum: ≥ 92 mg/dL
• Glicemia à 1 hora: ≥ 180 mg/dL
• Glicemia às 2 horas: ≥ 153 mg/dL

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo LADA LADA Autoimmune diabetes in adults with slowly progressive pancreatic beta cell failure and the presence of circulating autoantibodies to pancreatic islets cell antigens. Diabetes Mellitus

• Mesmos critérios de diagnóstico da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2
• Anticorpos GAD65 positivos: ajudam a identificar pacientes que parecem sofrer de DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2, mas que provavelmente precisarão de insulina para controlar os níveis de glicose

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo MODY MODY Diabetes Mellitus

• Para distinguir da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1: ausência de autoanticorpos séricos
• Para distinguir da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2:
  • Atualmente não existem bons marcadores bioquímicos
  • História familiar de DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus não sugestiva
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus na ausência de obesidade ou marcadores secundários de sensibilidade à insulina podem ser sugestivos.
  • Testes Testes Gonadal Hormones genéticos

Monitorização

Auto-monitorização

• Monitorização de glicemia:
  • Em jejum
  • Próximo das refeições (antes e/ou depois, dependendo do paciente)
  • Com sintomas de hipoglicemia ou hiperglicemia
  • Antes de atividades importantes (e.g., pilotar um avião/conduzir um autocarro escolar)
  • Atualmente existem novos sistemas de monitorização contínua de glicose utilizados na DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1
• Higiene regular Regular Insulin dos pés e auto-vigilância de úlceras cutâneas

Monitorização clínica

• Verificação regular Regular Insulin do peso e pressão arterial
• Análises laboratoriais dos níveis de HbA_1c anualmente para avaliar o controlo glicémico e a eficácia do tratamento:
  • A HbA_1c fornece uma estimativa da glicemia do paciente nos 3 meses anteriores.
  • Alvo: < 7%
  • Menos rigoroso em pacientes idosos/crianças
• Medição da razão microalbumina:creatinina anualmente
• Perfil lipídico anualmente:
  • Colesterol total
  • HDL
  • LDL, com objetivo < 100 mg/dL
  • Triglicerídeos
• Exame oftalmológico anual
• Vacinas profiláticas (gripe, pneumocócica)
• Exames dentários regulares

Tratamento

Não existe cura definitiva para a diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus. O tratamento centra-se na correção da hiperglicemia com insulina (tipo 1) ou medicação oral (tipo 2), evitando hipoglicemias e tratando os efeitos clínicos da hiperglicemia crónica.

Abordagem multidisciplinar

A abordagem inicial é realizada com a educação e apoio do paciente.

• Modificações no estilo de vida:
  • Dieta equilibrada
  • Exercício regular Regular Insulin
  • Perda ponderal com diminuição da ingestão calórica em caso de excesso de peso ou obesidade
• Cessação tabágica para diminuir o risco de complicações comórbidas
• Gestão do stress
• Tratamentos farmacológicos para atingir alvos glicémicos individualizados:
  • A escolha da medicação depende do nível de HbA_1c no momento do diagnóstico
  • Necessitam de ajuste se intolerância ou doença renal crónica (DRC)

Fármacos orais

Classes de fármacos orais utilizados para o tratamento da diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus resistente à insulina (geralmente tipo 2):

• Biguanida (metformina): fármaco de 1.ª linha
• Inibidores do cotransportador de sódio-glicose-2 (SGLT-2, pela sigla em inglês): benefício demonstrado em eventos cardiorrenais, especialmente em hospitalização por insuficiência cardíaca, risco de progressão da doença renal e mortalidade
• Inibidores da dipeptidil peptidase-4 (DPP-4)
• Sulfonilureias
• Tiazolidinedionas

Tratamento com insulina

A insulina é utilizada para o tratamento da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1 e, por vezes, da DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2, quando os fármacos orais não são suficientes.

• Insulinas de ação rápida: início de ação em 10 a 15 minutos
  • Glulisina (nome comercial Apidra)
  • Lispro Lispro Insulin that has been modified so that the b-chain contains a lysine at position 28 instead of a proline and a proline at position 29 instead of a lysine. It is used to manage blood glucose levels in patients with type 2 diabetes. Insulin (nome comercial Humalog)
  • Aspart Aspart Insulin that has been modified to contain an aspartic acid instead of a proline at position 38 of the b-chain. Insulin (nome comercial NovoLog)
• Insulina de ação curta:
  • Início de ação em 30 minutos, atinge o pico em 2-3 horas
  • As insulinas de ação rápida e de ação curta são utilizadas em combinação com insulinas de ação mais MAIS Androgen Insensitivity Syndrome longa ou em bombas de insulina para a diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1
• Insulina de ação longa: duração de 12 a 24 horas
  • NPH NPH Normal pressure hydrocephalus (NPH) is a neurodegenerative disorder characterized by the triad of gait abnormalities, dementia, and urinary urgency or incontinence. Normal pressure hydrocephalus can be either idiopathic or secondary to intraventricular or subarachnoid hemorrhage. Normal Pressure Hydrocephalus (genérica, também conhecida como protamina neutra de Hagedorn)
  • Glargina (nome comercial Lantus ou Basaglar)
  • Detemir Detemir A recombinant long-acting insulin and hypoglycemic agent in which a myristic acid is conjugated to a lysine at position b29. It is used to manage blood glucose levels in patients with diabetes mellitus. Insulin (nome comercial Levemir)

Tratamentos injetáveis não insulínicos

• Agonistas do recetor do peptídeo 1 semelhante ao glucagon Glucagon A 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal glucagon-like peptides. Glucagon is secreted by pancreatic alpha cells and plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes. Gastrointestinal Secretions ( GLP-1 GLP-1 A peptide of 36 or 37 amino acids that is derived from proglucagon and mainly produced by the intestinal l cells. Glp-1(1-37 or 1-36) is further n-terminally truncated resulting in glp-1(7-37) or glp-1-(7-36) which can be amidated. These glp-1 peptides are known to enhance glucose-dependent insulin release, suppress glucagon release and gastric emptying, lower blood glucose, and reduce food intake. Insulinomas, pela sigla em inglês): preferidos em pacientes que já apresentam comorbilidades cardíacas ou renais:
  • Exenatida (nome comercial Byetta)
  • Dulaglutida (nome comercial Trulicity)
  • Liraglutida (nome comercial Victoza)
  • Semaglutida (Ozempic) – também disponível em comprimido (Rybelsus)
• Pramlintide Pramlintide Non-insulinotropic Diabetes Drugs mimético da amilina (nome comercial Symlin) (não é utilizado com frequência):
  • Suprime a secreção plasmática de glucagon Glucagon A 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal glucagon-like peptides. Glucagon is secreted by pancreatic alpha cells and plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes. Gastrointestinal Secretions
  • Atrasa o esvaziamento gástrico
  • Promove a saciedade

Considerações especiais com o uso de insulina

O fenómeno do amanhecer:

• No início da manhã, o efeito da insulina exógena administrada no dia anterior desaparece.
• As hormonas antagonistas da insulina aumentam fisiologicamente pela manhã.
• Pode causar hiperglicemia matinal

O efeito Somogyi:

• Hiperglicemia matinal de rebound
• Resposta à hipoglicemia durante a noite após quantidades excessivas de insulina exógena na noite anterior

Complicações

Complicações potenciais

Tipo 1:

• CAD:
  • Hiperglicemia grave
  • Apresenta-se com vómitos, respiração superficial e confusão
  • O aumento do beta-hidroxibutirato sérico e de cetonas na urina são diagnósticas.
  • Pode levar ao coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma e à morte se não for tratada
  • Requer hospitalização
• Hipoglicemia grave induzida pela insulina:
  • Confusão
  • Irritabilidade
  • Ansiedade
  • Discurso arrastado
  • Diplopia Diplopia A visual symptom in which a single object is perceived by the visual cortex as two objects rather than one. Disorders associated with this condition include refractive errors; strabismus; oculomotor nerve diseases; trochlear nerve diseases; abducens nerve diseases; and diseases of the brain stem and occipital lobe. Myasthenia Gravis
  • Pode levar à perda de consciência, convulsões ou morte se não for tratada
  • Tratamento com injeção ou administração nasal de glucagon Glucagon A 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal glucagon-like peptides. Glucagon is secreted by pancreatic alpha cells and plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes. Gastrointestinal Secretions

Tipo 2:

• Síndrome hiperglicémico hiperosmolar (SHH):
  • A hiperglicemia grave resulta em aumento da osmolaridade sem cetoacidose significativa.
  • Os sintomas incluem sinais de desidratação, fadiga, cãibras nas pernas, alterações da visão e do nível de consciência.
  • Requer hospitalização
• Ganho ponderal associado à insulina e causas potenciais:
  • Continuação da indiscrição alimentar
  • Redução da glicosúria com a melhoria do controlo glicémico
  • Lanches para suportar uma dose de insulina muito alta (tratamento excessivo de hipoglicemia)
  • O ganho de peso agrava a resistência à insulina e pode provocar o aumento da dose de insulina, levando a um círculo vicioso.

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional:

O risco de complicações é proporcional ao nível de hiperglicemia:

• Aborto espontâneo
• Anomalias fetais
• Feto grande para a idade gestacional, muitas vezes com necessidade de cesariana
• Macrossomia
• Pré-eclâmpsia
• Hipoglicemia no recém-nascido

Diagnóstico Diferencial

Tipo 1

• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo MODY MODY Diabetes Mellitus: patologia clinicamente heterogénea, caracterizada por diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus não insulino-dependente diagnosticada em idade jovem (< 25 anos), com transmissão autossómica dominante e ausência de autoanticorpos.
• Polidipsia psicogénica: ingestão volitiva excessiva de água. A polidipsia psicogénica é frequentemente observada em pacientes com doença mental grave e/ou alteração do desenvolvimento. Podem não ocorrer efeitos físicos, mas pode estar presente hiponatremia.
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus insípida nefrogénica: forma de diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus insípida que ocorre por patologia renal. A diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus insípida nefrogénica difere da diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus insípida central/neurogénica, esta última causada por níveis insuficientes de hormona antidiurética (ADH).
• Insuficiência renal de alto débito: associada a poliúria por outras causas, incluindo stress, trauma, queimaduras ou cirurgia.

Tipo 2

• Síndrome metabólica: grupo de condições que incluem obesidade central, aumento da pressão arterial, aumento da glicemia, triglicerídeos séricos elevados e HDL sérico baixo.
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo LADA LADA Autoimmune diabetes in adults with slowly progressive pancreatic beta cell failure and the presence of circulating autoantibodies to pancreatic islets cell antigens. Diabetes Mellitus: forma de DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1. Quando o diagnóstico não é claro, a avaliação da presença de anticorpos em pacientes com diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus com manifestação recente é útil para estabelecer este diagnóstico.
• Hiperglicemia induzida por corticosteróides: a prednisona e fármacos semelhantes podem causar hiperglicemia significativa. A hiperglicemia induzida por corticosteróides pode ser transitória e desaparecer com o fim do tratamento ou pode persistir e revelar uma DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2 subjacente.
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus secundária: devido a doença de Cushing, acromegalia ou hipersecreção de glucagon Glucagon A 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal glucagon-like peptides. Glucagon is secreted by pancreatic alpha cells and plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes. Gastrointestinal Secretions causada por tumor Tumor Inflammation das células alfa dos ilhéus pancreáticos, síndrome de Down (trissomia 21) ou hemocromatose, pancreatite crónica ou malignidade pancreática.