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Secondary Diabetes Mellitus Wiki

Fibrocalculous Pancreatic Diabetes: A Case Report

Fibrocalculous Pancreatic Diabetes: A Case Report

Fibrocalculous pancreatic diabetes: a case report DissanayakeMudiyanselagePriyanthaUdayaKumaraRalapanawa 1 Email author , EkanayakeMudiyanselageMadhushankaEkanayake 2 Ralapanawa et al.; licensee BioMed Central.2015 Diabetes is now becoming a major cause of morbidity and mortality in both developing and developed countries. Even though type 1 and type 2 are the commonest, diabetes mellitus due to secondary causes have been identified. Fibrocalculous Pancreatic Diabetes is a unique entity wherein pancreatic calcification and chronic inflammation lead to exocrine and endocrine failure of the pancreas. This form of non-alcoholic pancreatopathy is exclusively seen among the young, with a male preponderance and commonly in tropical countries where malnutrition and poverty go hand in hand. Whereas, interestingly this case has a late presentation in a female, unlike in other reported cases. For the best of our knowledge this is the first such documented case reported in Sri Lanka. A 57year old non-alcoholic Sinhalese female from Sri Lanka, presented with a history of chronic pancreatitis of nine years duration, after which she had developed severe Insulin Dependent Diabetes Mellitus. Imaging of the abdomen showed typical pancreatic calcifications, and this presentation accords with the criteria for Fibrocalculous pancreatic diabetes. This case report demonstrates a rare form of secondary diabetes in a middle aged female, without a childhood history of abdominal pain suggestive of pancreatitis, indicating late onset disease. Therefore a high index of suspicion is necessary even though the diagnostic criteria indicates the presence of childhood onset of disease. Diabetes MellitusChronic pancreatitisFibrocalculous pancreatopathyTropical pancreatitisSri Lanka Fibrocalculous pancre Continue reading >>

Other Types Of Diabetes Mellitus

Other Types Of Diabetes Mellitus

In most cases of diabetes, referred to as type 1 and type 2, no specific cause can be identified. This is referred to as primary or idiopathic diabetes. A small minority of cases, estimated at about 2%, arise as the consequence of some other well-defined disease or predisposing factor such as pancreatitis or steroid excess. This is called 'secondary diabetes'. Secondary diabetes can be sub-divided into single-gene disorders affecting insulin secretion or resistance, damage to the exocrine pancreas, other endocrine disease, drug-induced diabetes, uncommon manifestations of autoimmune diabetes, and genetic syndromes associated with diabetes. Gestational diabetes (diabetes arising for the first time in pregnancy) has a diagnostic category all to itself, but is included in this section for convenience. Secondary diabetes is often (but not always) associated with a relatively mild metabolic disturbance, but may nonetheless result in typical long-term complications such as retinopathy. Although it is relatively uncommon, the possibility of secondary diabetes should always be considered, since it may be a pointer to other disease, often requires a different approach to therapy, and is sometimes reversible. Background The common denominator of all the forms of diabetes discussed here is that something sets them apart from type 1 and type 2 diabetes. Since type 2 diabetes is hard to define, this implies that for most forms of diabetes in this category there is a pointer to a different pathophysiological explanation! The current WHO classification of diabetes, adopted and regularly updated by the American Diabetes Association, identifies four main categories of diabetes, and secondary diabetes is clssified under 'other specific types' (see figures). The common categories of secon Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

"Diabetes" redirects here. For other uses, see Diabetes (disambiguation). Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.[7] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2] Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.[8] There are three main types of diabetes mellitus:[2] Type 1 DM results from the pancreas's failure to produce enough insulin.[2] This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".[2] The cause is unknown.[2] Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses a lack of insulin may also develop.[9] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is excessive body weight and insufficient exercise.[2] Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.[2] Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with t Continue reading >>

Principles Of Biochemistry/glucose, Glycogen And Diabetes

Principles Of Biochemistry/glucose, Glycogen And Diabetes

Glucose (C6H12O6, also known as D-glucose, dextrose, or grape sugar) is a simple sugar (monosaccharide) and an important carbohydrate in biology. Cells use it as a source of energy and a metabolic intermediate. Glucose is one of the main products of photosynthesis and starts cellular respiration. Glucose exists in several different structures, but all of these structures can be divided into two families of mirror-images (stereoisomers). Only one set of these isomers exists in nature, those derived from the "right-handed form" of glucose, denoted D-glucose. D-glucose is often referred to as dextrose. The term dextrose is derived from dextrorotatory glucose. Solutions of dextrose rotate polarized light to the right (in Latin: dexter = "right"). Starch and cellulose are polymers derived from the dehydration of D-glucose. The other stereoisomer, called L-glucose, is hardly found in nature. The name "glucose" comes from the Greek word glukus (γλυκύς), meaning "sweet". The suffix "-ose" denotes a sugar. The name "dextrose" and the 'D-' prefix come from Latin dexter ("right"), referring to the handedness of the molecules. Glucose is a monosaccharide with formula C6H12O6 or H-(C=O)-(CHOH)5-H, whose five hydroxyl (OH) groups are arranged in a specific way along its six-carbon backbone.[1] In its fleeting open-chain form, the glucose molecule has an open (as opposed to cyclic) and unbranched backbone of six carbon atoms, C-1 through C-6; where C-1 is part of an aldehyde group H(C=O)-, and each of the other five carbons bears one hydroxyl group -OH. The remaining bonds of the backbone carbons are satisfied by hydrogen atoms -H. Therefore glucose is an hexose and an aldose, or an aldohexose. Each of the four carbons C-2 through C-5 is chiral, meaning that its four bonds conne Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Author: Charles F Potter, MD; Chief Editor: Ted Rosenkrantz, MD more... Infants of diabetic mothers (IDMs) have experienced a nearly 30-fold decrease in morbidity and mortality rates since the development of specialized maternal, fetal, and neonatal care for women with diabetes and their offspring. Before then, fetal and neonatal mortality rates were as high as 65%. Today, 3-10% of pregnancies are affected by abnormal glucose regulation and control. Of these cases, 80-88% are related to abnormal glucose control of pregnancy or gestational diabetes mellitus. Of mothers with preexisting diabetes, 35% have been found to have type 1 diabetes mellitus, and 65% have been found to have type 2 diabetes mellitus. Infants born to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to the following: Growth abnormalities (large for gestational age [LGA], small for gestational age [SGA]) Hypocalcemia , hypomagnesemia, and iron abnormalities These infants are likely to be born by cesarean delivery for many reasons, among which are such complications as shoulder dystocia with potential brachial plexus injury related to the infant's large size. These mothers must be closely monitored throughout pregnancy. If optimal care is provided, the perinatal mortality rate, excluding congenital malformations, is nearly equivalent to that observed in normal pregnancies. Communication between members of the perinatal team is of crucial importance to identify infants who are at the highest risk for complications from maternal diabetes. Fetal congenital malformations are most common when maternal glucose control has been poor during the first trimester of pregnancy. As such, the need for preconceptional glycemic control in women with diabetes cannot be overst Continue reading >>

Metabolic Surgery - A Sages Wiki Article

Metabolic Surgery - A Sages Wiki Article

Type 2 diabetes mellitus (T2DM) is a major cause of death in the world given its relation to kidney failure, blindness, amputations, heart attack and others as erectlie dysfunction, diarrhea and gastroparesis . Medical therapy for this disease has advanced considerably but still leaves a majority of patients susceptible to its severe effects. While new drug therapies continue to improve medical therapy for this disease, a majority never reach the defined targets for success . Clinical resolution of T2DM, usually defined as independence from all antidiabetic medications, was reported to occur in 48% of patients after adjustable gastric banding (AGB), 84% after Roux-en-Y gastric bypass(RYGB) and 98% after bilio pancreatic diversion (BPD) . T2DM resolution in AGB is proportional to weight loss. The remarkable resolution of diabetes after the 2 last mentioned procedures typically occurs too fast to be accounted for by weight loss alone, suggesting that there may have a direct and more profound impact on glucose homeostasis. The antidiabetic effect of bariatric surgery is long lasting. Long-term control of glycemia and normal levels of glycosylated hemoglobin after RYGB have been documented in large series with up to 14 years of follow up . While T2DM is often associated with obesity, this relationship is highly dependant on geographic location. The average BMI of a T2DM patient in the United States is 30 while in India, the average is 27 .Despite its efficacy with respect to weight loss and resolution of co-morbid health conditions, bariatric surgery is in theory, less desirable for normal/overweight patients. Bariatric operations have occasionally been performed in non-morbidly obese individuals. Cohen et al.,recently published the surgical treatment of 37 patients outsid Continue reading >>

Secondary Diabetes

Secondary Diabetes

Tweet Secondary diabetes is diabetes that results as a consequence of another medical condition. Because the cause of diabetes ranges between different conditions, the way in which blood glucose levels are controlled can also vary. Secondary diabetes will often be permanent but for some forms, it may be possible to reverse or eradicate the effects of hyperglycemia. Which conditions can lead to secondary diabetes? Health conditions which can cause diabetes include: Cystic fibrosis Hemochromatosis Chronic pancreatitis Polycystic ovary syndrome (PCOS) Cushing's syndrome Pancreatic cancer Pancreatectomy Drug induced diabetes includes diabetes that results from taking certain medications. Medications which may bring on diabetes include corticosteroids, beta-blockers and thiazide diuretics. Read more on drug induced diabetes Managing secondary diabetes How secondary diabetes is managed can vary quite significantly depending on which condition has caused it. Insulin resistance Some medical conditions listed will result in insulin resistance, which is where the body is not able to adequately respond to insulin. This forces the body to release more insulin in an attempt to keep blood glucose levels under control. Insulin resistance is a characteristic of type 2 diabetes. Insulin resistance is a feature of diabetes caused by Cushing’s syndrome and PCOS. Lifestyle changes are an important part of treatment. If medication is required to control blood glucose levels, metformin is commonly prescribed with stronger medication, including insulin, available if blood glucose levels remain elevated. Loss of pancreatic function Some forms of secondary diabetes, such as diabetes as a result of pancreatitis, cystic fibrosis or hemochromatosis, may result in a loss of pancreatitic function; Continue reading >>

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3] Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatri Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Pancreatogenic (type 3c) Diabetes

Pancreatogenic (type 3c) Diabetes

1. Definition Pancreatogenic diabetes is a form of secondary diabetes, specifically that associated with disease of the exocrine pancreas. The most common disease of the exocrine pancreas associated with the development of diabetes is chronic pancreatitis. Analogous to chronic pancreatitis-associated diabetes is cystic fibrosis-related diabetes (CFRD), in which pancreatic exocrine insufficiency pre-dates the pancreatic endocrine insufficiency responsible for the development of diabetes. Because diabetes in cystic fibrosis is associated with worse nutritional status, more severe inflammatory lung disease, and greater mortality from respiratory failure, CFRD has long been recognized as a distinct form of diabetes requiring a specified approach to evaluation and treatment (30) now recognized by the American Diabetes Association (28). While the distinct pathogenesis of diabetes in chronic pancreatitis has also long been appreciated, only recently have guidelines been developed supporting a specified diagnostic and therapeutic algorithm (37). Finally, other less common forms of pancreatogenic diabetes exist, such as that due to pancreatic cancer (18), as well as post-pancreatectomy diabetes, with each requiring individualized approaches to care. 2. Classification Pancreatogenic diabetes is classified by the American Diabetes Association and by the World Health Organization as type 3c diabetes mellitus (T3cDM) and refers to diabetes due to impairment in pancreatic endocrine function related to pancreatic exocrine damage due to acute, relapsing and chronic pancreatitis (of any etiology), cystic fibrosis, hemochromatosis, pancreatic cancer, and pancreatectomy, and as well rare causes such as neonatal diabetes due to pancreatic agenesis (1). Prevalence data on T3cDM are scarce b Continue reading >>

Dcct - Wiki Journal Club

Dcct - Wiki Journal Club

In patients with T1DM, how does strict glycemic control with intensive therapy compare with conventional therapy in preventing microvascular complications? Among patients with T1DM, strict glycemic control prevents up to 70% of microvascular complications, particularly retinopathy. The Diabetes Control and Complications Trial (DCCT) demonstrated that strict glycemic control targeting lower HbA1c goals among patients with T1DM can both delay the onset of retinopathy, nephropathy, and neuropathy and slow the progression of existing microvascular complications. This came at the expense of a threefold higher risk of hypoglycemia, underlying the fact that HbA1c goals should be tailored to the individual. DCCT was unable to demonstrate a reduction in CV events, likely because the study population was relatively young at the time. However, EDIC and other follow-up studies did demonstrate such benefits. Despite the fact that DCCT studied only patients with T1DM, many physicians began recommending strict glycemic control to patients with T2DM as well. Randomized to intensive vs. conventional therapy Stratified according to primary-prevention and secondary-intervention cohorts at each center Retinopathy assessed by Early Treatment Diabetic Retinopathy Study (ETDRS) protocol Scale of 25 steps which represent overall extent of retinopathy Development or progression of retinopathy defined as sustained (6 month) change of 3 steps from baseline Intensive therapy: injections of insulin 3 times daily or via external pump; dosages adjusted according to self-monitoring of blood glucose QID Appointments every 1 month and frequent telephone calls Conventional therapy: injections of insulin one or two times daily; self-monitoring of urine or blood glucose daily, daily adjustments Absence of Continue reading >>

Risk Factors And Aetiology Of Diabetes Mellitus

Risk Factors And Aetiology Of Diabetes Mellitus

type 2 diabetes mellitus introduction it is thought that T2DM develops when a diabetogenic lifestyle (ie. excessive caloric intake, inadequate caloric expenditure, obesity) is superimposed on a susceptible genotype genetic factors prenatal factors hypertension hyperlipidaemia type 1 diabetes mellitus it is considered to be an autoimmune destruction of pancreatic β-cells in those who have genetic susceptibility and an environmental trigger (perhaps viral or toxin related) monozygotic twins will share the diagnosis more than 50% of the time by the age of 40 years child of mother with T1DM has 2-3% risk while child of father with T1DM has 5-6% risk, and 30% if both parents have T1DM Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

This article is about the effects of pre-existing diabetes upon pregnancy. For temporary diabetic symptoms as a complication of pregnancy, see Gestational diabetes. For pregnant women with diabetes mellitus some particular challenges for both mother and child. If the woman has diabetes as an intercurrent disease in pregnancy, it can cause early labor, birth defects, and very large babies. Planning in advance is emphasized if one wants to have a baby and has type 1 diabetes mellitus or type 2 diabetes mellitus. Pregnancy management for diabetics needs stringent blood glucose control even in advance of having pregnancy. Physiology[edit] During a normal pregnancy, many physiological changes occur such as increased hormonal secretions that regulate blood glucose levels, such as a glucose-'drain' to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin. Risks for the child[edit] The risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits,[1] polyhydramnios and birth defects.[citation needed] A hyperglycemic maternal environment has also been associated with neonates that are at greater risk for development of negative health outcomes such as future obesity, insulin resistance, type 2 diabetes mellitus, and metabolic syndrome.[2] Mild neurological and cognitive deficits in offspring — including increased symptoms of ADHD, impaired fine and gross motor skills, and impaired explicit memory performance — have been linked to pregestational type 1 diabetes and gestational diabetes.[3][4][5] Prenatal iron deficiency has been suggested as a possible mechanism for these problems.[6] Birth defects are Continue reading >>

Secondary Diabetes Mellitus

Secondary Diabetes Mellitus

Also found in: Dictionary, Thesaurus, Encyclopedia. secondary diabetes mellitus DM that results from damage to the pancreas (e.g., after frequent episodes of pancreatitis) or from drugs such as corticosteroids (which increase resistance to the effects of insulin). diabetes mellitus a broadly applied term used to denote a complex group of syndromes that have in common a disturbance in the oxidation and utilization of glucose, which is secondary to a malfunction of the beta cells of the pancreas, whose function is the production and release of insulin. Because insulin is involved in the metabolism of carbohydrates, proteins and fats, diabetes is not limited to a disturbance of glucose homeostasis alone. Diabetes mellitus has been recorded in all species but is most commonly seen in middle-aged to older, obese, female dogs. A familial predisposition has been suggested. It is possible to identify two types of diabetes, corresponding to the disease in humans, depending on the response to an intravenous glucose tolerance test. Type I is insulin-dependent and comparable to the juvenile onset form of the disease in children in which there is an absolute deficiency of insulin—there is a very low initial blood insulin level and a low response to the injected glucose. This form is seen in a number of dog breeds, particularly the Keeshond, Doberman pinscher, German shepherd dog, Poodle, Golden retriever and Labrador retriever. Type II is non-insulin-dependent, similar to the adult onset diabetes in humans due to pancreatic damage—there is a high or normal initial blood insulin level and no increase in insulin levels as a result of the glucose load. It is the form seen most often in cats. brittle diabetes mellitus diabetes mellitus that is difficult to control, characterized by Continue reading >>

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes of Ketosis-Prone Diabetes Mellitus Ashok Balasubramanyam , Ramaswami Nalini , Christiane S. Hampe , and Mario Maldonado Translational Metabolism Unit (A.B., R.N., M.M.), Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas 77030; Endocrine Service (A.B., R.N.), Ben Taub General Hospital, Houston, Texas 77030; Robert H. Williams Laboratory (C.S.H.), University of Washington, Seattle, Washington 98195; and Novartis, Inc. (M.M.), CH-4002 Basel, Switzerland Address all correspondence and requests for reprints to: Ashok Balasubramanyam, M.D., Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Room 700B, One Baylor Plaza, Houston, Texas 77030. E-mail: [email protected] Received 2007 Aug 13; Accepted 2008 Jan 9. Copyright 2008 by The Endocrine Society This article has been cited by other articles in PMC. Ketosis-prone diabetes (KPD) is a widespread, emerging, heterogeneous syndrome characterized by patients who present with diabetic ketoacidosis or unprovoked ketosis but do not necessarily have the typical phenotype of autoimmune type 1 diabetes. Multiple, severe forms of -cell dysfunction appear to underlie the pathophysiology of KPD. Until recently, the syndrome has lacked an accurate, clinically relevant and etiologically useful classification scheme. We have utilized a large, longitudinally followed, heterogeneous, multiethnic cohort of KPD patients to identify four clinically and pathophysiologically distinct subgroups that are separable by the presence or absence of -cell autoimmunity and the presence or absence of -cell functional reserve. The resulting A classification system of KPD has proven to be highly accurate and predictive of such clinically importan Continue reading >>

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