Classification of diabetes mellitus:
A) Primary diabetes:
1. Type I:
Also described as insulin-dependent diabetes mellitus(IDDM),juvenile-
onset or ketosis-prone diabetes.
a. most common in children and in adults < 30 years old ,but may occur at any age.
b. Predisposed to Ketoacidoses ( accumulation of ketone bodies in body tissues and
fluids.
c. Dependent upon exogenous insulin replacement therapy to prevent ketoacidoses
and sustain life.
d. The essential difference between type I and type II DM is that insulin production
and secretion in type I is destroyed; in type II DM, insulin production and secretion may
be altered or reduced, but is not totally lacking.
2. Type II:
Also described as non-insulin-dependent diabetes mellitus(NIDDM),or
adult-onset diabetes.
a. Approximately 90% of individuals with diabetes in the United States have type
II diabetes with a disproportion among certain ethnic groups and the elderly.
b. Usually diagnosed in adults > 30 years old, but may occur at any age.
c. Endogenous insulin levels may appear normal, increased, or decreased and the
requirement for exogenous insulin is variable. In spite of apparently "normal" or "increased"
insulin levels, beta-cell dysfunction is manifest by a relative insulin insufficiency to
maintain euglycemia, especially in the face of significant insulin resistance.
d. Not prone to ketosis except during periods of severe physical stress such as
infection, trauma or surgery.
e. Approximately 80% of patients are obese at the time of DM diagnosis.
3. Gestational diabetes mellitus (GDM):
a. Defined as any degree of glucose intolerance that has its onset or is first detected
during pregnancy.
b. Occurs in approximately 2%-4% of pregnant women, generally
during the second or third trimester.
c. Six weeks after the pregnancy, a follow –up glucose tolerancetest should be
performed. Glucose regulation would then bereclassified as DM, IFG, IGT, or
normoglycemia. In the majority of cases, glucose regulation returns to normal post-
pregnancy.
d. Occurrence of GDM increases future risk for developing type II diabetes.
B) Secondary diabetes:
Broad term used to classify patients who have unusual causes of diabetes due to certain
diseases of the pancreas, genetic defects, indocrinopathies or drugs.
Pre-diabetes:
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher
than normal but not high enough for a diagnosis of diabetes. It is estimated that 16 million
Americans have pre-diabetes, in addition to the 17 million with diabetes.
Before people develop type II diabetes, they almost always have "pre-diabetes". Blood
glucose levels that are higher than normal but not yet high enough to be diagnosed as
diabetes. At least 16 million people in the United States (15.6% of the population), ages 40
to 74, have pre-diabetes. Recent research has shown that some long-term damage to the
body, especially the heart and circulatory system, may already be occurring during pre-
diabetes.Research also shown that taking action to control blood glucose in case of pre-
diabetes, delays or prevent type II diabetes from ever developing.
Detection of pre-diabetes:
There are two different tests can be used to detect pre-diabetes : The Fasting Plasma
Glucose test (FPG) or the Oral Glucose Tolerance test (OGTT) (Figure: 3). The blood
glucose levels measured after these tests determine whether a normal metabolism, or
whether pre-diabetes or diabetes. If blood glucose level is abnormal following the FPG,
there is Impaired Fasting Glucose (IFG); if blood glucose level is abnormal following the
OGTT, there is Impaired Glucose Tolerance (IGT).
Treatment of pre-diabetes:
Pre-diabetes is a serious medical condition that can be treated. The good news is that
the recently completed Diabetes Prevention Program (DPP) study conclusively showed
that people with pre-diabetes can prevent the development of type II diabetes by making
changes in their diet and increasing their level of physical activity. They may even be able
to return their blood glucose levels to the normal range.
While the DPP also showed that some medications may delay the development of
diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical
activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in
diabetes.
A) Primary diabetes:
1. Type I:
Also described as insulin-dependent diabetes mellitus(IDDM),juvenile-
onset or ketosis-prone diabetes.
a. most common in children and in adults < 30 years old ,but may occur at any age.
b. Predisposed to Ketoacidoses ( accumulation of ketone bodies in body tissues and
fluids.
c. Dependent upon exogenous insulin replacement therapy to prevent ketoacidoses
and sustain life.
d. The essential difference between type I and type II DM is that insulin production
and secretion in type I is destroyed; in type II DM, insulin production and secretion may
be altered or reduced, but is not totally lacking.
2. Type II:
Also described as non-insulin-dependent diabetes mellitus(NIDDM),or
adult-onset diabetes.
a. Approximately 90% of individuals with diabetes in the United States have type
II diabetes with a disproportion among certain ethnic groups and the elderly.
b. Usually diagnosed in adults > 30 years old, but may occur at any age.
c. Endogenous insulin levels may appear normal, increased, or decreased and the
requirement for exogenous insulin is variable. In spite of apparently "normal" or "increased"
insulin levels, beta-cell dysfunction is manifest by a relative insulin insufficiency to
maintain euglycemia, especially in the face of significant insulin resistance.
d. Not prone to ketosis except during periods of severe physical stress such as
infection, trauma or surgery.
e. Approximately 80% of patients are obese at the time of DM diagnosis.
3. Gestational diabetes mellitus (GDM):
a. Defined as any degree of glucose intolerance that has its onset or is first detected
during pregnancy.
b. Occurs in approximately 2%-4% of pregnant women, generally
during the second or third trimester.
c. Six weeks after the pregnancy, a follow –up glucose tolerancetest should be
performed. Glucose regulation would then bereclassified as DM, IFG, IGT, or
normoglycemia. In the majority of cases, glucose regulation returns to normal post-
pregnancy.
d. Occurrence of GDM increases future risk for developing type II diabetes.
B) Secondary diabetes:
Broad term used to classify patients who have unusual causes of diabetes due to certain
diseases of the pancreas, genetic defects, indocrinopathies or drugs.
Pre-diabetes:
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher
than normal but not high enough for a diagnosis of diabetes. It is estimated that 16 million
Americans have pre-diabetes, in addition to the 17 million with diabetes.
Before people develop type II diabetes, they almost always have "pre-diabetes". Blood
glucose levels that are higher than normal but not yet high enough to be diagnosed as
diabetes. At least 16 million people in the United States (15.6% of the population), ages 40
to 74, have pre-diabetes. Recent research has shown that some long-term damage to the
body, especially the heart and circulatory system, may already be occurring during pre-
diabetes.Research also shown that taking action to control blood glucose in case of pre-
diabetes, delays or prevent type II diabetes from ever developing.
Detection of pre-diabetes:
There are two different tests can be used to detect pre-diabetes : The Fasting Plasma
Glucose test (FPG) or the Oral Glucose Tolerance test (OGTT) (Figure: 3). The blood
glucose levels measured after these tests determine whether a normal metabolism, or
whether pre-diabetes or diabetes. If blood glucose level is abnormal following the FPG,
there is Impaired Fasting Glucose (IFG); if blood glucose level is abnormal following the
OGTT, there is Impaired Glucose Tolerance (IGT).
Treatment of pre-diabetes:
Pre-diabetes is a serious medical condition that can be treated. The good news is that
the recently completed Diabetes Prevention Program (DPP) study conclusively showed
that people with pre-diabetes can prevent the development of type II diabetes by making
changes in their diet and increasing their level of physical activity. They may even be able
to return their blood glucose levels to the normal range.
While the DPP also showed that some medications may delay the development of
diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical
activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in
diabetes.
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Diabetes Mellitus
