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Diagnosing Type 1 Diabetes In Adults

What Is The Best Way To Distinguish Type 1 And 2 Diabetes?

What Is The Best Way To Distinguish Type 1 And 2 Diabetes?

Onset of diabetes in childhood with ketoacidosis and insulin dependency has traditionally been sufficient to diagnose type 1 diabetes, while onset in older, obese patients with primary insulin resistance suggested type 2 diabetes. Unfortunately, features of type 1 and type 2 diabetes may be present in the same patient, making differentiation difficult. No diagnostic studies in the literature were identified that definitively demonstrate how to separate type 1 from type 2 diabetes. A patient’s age may suggest, but does not reliably distinguish, diabetes types. A study of 569 new-onset type 1 and type 2 diabetic children and adolescents showed that older age was only weakly associated with type 2 diagnosis (odds ratio [OR]= 1.4 for each 1-year increment in age; 95% confidence interval [CI], 1.3–1.6).2 In fact, newly diagnosed 12-year-old children have an equal incidence of type 1 as type 2 diabetes. Likewise, adults with type 2 phenotype (no initial insulin requirement) can present with positive autoantibodies typically found in younger type 1 patients. Older patients who fit this profile have been classified as type 1.5 diabetes or latent autoimmune disease in adults (LADA).3 A history of diabetic ketoacidosis (DKA) also does not reliably distinguish between types 1 and 2. A retrospective chart review gathered data on adults over 18 years of age who were admitted for DKA in a urban US hospital. Many patients with DKA were subsequently diagnosed with type 2 diabetes. Rates of type 2 diabetes in patients with DKA varied by race: 47% of Hispanics, 44% of African Americans, and 17% of Caucasians had type 2 diabetes.4 The overlapping presence of autoantibodies in both types of diabetes limits their use (TABLE). Autoantibodies do predict an earlier need for insulin. One pr Continue reading >>

Test Center

Test Center

Test Guide Laboratory Testing for Diabetes Diagnosis and Management This Test Guide discusses the use of laboratory tests (Table 1) for diagnosing diabetes mellitus and monitoring glycemic control in individuals with diabetes. Diagnosis Tools for diagnosing diabetes mellitus include fasting plasma glucose (FPG) measurement, oral glucose tolerance tests (OGTT), and standardized hemoglobin A1c (HbA1c) assays (Table 2). FPG and OGTT tests are sensitive but measure glucose levels only in the short term, require fasting or glucose loading, and give variable results during stress and illness.1 In contrast, HbA1c assays reliably estimate average glucose levels over a longer term (2 to 3 months), do not require fasting or glucose loading, and have less variability during stress and illness.1,2 In addition, HbA1c assays are more specific for identifying individuals at increased risk for diabetes.1 Clinically significant glucose and HbA1c levels are shown in Table 2.1 The American Diabetes Association® (ADA) recommends using these values for diagnosing diabetes and increased diabetes risk (prediabetes). Management Following a diagnosis of diabetes, a combination of laboratory and clinical tests can be used to monitor blood glucose control, detect onset and progression of diabetic complications, and predict treatment response. Table 3 shows the recommended testing frequency and target results for these tests. Different laboratory tests are available for monitoring blood glucose control over the short, long, and intermediate term to help evaluate the effectiveness of a management plan.1 Self-monitoring of blood glucose (SMBG) is useful for tracking short-term treatment responses in insulin-treated patients, but its usefulness is less clear in non–insulin-treated patients.1 By co Continue reading >>

How Is Latent Autoimmune Diabetes In Adults Best Diagnosed And Treated?

How Is Latent Autoimmune Diabetes In Adults Best Diagnosed And Treated?

Q: What is latent autoimmune diabetes in adults (LADA)? A: In LADA, patients appear to have type 2 diabetes phenotypically. They do not, however, have an early requirement for insulin. They are also positive for autoantibodies usually associated with type 1 diabetes. When compared to those with type 1 diabetes, these patients generally have greater preservation of ß-cell function with a slower development of absolute insulin deficiency; however, they do invariably develop a need for insulin.1 The proposed diagnostic criteria for LADA include: 1) Adult age at diagnosis (usually ≥30). 2) Positivity for at least one antibody usually seen in type 1 diabetes including islet cell autoantigen-2 antibodies, islet cell antibodies, insulin antibodies, and glutamic acid decarboxylase 65 antibodies (anti-GAD). 3) Evidence of at least temporary preservation of ß-cells with a delay in the need for insulin therapy at least 6 months after initial diagnosis.2 These patients usually will require insulin within 6 years of diagnosis as ß-cells fail with the autoimmune pancreatic effects. Q: Should I check antibody levels on all new onset adult patients with diabetes to evaluate for the presence of LADA? A: No. LADA accounts for approximately 10% of cases of diabetes in adults.3 In a majority of patients presenting in the ambulatory setting, the determination of type 1 versus type 2 diabetes is often based on the clinical presentation at diagnosis. However, in patients where the diagnosis is not clear—eg, patients who have little evidence of insulin resistance but whose apparent type 2 diabetes is controlled by oral medications or those who are of normal weight, have an active lifestyle, and do not have a family history of diabetes—checking antibodies is a reasonable approach to he Continue reading >>

Diagnosis

Diagnosis

It's important for diabetes to be diagnosed early so treatment can be started as soon as possible. If you experience the symptoms of diabetes, visit your GP as soon as possible. They'll ask about your symptoms and may request blood and urine tests. Your urine sample will be tested for glucose. Urine doesn't normally contain glucose, but glucose can pass from the kidneys into your urine if you have diabetes. If your urine contains glucose, a specialised blood test known as glycated haemoglobin (HbA1c) can be used to determine whether you have diabetes. Glycated haemoglobin (HbA1c) test The glycated haemoglobin (HbA1c) test can be used to diagnose diabetes. It can also be used to show how well diabetes is being controlled. The HbA1c test gives your average blood glucose level over the previous two to three months. The results can indicate whether the measures you're taking to control your diabetes are working, by meeting agreed personal targets. If you've been diagnosed with diabetes, it's recommended that you have your HbA1c measured at least twice a year. However, you may need to have your HbA1c measured more frequently if: you've recently been diagnosed with diabetes your blood glucose remains too high your treatment plan has been changed The HbA1c test can be carried out at any time of day and doesn't require any special preparation, such as fasting. However, it's less reliable in certain situations, such as during pregnancy. The advantages associated with the HbA1c test make it the preferred method of assessing how well blood glucose levels are being controlled in a person with diabetes. HbA1c is also increasingly being used as a diagnostic test for type 2 diabetes, and as a screening test for people at high risk of diabetes. Type 1 diabetes in children The majority Continue reading >>

Diabetes: The Differences Between Types 1 And 2

Diabetes: The Differences Between Types 1 And 2

Diabetes, or diabetes mellitus (DM), is a metabolic disorder in which the body cannot properly store and use sugar. It affects the body's ability to use glucose, a type of sugar found in the blood, as fuel. This happens because the body does not produce enough insulin, or the cells do not correctly respond to insulin to use glucose as energy. Insulin is a type of hormone produced by the pancreas to regulate how blood sugar becomes energy. An imbalance of insulin or resistance to insulin causes diabetes. Diabetes is linked to a higher risk of cardiovascular disease, kidney disease, vision loss, neurological conditions, and damage to blood vessels and organs. There is type 1, type 2, and gestational diabetes. They have different causes and risk factors, and different lines of treatment. This article will compare the similarities and differences of types 1 and 2 diabetes. Gestational diabetes occurs in pregnancy and typically resolves after childbirth. However, having gestational diabetes also increases the risk of developing type 2 diabetes after pregnancy, so patients are often screened for type 2 diabetes at a later date. According to the Centers for Disease Control and Prevention (CDC), 29.1 million people in the United States (U.S.) have diabetes. Type 2 diabetes is much more common than type 1. For every person with type 1 diabetes, 20 will have type 2. Type 2 can be hereditary, but excess weight, a lack of exercise and an unhealthy diet increase At least a third of people in the U.S. will develop type 2 diabetes in their lifetime. Both types can lead to heart attack, stroke, nerve damage, kidney damage, and possible amputation of limbs. Causes In type 1 diabetes, the immune system mistakenly attacks the insulin-producing pancreatic beta cells. These cells are destro Continue reading >>

Diagnosing Type 1.5 Diabetes

Diagnosing Type 1.5 Diabetes

Caraline McLeod wasn't the only one surprised by tests confirming she had an uncommon type of diabetes she'd read about on the internet. I'd heard there was a new woman GP in town, so, at my doctor-husband's urging, I booked an appointment for a routine check-up. I was feeling well and had no need to suspect anything was amiss. The GP detected nothing out of the ordinary and, with the exception of slightly elevated cholesterol levels, my blood tests came back normal. My GP told me to try to lower my cholesterol levels with diet and exercise and she'd see me again in six months. I embarked upon a calorie-controlled, low-fat diet and worked out most nights for 45 to 60 minutes on my treadmill and weights machine. I was feeling fit and healthy and was close to my ideal weight when the time arrived for my follow-up visit. Rapid change In preparation for the visit my husband organised repeat blood tests and sent a copy to my GP. The results arrived the following afternoon. Though my cholesterol had lowered from 5.6 mmol/L to 5.2 mmol/L, we were both surprised to see that my fasting blood glucose had gone from a perfectly normal 5.2 mmol/L to a perfectly diabetic 9.3 mmol/L. A follow-up fasting blood glucose, organised by my husband, confirmed I had diabetes. A few days later my GP reaffirmed that I had type 2 diabetes and warned me of the complications if this was not treated correctly with a combination of diet, exercise and oral medication. I wondered how diet and exercise were going to save me, when previous dedication in this area had let me down so badly. The following week I dutifully attended a session with a diabetes dietitian. Of the six people at the clinic, I was the only one who had taken the fast lane to the dark side, everyone else was pre-diabetic. Along with Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 diabetes (previously called insulin-dependent or juvenile diabetes) is usually diagnosed in children, teens, and young adults, but it can develop at any age. If you have type 1 diabetes, your pancreas isn’t making insulin or is making very little. Insulin is a hormone that enables blood sugar to enter the cells in your body where it can be used for energy. Without insulin, blood sugar can’t get into cells and builds up in the bloodstream. High blood sugar is damaging to the body and causes many of the symptoms and complications of diabetes. Type 1 diabetes is less common than type 2—about 5% of people with diabetes have type 1. Currently, no one knows how to prevent type 1 diabetes, but it can be managed by following your doctor’s recommendations for living a healthy lifestyle, controlling your blood sugar, getting regular health checkups, and getting diabetes self-management education. Shakiness Nervousness or anxiety Sweating, chills, or clamminess Irritability or impatience Dizziness and difficulty concentrating Hunger or nausea Blurred vision Weakness or fatigue Anger, stubbornness, or sadness If your child has type 1 diabetes, you’ll be involved in diabetes care on a day-to-day basis, from serving healthy foods to giving insulin injections to watching for and treating hypoglycemia (low blood sugar; see below). You’ll also need to stay in close contact with your child’s health care team; they will help you understand the treatment plan and how to help your child stay healthy. Much of the information that follows applies to children as well as adults, and you can also click here for comprehensive information about managing your child’s type 1 diabetes. Causes Type 1 diabetes is caused by an autoimmune reaction (the body attacks itself by mistak Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 diabetes can occur at any age. It is most often diagnosed in children, adolescents, or young adults. Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy. With type 1 diabetes, beta cells produce little or no insulin. Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. This buildup of glucose in the blood is called hyperglycemia. The body is unable to use the glucose for energy. This leads to the symptoms of type 1 diabetes. The exact cause of type 1 diabetes is unknown. Most likely, it is an autoimmune disorder. This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type 1 diabetes, an infection or another trigger causes the body to mistakenly attack the cells in the pancreas that make insulin. The tendency to develop autoimmune diseases, including type 1 diabetes, can be passed down through families. Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 diabetes (also known as insulin-dependent diabetes mellitus — IDDM — or juvenile diabetes) occurs when the pancreas does not make enough insulin because the cells that produce insulin have been destroyed by the immune system. Without insulin, sugar is not able to move into the cells. Sugar therefore remains in the blood, leading to hyperglycemia (high blood sugar). Type 1 is the most common type of diabetes found in children and young adults. It is now believed that diabetes develops gradually, over many months or even years. The immune system destroys more and more insulin-producing (beta) cells in the pancreas over time, until the diagnosis of type 1 diabetes is made. Who gets type 1 diabetes? Type 1 diabetes is seen most often in children and young adults, although the disease can occur at any age. People with Type 1 disease are often thin to normal weight and often lose weight prior to diagnosis. Type 1 diabetes accounts for about 5-10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes: Any combination of the following factors may put people at a higher risk for type 1 diabetes: Self-allergy (autoimmunity): The immune system usually protects us from disease, but in the case of type 1 diabetes, the immune system turns against the cells in the pancreas that produce insulin (beta cells). If you have any type of autoimmune disease, your risk of developing diabetes increases. Doctors can test for diabetes antibodies, specifically one called GAD65. Measuring this antibody early in the disease can help your medical team determine if you have type 1 or type 2 diabetes. Genes: People with type 1 diabetes are more likely to have inherited genes putting them at risk. Over 50% of those diagnosed with type 1 diabetes also have a close relative with Continue reading >>

Diagnosis And Management Of Type 1 Diabetes In Adults: Summary Of Updated Nice Guidance

Diagnosis And Management Of Type 1 Diabetes In Adults: Summary Of Updated Nice Guidance

Offer all adults with type 1 diabetes a structured education programme in self management of diabetes six to 12 months after diagnosis or, if this was not achieved, at any time that is clinically appropriate and suitable for the person Support adults to aim for a target glycated haemoglobin 48 mmol/mol (6.5%) or lower, to minimise risk of vascular complications; ensure that aiming for the target is not accompanied by problematic hypoglycaemia, and support four to 10 daily self monitoring blood tests as routine Offer all adults daily basal-bolus insulin injection regimens, with twice daily insulin detemir as basal insulin therapy and rapid acting insulin analogues injected before meals for mealtime insulin “boluses” Assess awareness of hypoglycaemia at least annually using a scoring system Patients were involved at every stage of creating the guideline. Patient groups and individuals contributed to the scoping of the update and at the consultation stage. Lay members were active in the Guideline Development Group, contributing to the formulation of the recommendations summarised here, and were instrumental in setting the new treatment targets. Having type 1 diabetes reduces the life expectancy of adults in the United Kingdom by as much as 13 years.1 Despite incontrovertible evidence that good care reduces the risk of complications such as blindness, renal failure, and premature cardiovascular disease and death,2 as well as complications of treatment such as severe hypoglycaemia,3 fewer than 30% of UK adults with type 1 diabetes achieve current national treatment targets for glucose control.4 The challenges of managing type 1 diabetes do not lessen after the age of 18 years. Since the publication of the 2004 National Institute for Health and Care Excellence (NICE) guid Continue reading >>

Symptoms Of Diabetes Type 1 In Adults

Symptoms Of Diabetes Type 1 In Adults

Symptoms of type 1 diabetes in adults may occur suddenly It’s important to realize that early signs of type 1 diabetes in adults often develop quickly and may sometimes be brushed off—or mistaken for illness. Here’s what you should look out for: Frequent Urination: If you’re constantly running to the bathroom, your kidneys may be trying to rid your blood of excess sugar, resulting in an increased need to urinate. Extreme thirst: Increased urination can then result in dehydration, which will leave you feeling more thirsty than normal. Increased appetite: If you’re suddenly hungry all the time it may be because your body isn’t able to get proper energy from the food you eat. Unexpected weight loss: Along the same lines, if your body is losing sugar in your urine instead of absorbing it, you may lose weight without trying. Other symptoms of type 1 diabetes in adults Other diabetic symptoms in adults include feeling drowsy or lethargic; sudden vision changes; fruity or sweet-smelling breath; heavy or labored breathing; and stupor or unconsciousness. If you do have high blood sugar and it goes untreated, it could develop into diabetic ketoacidosis—a life-threatening condition. So please see your doctor immediately if you are exhibiting these warning signs. So what are the low blood sugar symptoms you should look out for? It’s important to realize that the signs of… The reality is that signs of type 1 diabetes usually develop suddenly. And, that’s why it can be… Continue reading >>

Iddm (type 1 Diabetes)

Iddm (type 1 Diabetes)

A patient who reqires insulin therapy to prevent ketoacidosis has type 1 diabetes (insulin dependent diabetes mellitus (IDDM)). Typically a young patient will present with a short history of polydipsia, polyuria, weight loss and malaise: polyuria is due to the osmotic diurectic effect of glucose and ketone bodies in the urine weight loss is due to the combined effects of dehydration and catabolism There may be associated features such as: infections: often bacterial and fungal skin infections urinary tract infections candidal genital infections cramps and abdominal pain Some patients will present with overt diabetic ketoacidosis which is characterised by: nausea and vomiting acidotic breathing ketones on the breath NICE however state with respect to diagnosis of type 1 diabetes that (1): diagnose type 1 diabetes on clinical grounds in adults presenting with hyperglycaemia, bearing in mind that people with type 1 diabetes typically (but not always) have one or more of: ketosis rapid weight loss age of onset below 50 years BMI below 25 kg/m2 personal and/or family history of autoimmune disease do not discount a diagnosis of type 1 diabetes if an adult presents with a BMI of 25 kg/m2 or above or is aged 50 years or above Type 1 diabetes (IDDM) presents long term medical challenges: recurrent acute crises: diabetic ketoacidosis during times of physiological stress e.g. infections, myocardial infarction etc chronic complications of IDDM: cardiovascular disease neuropathy nephropathy retinopathy Reference: Continue reading >>

Diagnosis And Classification Of Diabetes

Diagnosis And Classification Of Diabetes

Diagnosis and Classification of Diabetes is a topic covered in the Johns Hopkins Diabetes Guide. Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics: -- The first section of this topic is shown below -- Diabetes is classified as type 1 (formerly called juvenile-onset or insulin-dependent diabetes mellitus), type 2 (formerly called adult-onset or non-insulin dependent diabetes mellitus), gestational or other specific types. Type 1 diabetes: complete or almost complete insulin deficiency, usually caused by autoimmunity. Clinical features: younger onset (usually but not always before 30 years old), normal body weight, usually no family history of diabetes, insulin treatment required immediately or within about a year, positive GAD, IA2 and/or islet cell antibodies, susceptibility to ketoacidosis and unstable blood glucose levels. Type 1b or idiopathic diabetes: an unusual form of phenotypic type 1 diabetes with almost complete insulin deficiency, a strong hereditary component, and no evidence of autoimmunity. Reported mainly in Africa and Asia. Latent autoimmune diabetes of adulthood (LADA): a form of type 1 diabetes with adult onset, slowly progressive, eventual insulin requirement but may respond to oral agents initially, usually no ketoacidosis on presentation, positive GAD, IA2 and/or islet cell antibodies. Type 2 diabetes: insulin resistance with preserved endogenous insulin secretion but inadequate to overcome the resistance. About 90-95% of all diabetes, more common type in ethnic minorities. Clinical features: older onset (often >35 years old, though recently occurring more often in youth), over Continue reading >>

Type 1 Diabetes In Children

Type 1 Diabetes In Children

What is type 1 diabetes? Type 1 diabetes is an autoimmune disease that causes an unhealthy amount of a simple sugar (glucose) to build up in a person's blood. Someone with type 1 diabetes can't produce enough insulin, a hormone that moves glucose from the bloodstream into cells throughout the body, where it supplies energy and fuels growth. Normally, a child's immune system protects her body from diseases by destroying unhealthy cells and germs. But when a child has type 1 diabetes, her body also mistakenly attacks the healthy insulin-producing cells of the pancreas (a gland behind the stomach). Without these cells, her pancreas produces very little or no insulin, which leads to an abnormally high amount of sugar in her blood. Without proper care, type 1 diabetes can cause serious, wide-ranging health problems that can damage organs throughout the body over the long-term. If your child has been diagnosed with type 1 diabetes, it's understandable that you might worry. But diabetes can be kept under control by carefully monitoring your child's blood sugar and following her treatment plan. A team of doctors, nurses, and nutritionists can help your child be as healthy as possible and teach her to manage the condition so she stays that way. What are the symptoms of type 1 diabetes in children? Symptoms of type 1 diabetes include: Extreme thirst Peeing more than usual (You might notice more wet diapers if your child is very young, or "accidents" if your child is potty trained.) Extreme hunger Weight loss Unusual tiredness Crankiness Yeast infection or diaper rash If your child has one or more of these symptoms, call his doctor right away. Type 1 diabetes symptoms can start quickly and become very serious without treatment. Get medical care immediately if your child has any of Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management

Type 1 Diabetes In Adults: Diagnosis And Management

Excerpt Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability. The number of adults with type 1 diabetes means that, while the condition is certainly not rare, it is not common enough to provide and maintain all the necessary skills in its management for all healthcare professionals who will deal with it. The aim of this guideline is, therefore, to provide evidence-based, practical advice on the steps necessary to support adults with type 1 diabetes to live full, largely unrestricted, lives and avoid the acute and long-term complications of both the disease and of its treatment. NICE last produced such a guideline in 2004. The present guideline is an update of many sections of that guideline, focusing on areas where new knowledge and new treatment opportunities have arisen in the last decade. There have been many such developments, resulting in improving outcomes for adults with type 1 diabetes, but also presenting more challenges in the diversity and complexity of the tools they now have to achieve these outcomes. Continue reading >>

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