Diabetes Mellitus

Types

Type 1 Diabetes Mellitus/ Juvenile Onset Diabetes mellitus

Type 2 Diabetes Mellitus/ Adult-onset Diabetes Mellitus

Causes

Autoimmune

Secondary causes of Diabetes secondary to other medical conditions

Endocrine causes

Cushing’s syndrome

Acromegaly

Pheochromocytoma

Haemochromatosis

Chronic pancreatitis

PCOS

Medications

Thiazide diuretics

Corticosteroid therapy

High dose estrogen therapy

Others

Gestational diabetes

Risk factors

Age >40

Obesity

People from the Indian subcontinent, Aboriginal and Torres Strait, Chinese

Positive family history of diabetes

Gestational diabetes

Sedentary lifestyle

PCOS

Ischemic heart disease

Hypertension

Medications such as corticosteroids therapy, thiazide diuretics

Clinical features

Tiredness/fatigue

Polyuria

Polydipsia

Weight loss

Increase skin bacterial infections/ fungal infections such as thrush

Other features related to complications of Diabetes and will be discussed later

Diabetes diagnosis

HbA1c ≥6.5% (48 mmol/mol)

Fasting glucose ≥7.0 mmol/L.- Needs 2 readings if asymptomatic

Random glucose ≥11.1 mmol/L.

On a 75 g oral glucose tolerance test: fasting glucose ≥7.0 mmol/L or 2 hr glucose ≥11.1 mmol/L.

Note  for fasting glucose levels

If the patient is asymptomatic then at least 2 separate values are required

If the patient is symptomatic such as polydipsia, polyuria, then only one reading is enough

Diabetic  groups of medications used to treat Diabetes Mellitus

Biguanides
(metformin)

• blocks glucose release from the liver
• improves insulin sensitivity
• increases the peripheral utilisation of glucose.

Side effects

• nausea
• vomiting
• anorexia
• diarrhoea.

Sulphonylureas

(glibenclamide, gliclazide, glimepiride, glipizide)

• stimulates the pancreas to release more insulin
• may decrease insulin resistance.

Side effects

• hypoglycaemia
• weight gain.

DPP-4 inhibitors

(alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliptin)

• blocks the action of the DPP-4 enzyme
• stimulates the release of insulin
• blocks the release of glucose from the liver.

Side effects

• respiratory tract infections
• common cold symptoms
  (sore throat, runny nose, cough)
• hypoglycaemia (when used with insulin or a sulphonylurea)
• headaches
• musculoskeletal pain.

SGLT2 inhibitors

(dapagliflozin, empagliflozin, ertugliflozin)

• blocks glucose from being reabsorbed by the kidneys

Side effects

• urinary tract infections
• yeast infections
• dehydration
• constipation
• nausea
• increased thirst
• hypoglycaemia (when used with insulin or a sulphonylurea)
• increased urination or pain on urination.

Thiazolidinediones

(pioglitazone)

• improves the sensitivity of cells to insulin
• decreases glucose release from the liver.

Side effects

• weight gain
• fluid accumulation
• headache
• dizziness
• joint or muscle pain.

Alpha-glucosidase inhibitors

(acarbose)

• slows down the digestion of carbohydrates from food.

Side effects

• flatulence (wind)
• bloating
• diarrhoea
• abdominal pain.

Diabetes injectable preparations

GLP-1 agonists

(dulaglutide, exenatide, liraglutide, semaglutide)

• blocks glucose release from the liver
• slows glucose release from the gut
• stimulates the release of insulin
• decreases appetite.

Side effects

• nausea
• vomiting
• diarrhoea
• constipation
• reflux
• abdominal pain
• fatigue
• injection site reaction
• hypoglycaemia (when used with insulin or a sulphonylurea)

Insulin

• Allows glucose to move from the bloodstream to the body cells

Side effects

• hypoglycaemia
• injection site reaction
• weight gain

Diabetes Complications

Hypertension

Stroke

Ischemic heart disease/ Angina/Myocardial infarction

Diabetic nephropathy

Diabetic cardiomyopathy.

Diabetic peripheral neuropathy

Diabetic retinopathy

Diabetic ketoacidosis

Non ketotic hyperosmolar coma

Foot gangrene/ ulcer/ diabetic foot

Recurrent skin infections- Bacterial /fungal

Peripheral vascular disease

Hypoglycemia

Cataract

Depression (Common with all chronic illnesses and often forgotten in the exam)