Clinical evaluation:
1. physical findings:
a. Symptom severity and onset help differentiate type I from type II DM.
1) Type I DM typically presents with an abrupt onset and an acute presentation.
2) Symptoms in individuals with type II DM generally develop gradually, with some
patients being asymptomatic or having only mild symptoms upon diagnosis.
b. Classic signs and symptoms of DM include polydipsia (excessive thirst), polyuria
(excessive urination), and polyphagia (excessive hunger). Other common findings include
dry skin, fatigue, weakness, frequent skin and vaginal infections, weight alterations and
visual disturbances.
c. Individuals with type I DM my additionally present with unintentional weight loss,
with or without signs and symptoms of ketoacidosis.
d. Some of the progressive changes of long-standing DM may be evident at time of
diagnosis of type II DM: deterioration in function or structure of the retina, kidneys,
peripheral nervous system and integumentary system.
2. laboratory findings:
Diagnostic criteria. (Non-pregnant adults).
a. A random (casual) plasma glucose level ≥ 200 mg/dl with classic symptoms of DM,
including polydipsia, polyuria, polyohagia, and weight loss.
1) A fasting plasma glucose level of ≥ 126 mg/dl.
2) A 2-hour plasma glucose ≥ 200 mg/ld during an oral glucose tolerance test (OGTT)
using 75g anhydrous glucose dissolved in water.
3) In the absence of unequivocal hyperglycemia with acute decompensation, the
above criteria should be confirmed with repeat testing on a different day.
b. Individuals not meeting the above criteria but with abnormal test results can be
classified as one of the following:
1) Impaired Fasting Glucose (IFG) = fasting plasma glucose level ≥ 110 mg/dl and < 126
mg/dl.
2) Impaired Glucose Tolerance (IGT) = 2-hour OGTT plasma glucose ≥ 140 mg/dl and <
200 mg/dl.
The terms IFT and IGT refer to an intermediate metabolic stage between glucose
homeostasis and diabetes.
c. Gestational diabetes.
1) A screening test is done between 24 and 28 weeks of gestation in all women except
those meeting the following criteria:
• Less than 25 years of age.
• Normal body weight.
• No first-degree relative with DM, and not Hispanic.
• African-American, Asian or Native American.
The screening is done using a 50 g oral glucose load followed by a 1-hr plasma measurement.
A value ≥ 140 mg/dl leads to a follow-up diagnostic test using a 100 g glucose load over 3
hrs.
2) Following the 100 g oral glucose load, diagnosis of GDM may be made if two plasma
glucose values equal or exceed the followings:
Fasting 150 mg/dl.
1- hr 190 mg/dl.
2- hr 165 mg/dl.
3- hr 145 mg/dl.
1. physical findings:
a. Symptom severity and onset help differentiate type I from type II DM.
1) Type I DM typically presents with an abrupt onset and an acute presentation.
2) Symptoms in individuals with type II DM generally develop gradually, with some
patients being asymptomatic or having only mild symptoms upon diagnosis.
b. Classic signs and symptoms of DM include polydipsia (excessive thirst), polyuria
(excessive urination), and polyphagia (excessive hunger). Other common findings include
dry skin, fatigue, weakness, frequent skin and vaginal infections, weight alterations and
visual disturbances.
c. Individuals with type I DM my additionally present with unintentional weight loss,
with or without signs and symptoms of ketoacidosis.
d. Some of the progressive changes of long-standing DM may be evident at time of
diagnosis of type II DM: deterioration in function or structure of the retina, kidneys,
peripheral nervous system and integumentary system.
2. laboratory findings:
Diagnostic criteria. (Non-pregnant adults).
a. A random (casual) plasma glucose level ≥ 200 mg/dl with classic symptoms of DM,
including polydipsia, polyuria, polyohagia, and weight loss.
1) A fasting plasma glucose level of ≥ 126 mg/dl.
2) A 2-hour plasma glucose ≥ 200 mg/ld during an oral glucose tolerance test (OGTT)
using 75g anhydrous glucose dissolved in water.
3) In the absence of unequivocal hyperglycemia with acute decompensation, the
above criteria should be confirmed with repeat testing on a different day.
b. Individuals not meeting the above criteria but with abnormal test results can be
classified as one of the following:
1) Impaired Fasting Glucose (IFG) = fasting plasma glucose level ≥ 110 mg/dl and < 126
mg/dl.
2) Impaired Glucose Tolerance (IGT) = 2-hour OGTT plasma glucose ≥ 140 mg/dl and <
200 mg/dl.
The terms IFT and IGT refer to an intermediate metabolic stage between glucose
homeostasis and diabetes.
c. Gestational diabetes.
1) A screening test is done between 24 and 28 weeks of gestation in all women except
those meeting the following criteria:
• Less than 25 years of age.
• Normal body weight.
• No first-degree relative with DM, and not Hispanic.
• African-American, Asian or Native American.
The screening is done using a 50 g oral glucose load followed by a 1-hr plasma measurement.
A value ≥ 140 mg/dl leads to a follow-up diagnostic test using a 100 g glucose load over 3
hrs.
2) Following the 100 g oral glucose load, diagnosis of GDM may be made if two plasma
glucose values equal or exceed the followings:
Fasting 150 mg/dl.
1- hr 190 mg/dl.
2- hr 165 mg/dl.
3- hr 145 mg/dl.
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Diabetes Mellitus
