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Why Is Dka Rare In Type 2 Diabetes

Ketosis-prone Type 2 Diabetes

Ketosis-prone Type 2 Diabetes

Time to revise the classification of diabetes Diabetic ketoacidosis (DKA) is the most serious hyperglycemic emergency in patients with diabetes. DKA is reported to be responsible for >100,000 hospital admissions per year in the U.S. (1) and is present in 25–40% of children and adolescents with newly diagnosed diabetes (2) and in 4–9% of all hospital discharge summaries among adult patients with diabetes (3,4). DKA has long been considered a key clinical feature of type 1 diabetes, an autoimmune disorder characterized by severe and irreversible insulin deficiency. In recent years, however, an increasing number of ketoacidosis cases without precipitating cause have also been reported in children, adolescents, and adult subjects with type 2 diabetes (5–7). These subjects are usually obese and have a strong family history of diabetes and a low prevalence of autoimmune markers. At presentation, they have impairment of both insulin secretion and insulin action, but aggressive diabetes management results in significant improvement in β-cell function and insulin sensitivity sufficient to allow discontinuation of insulin therapy within a few months of treatment (7–9). Upon discontinuation of insulin, the period of near-normoglycemic remission may last for a few months to several years (10–13). This clinical presentation has been reported primarily in Africans and African Americans (6,7,14–16) and also in other minority ethnic groups (12,17,18). This variant of type 2 diabetes has been referred to in the literature as idiopathic type 1 diabetes, atypical diabetes, Flatbush diabetes, diabetes type 1 (1/2) (somewhere between type 1 and type 2 diabetes), and more recently as ketosis-prone type 2 diabetes (9). In this issue of Diabetes Care, Balasubramayam et al. (19) co Continue reading >>

New Class Of Type 2 Diabetes Drug Associated With Rare, Life-threatening Outcome

New Class Of Type 2 Diabetes Drug Associated With Rare, Life-threatening Outcome

A new class of drugs, known as SGLT2 inhibitors, is increasingly being prescribed for the treatment of type 2 diabetes, but may increase the risk of rare but serious complication known as diabetic ketoacidosis. In a new study published in the New England Journal of Medicine, investigators from Brigham and Women's Hospital quantify that risk, finding that patients are twice as likely to experience diabetic ketoacidosis if taking an SGLT2 inhibitor rather than another class of diabetes drugs. However, diabetic ketoacidosis is still extremely rare: even for patients taking an SGLT2 inhibitor, only about one in every 1,000 patients will experience this complication, the researchers estimate. The research team studied 40,000 patients taking SGLT2 inhibitors, comparing their outcomes to those of patients taking a DPP4 inhibitor. After 180 days, 55 patients taking an SGLT2 inhibitor had experienced diabetic ketoacidosis, while 26 patients taking the other class of drug had experienced this side effect. SGLT2 inhibitors were first brought to market in April of 2013 and, based on clinical trials data, appeared to be quite safe. However, case reports of diabetic ketoacidosis among people with type 2 diabetes taking SGLT2 inhibitors prompted the FDA to issue a warning in 2015 about the class of drugs. Diabetic ketoacidosis is usually associated with type 1 diabetes - it's very uncommon for people with type 2 diabetes to experience this complication. Those who do suffer from this complication have high levels of acids, called ketones, in their blood and can experience vomiting, abdominal pain, shortness of breath, swelling in the brain and, if left untreated, diabetic ketoacidosis can be fatal. Corresponding author Michael Fralick, MD, FRCPC, of the BWH Division of Pharmacoepidemio Continue reading >>

What Is Diabetic Ketoacidosis?

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis is a serious condition characterized by high blood sugar (hyperglycemia), low insulin, and the presence of moderate to large amounts of ketones in the blood. It's a medical emergency that requires treatment in a hospital. If not treated in a timely fashion, ketoacidosis can lead to coma and death. While diabetic ketoacidosis (or DKA) is much more common among people with type 1 diabetes, it can also occur in people with type 2 diabetes, so ketone monitoring is something everyone with diabetes should understand. Diabetic Ketoacidosis Symptoms Signs and symptoms of ketoacidosis include: Thirst or a very dry mouth Frequent urination Fatigue and weakness Nausea Vomiting Dry or flushed skin Abdominal pain Deep breathing A fruity breath odor What Are Ketones? Ketones, or ketone bodies, are acidic byproducts of fat metabolism. It's normal for everyone to have a small amount of ketones in the bloodstream, and after a fast of 12 to16 hours, there may be detectable amounts in the urine. As is the case with glucose, if blood levels of ketones get too high, they spill over into the urine. An elevated level of ketones in the blood is known as ketosis. People who follow low-carbohydrate diets often speak of ketosis as a desirable state — it's evidence that their bodies are burning fat, not carbohydrate. But the level of ketosis that results from low carbohydrate consumption isn't harmful and is much lower than the level seen in diabetic ketoacidosis. When Should Ketones Be Monitored? Ketone monitoring is less of a concern for people with type 2 diabetes than for those with type 1 diabetes. This is because most people with type 2 diabetes still make some of their own insulin, making diabetic ketoacidosis less likely to develop. Nonetheless, people with type 2 d Continue reading >>

The Occurrence Of Diabetic Ketoacidosis In

The Occurrence Of Diabetic Ketoacidosis In

Type 2 Diabetic Adults Chih-Hsun Chu; Jenn-Kuen Lee; Hing-Chung Lam; Chih-Chen Lu Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital-Kaohsiung, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Running title: The Occurrence of Diabetic Ketoacidosis in Type 2 Diabetic Adults Abstract OBJECTIVE. To study the diabetic ketoacidosis (DKA) episodes which occurred in the type 2 diabetic adults. STUDY DESIGN. We reviewed retrospectively the charts of patients who were admitted to the division of endocrinology and metabolism from Jan. 1991 to Dec. 1997 due to DKA. RESULTS. Total 121 adult patients with 137 episodes (57 females and 80 males) of DKA, with mean age of 45.90 years. 98 episodes (71.5%) occurred in type 2 diabetes mellitus (DM) with mean age of 48.73, which was significantly older than type 1 diabetic patients. Among ten patients suffered from repeated episodes of DKA, 2 four patients belonged to type 2 DM. 33 episodes (24.1%) occurred in patients without a history of DM, however, up to 24 episodes were classified as in type 2. Infection was the most important precipitating factor in type 2 diabetic patients, with respiratory tract and urinary tract accounting for the two most common foci. In type 1 diabetic patients, poor drug compliance accounted for the leading one. Twelve patients (one in type 1 DM and eleven in type 2 DM) expired, giving the mortality rate of 8.8%. Only old age contributed to fatality in type 2 diabetic patients. Type 2 diabetic patients had lower value of serum potassium and the occurrence of hyperkalemia was less than that of type 1. CONCLUSION. Owing to high percentage of adult DKA episodes occurred in type 2 DM, more attention should be pay to these patients. KEYWORDS: diabetes mellitu Continue reading >>

Forms Of Diabetes

Forms Of Diabetes

Type 1 diabetes accounts for roughly 10% of the diabetes cases in the world with the majority being Type 2. An estimated 1-5% of all diagnosed cases of diabetes are rare types, such as latent autoimmune diabetes in adults (LADA), maturity onset diabetes in the young (MODY), cystic fibrosis related diabetes (CFRD), Cushing’s syndrome and others. Explore these various forms of diabetes and what makes them distinct in the diabetes family. Learn how to test for diabetes type. What is Type 1 Diabetes? Type 1 diabetes is a chronic, autoimmune condition that occurs when the body’s own immune system attacks the insulin-producing beta cells of the pancreas. This attack leaves the pancreas with little or no ability to produce insulin, a hormone that regulates blood sugar. Without insulin, sugar stays in the blood and can cause serious damage to organ systems, causing people to experience Diabetic ketoacidosis (DKA).READ MORE What is Type 2 Diabetes? Type 2 diabetes occurs when the body cannot properly use insulin, a hormone that regulates blood sugar. This is also known as insulin resistance. In Type 2, the pancreas initially produces extra insulin, but eventually cannot keep up with production in order to keep blood sugar levels in check. Of the 415 million diabetes cases globally, 90% are estimated to be Type 2.READ MORE Gestational diabetes mellitus (GDM) is a form of diabetes that affects pregnant women, and occurs in 1 in 25 pregnancies worldwide. It is caused by the malfunctioning of insulin receptors, due to the presence of hormones from the placenta. It develops usually around the 24th week of pregnancy and will continue to affect both the mother and unborn child throughout the pregnancy.READ MORE LADA, (Latent Autoimmune Diabetes in Adults) diabetes is rare and known Continue reading >>

Diabetic Ketoacidosis In A Patient With Type 2 Diabetes On Canagliflozin And Dexamethasone

Diabetic Ketoacidosis In A Patient With Type 2 Diabetes On Canagliflozin And Dexamethasone

An 87-year-old Chinese male with type 2 diabetes presented to the emergency department with generalized weakness, lethargy, and anorexia for several days. His past medical history included resection of a frontal meningioma 10 days prior (discharged postoperative day 2), previous frontal meningioma resection in 2009, hypertension, hyperlipidemia, atrial fibrillation, and benign prostatic hypertrophy. His diabetes was diagnosed 7 years earlier, his hemoglobin A1c 20 days prior to admission was 6.5% (48 mmol/mol), and his body mass index was 22.5 kg/m2. He was not performing home glucose monitoring, and his blood glucose was not monitored with point-of-care testing during his surgical admission. He had stage 3 chronic kidney disease (estimated glomerular filtration rate, 53 mL/min; baseline creatinine, 89 μmol/L) but no retinopathy or neuropathy, and he had never required hospitalization for hyperglycemia. At presentation, his medications included: dexamethasone 2 mg orally twice a day (tapering dose, discharged on 4 mg three times a day), canagliflozin 100 mg orally daily (started 8 weeks prior), metformin 500 mg orally twice a day, sitagliptin 50 mg orally twice a day, doxazosin 4 mg orally nightly, finasteride 5 mg orally daily, niacin extended release 500 mg orally twice a day, rosuvastatin 5 mg orally daily, and acetylsalicylic acid 81 mg orally daily. He had previously been taking hydrochlorothiazide 12.5 mg orally daily and olmesartan 20 mg orally daily, but these medications were stopped 6 weeks prior to his surgery because of hypotension. At presentation, he denied any neurologic or infectious symptoms. On physical examination, he appeared lethargic and unwell. His vital signs were: heart rate 152 beats/minute, blood pressure 76/53 mm Hg, respiratory rate 28 brea Continue reading >>

Diabetes Drugs Linked To Higher Risk For Rare But Deadly Complication

Diabetes Drugs Linked To Higher Risk For Rare But Deadly Complication

A new class of type 2 diabetes drugs called SGLT2 inhibitors could increase the risk of a rare, life-threatening complication of the disease called ketoacidosis, a new study warns. SGLT2 inhibitors include prescription medications such as canagliflozin, dapagliflozin and empagliflozin. Brand names are Invokana, Invokamet, Farxiga, Xigduo XR, Jardiance and Glyxambi. These drugs first became available in 2013, but in 2015 the U.S. Food and Drug Administration issued a warning about an increased risk for diabetic ketoacidosis when SGLT2 inhibitors are used. The condition typically occurs in people with type 1 diabetes. And while it is uncommon in people with type 2 diabetes, case reports have shown it can occur with type 2 disease, according to the study authors. Ketoacidosis can cause vomiting, abdominal pain, shortness of breath and swelling in the brain. Left untreated, the condition can be fatal, the researchers said. The new study "essentially confirms what doctors had already suspected," said diabetes expert Dr. Stanislaw Klek, an endocrinologist at NYU Winthrop Hospital in Mineola, N.Y. "Fortunately, the rate of diabetic ketoacidosis is still very low and should not prevent the usage of this medication class," he added. "It is important to be aware of this potential complication and monitor for symptoms of diabetic ketoacidosis, particularly during periods of illness." In the new study, researchers at Brigham and Women's Hospital in Boston analyzed data from 40,000 people with type 2 diabetes. They found that those taking SGLT2 inhibitors were twice as likely to develop diabetic ketoacidosis than those taking another class of diabetes drugs called DPP4 inhibitors (drugs such as Januvia and Onglyza). Still, the risk to any one patient remains very slim, the researche Continue reading >>

Class Of Diabetes Drug Raises Risk For Diabetic Ketoacidosis

Class Of Diabetes Drug Raises Risk For Diabetic Ketoacidosis

A new class of type 2 diabetes drugs may increase the risk of a rare but serious complication known as diabetic ketoacidosis, according to a study published June 8 in the New England Journal of Medicine. Investigators from Brigham and Women's Hospital found that patients are twice as likely to experience diabetic ketoacidosis if taking sodium-glucose cotransporter-2 (SGLT2) inhibitors compared to another class of diabetes drugs. SGLT2s include canagliflozin, dapagliflozin, and empagliflozin and are approved for use with diet and exercise to lower blood sugar in adults with the disease. The researchers stress that the condition, while serious, is extremely rare. Only about one in every 1,000 patients taking an SGLT2 inhibitor will experience this complication. While cases of hospitalization are infrequent, it was one such case that inspired the study. Michael Fralick, MD, FRCPC, of the BWH Division of Pharmacoepidemiology and Pharmacoeconomics, began exploring the association between SGLT2 inhibitors and diabetic ketoacidosis after one of his patients taking SGLT2s arrived at an emergency room with symptoms of the complication. Using data available through one of the research platforms at Brigham and Women’s Hospital (Aetion Evidence Platform) Fralick’s team compared outcomes of 40,000 patients taking SGLT2 inhibitors to patients taking a DPP4 inhibitor. DPP4 inhibitors were chosen as the comparator medication because they are similarly used as a second-line treatment for diabetes but have no known association with diabetic ketoacidosis. After 180 days, 55 patients taking an SGLT2 inhibitor had experienced diabetic ketoacidosis compared to 26 patients taking a DPP4 inhibitor. Fralick emphasizes that even though diabetic ketoacidosis is uncommon, physicians need to be Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys f Continue reading >>

Severe Diabetic Ketoacidosis In A Newly Diagnosed Child With Type 2 Diabetes Mellitus: A Case Report

Severe Diabetic Ketoacidosis In A Newly Diagnosed Child With Type 2 Diabetes Mellitus: A Case Report

Abdulmoein E Al-Agha1* and Mohammed A Al-Agha2 1Department of Pediatric Endocrinology, King Abdul-Aziz University Hospital, Saudi Arabia 2Faculty of Medicine, King Abdul-Aziz University, Saudi Arabia Citation: Abdulmoein E Al-Agha1, Mohammed A Al-Agha (2017) Severe Diabetic ketoacidosis in a Newly Diagnosed Child with Type 2 Diabetes Mellitus: A Case Report. J Diabetes Metab 8:724. doi:10.4172/2155-6156.1000724 Copyright: © 2017 Al-Agha AE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Background: Diabetes ketoacidosis (DKA) is an acute complication of both type 1 and type 2 diabetes mellitus (DM). DKA is characterized by the presence of hyperglycemia, ketosis, ketonuria, and metabolic acidosis. Cerebral edema is a rare but rather a serious complication of DKA. Case presentation: An obese 12-year-old, Egyptian boy, previously medically free, presented to the emergency room (ER) of King Abdulaziz university hospital, with two weeks' histories of dizziness, shortness of breath, polyuria, polydipsia & nocturia. His symptoms were deteriorating with a change in sensorial and cognitive functions at the time of presentation. He was diagnosed with type 2 DM based upon clinical background, namely the presence of obesity (weight+7.57 Standard Deviation Score (SDS), height+1.4 SDS, and body mass index (BMI) of 34.77 kg/m2 (+3.97SDS) together with the presence of Acanthosis nigricans and biochemically based on, normal level of serum insulin, normal serum level of connecting peptide and negative autoantibodies. H Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

Diabetes - Type 2

Diabetes - Type 2

Description An in-depth report on the causes, diagnosis, treatment, and prevention of type 2 diabetes. Alternative Names Type 2 diabetes; Maturity onset diabetes; Noninsulin-dependent diabetes Highlights Diabetes Statistics According to the U.S. Centers for Disease Control and Prevention’s (CDC) National Diabetes Fact Sheet, nearly 26 million American adults and children have diabetes. About 79 million Americans aged 20 years and older have pre-diabetes, a condition that increases the risk for developing diabetes. Diabetes and Cancer Type 2 diabetes increases the risk for certain types of cancer, according to a consensus report from the American Diabetes Association and the American Cancer Society. Diabetes doubles the risk for developing liver, pancreatic, or endometrial cancer. Certain medications used for treating type 2 diabetes may possibly increase the risk for some types of cancers. Screening for Gestational Diabetes Mellitus The American Diabetes Association recommends that pregnant women without known risk factors for diabetes get screened for gestational diabetes at 24 - 28 weeks of pregnancy. Pregnant women with risk factors for diabetes should be screened for type 2 diabetes at the first prenatal visit. Aspirin for Heart Disease Prevention The American Diabetes Association now recommends daily low-dose (75 - 162 mg) aspirin for men older than age 50 and women older than age 60 who have diabetes and at least one additional heart disease risk factor (such as smoking, high blood pressure, high cholesterol, family history, or albuminuria). Guidelines for Treatment of Diabetic Neuropathy The anticonvulsant drug pregabalin (Lyrica) is a first-line treatment for painful diabetic neuropathy, according to recent guidelines released by the American Academy of Neurol Continue reading >>

Incidence Of Diabetic Ketoacidosis Among Patients With Type 2 Diabetes Mellitus Treated With Sglt2 Inhibitors And Other Antihyperglycemic Agents

Incidence Of Diabetic Ketoacidosis Among Patients With Type 2 Diabetes Mellitus Treated With Sglt2 Inhibitors And Other Antihyperglycemic Agents

Jump to Section 1. Introduction Diabetic ketoacidosis (DKA) is a serious, acute metabolic complication of diabetes characterized by absolute or relative insulin deficiency [[1], [2]], with an overall mortality rate of up to 5% in experienced healthcare centers [3]. Insulin deficiency, increased insulin counter-regulatory hormones (cortisol, glucagon, growth hormone, and catecholamines) and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance, which underlie the pathophysiology of DKA [2]. While DKA is a commonly recognized vulnerability in autoimmune diabetes, stressful conditions such as trauma, surgery, or infection also increase DKA risk in patients with type 2 diabetes mellitus [4]. In fact, studies have reported that patients with type 2 diabetes accounted for 12–56% of the DKA cases, had longer hospital stays, and higher mortality (which possibly was due to advanced age and comorbidities) than patients with type 1 diabetes [[3], [5]]. Sodium glucose co-transporter 2 inhibitors (SGLT2i’s) are a new class of oral antihyperglycemic agents (AHA) that lower blood glucose through an insulin-independent mechanism, by suppressing renal glucose reabsorption and increasing urinary glucose excretion [6]. Currently, 3 SGLT2i’s have been approved in the US and Europe for the treatment of type 2diabetes: canagliflozin, dapagliflozin, and empagliflozin (initial approval March 29, 2013, January 8, 2014, August 1, 2014 in the US, November 15, 2013, November 12, 2012, May 22, 2014 in Europe, respectively). By mid-2015, based on spontaneous adverse event reports, the US Food and Drug Administration and the European Medicines Agency [7] had both issued statements that medicines in the SGLT2i class of drugs may be associated with a Continue reading >>

Introduction To Diabetes

Introduction To Diabetes

Diabetes is a chronic state of hyperglycaemia caused by a lack of or diminished effectiveness of endogenous insulin. Over time it can cause specific tissue damage, particularly to the retina, kidney, nerves and arteries. The term diabetes mellitus literally means ‘passage of a large amount of sweet urine’ In the past the definitions IDDDM and NIDDDM were used for type 1 and type 2 diabetes respectively. However, this is not necessarily true in descriptive terms, as not all type 1 sufferers require insulin, and not all type 2 sufferers do not require insulin (many in the later stages of the disease do). More than 90% of diabetic patients have type 2 diabetes. Less than 10% have type 1. Diabetes affects 2% of the British population, i.e. over 1 million people, and takes up 5-10% of the health budget. The prevalence is increasing rapidly in Western World More than 90% of diabetic patients have type 2 diabetes; less than 10% have type 1. Pancreatectomy – in cases where greater than 90% of the pancreas has been removed Drug induced – steroids and thiazides Others – e.g. congential condition that may cause insulin receptor antibodies, glycogen storage diseases Clinical presentation Acute presentation – typically in those with type 1 diabetes, but not always Polyuria Thirst Weight loss Ketonuria which may progress to ketoacidosis Subacute presentation – in type 2 diabetes, same as above but also with the following: Lack of energy Blurred vision Such cases may also present with complications such as… Fasting glucose > 7 mmol/L and a glucose tolerance test OR random glucose > 11mmol/L (usually on 2 separate occasions) Type 1 diabetes: Insulin and dietary modification Type 2 diabetes: Lifestyle modification (>>+ metformin >>+ further drugs>> + insulin) Weight – Continue reading >>

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