Caused by an absolute or relative deficiency in the


Caused by an absolute or relative deficiency in the action of
insulin

Resistance to insulin

Insufficient insulin secretion

Both

Possible abnormally high amounts of glucagon and other
counterregulatory hormones

Growth hormone

Sympathomimetic amines

Corticosteroids

Insulin secretion in Type 1 Diabetes is normally deficient to non
existent

Type 2 Diabetes may have normal, high, or low insulin secretion

Hyperglycemia [fasting blood glucose (BG) > 110mg/dL] is a
common finding in all types of diabetes

Long-term complications include:

Microvascular disorders

Macrovascular disorders

Neuropathic disorders
VII.
VIII. Increased Risk for Diabetes: blood glucose levels that are higher
than normal but not yet high enough to be diagnosed as diabetes
 Fasting blood glucose (FBG) 100 – 125 mg/dL
 2 hour post prandial (during OGTT) 140 – 199 mg/dL
IX.
X.
II. CLASSIFICATION
XI.
1. Type 1 diabetes: Usually caused by an autoimmune destruction of beta
cells of the pancreas, resulting in absolute deficiency of insulin

Usually occurs in children and adolescents – but may
occur at any age

Prone to ketoacidosis

~ 10% of all diabetes cases are type 1

Screening for type 1 diabetes is not recommended
XII.
3

2. Type 2 diabetes: Caused by the presence of insulin resistance with an
inadequate compensatory increase in insulin secretion

Most patients have abdominal obesity

Patients often have “ metabolic syndrome ” – a
clustering of abnormalities sometimes referred to as
“insulin resistance syndrome”

Patients with metabolic syndrome are at increased risk
of macrovascular complications
XIII.

Clinical Identification of the Metabolic Syndrome
XIV.
 Any 3 of the 5 components must be present:
XV.
1. Abdominal obesity
o Waist circumference >40 inches (male)
o Waist circumference >35 inches (female)
2. Triglycerides ≥ 150 mg/dL
3. HDL cholesterol
o < 40 mg/dL (male)
o < 50 mg/dL (female)
4. Blood pressure ≥ 130/85 mmHg
5. Fasting blood glucose ≥ 110mg/dL
XVI.
3. Gestational diabetes mellitus: Glucose intolerance first recognized
during pregnancy

Complicates ~ 7% of pregnancies

Most patients will return to normoglycemia postpartum
XVII.
4. Other types secondary to specific causes:

Often caused by genetic defects

Endocrinopathies

Drugs
o Glucocorticoids
o niacin
o atypical antipsychotics (olanzapine)
 Infections
XVIII.
III. RISK FACTORS
XIX.

Type 2 diabetes
XX.
1. Family history (parents or siblings with diabetes)
2. Obesity

≥ 20% over ideal body weight
4


Body mass index (BMI) ≥ 25 kg/m 2
3. Habitual physical inactivity
4. Previously impaired glucose tolerance or impaired fasting glucose
5. Hypertension (≥ 140/90 mmHg in adults)
6. HDL cholesterol ≤ 35 mg/dL
7. Triglycerides ≥ 250 mg/dL
8. History of gestational diabetes mellitus (GDM)
9. Delivery of baby weighing > 9 pounds
10. History of vascular disease
11. History of polycystic ovary disease (PCOS)
XXI.