Diabetes

Type 1: Immune mediated destruction of beta cells. Islet cell antibodies, antibodies to insulin, glutamic acid decarboxylase and the tyrosine phosphatase, IA-2, are usually found in the serum of a person with type 1 diabetes Within 5 years they require insulin or they risk developing ketoacidosis. Usually rapid in onset Responsible for about 10% of DM Slow onset autoimmune diabetes is LADA Type 2: predominant insulin resistance with relative insulin deficiency to a predominant secretory defect, with or without insulin resistance.

Type 1diabetes usually presents with typical symptoms of hyperglycaemia including thirst, polyuria, polydipsia, recurrent infection (including genital thrush), blurring of vision and weight loss. Type 2 diabetes can be associated with few symptoms, or even none. As a result diagnosis may be delayed, and often complications are present at the time of diagnosis.

Risk factors for type 2 diabetes are:

Impaired glucose tolerance or impaired fasting glucose Previous gestational diabetes Age 45 and over, plus one or more of the following risk factors: Obesity (body mass index more than 30 kg/m2) First-degree relative with type 2 diabetes Hypertension Age 55 and over, if no other risk factors are present Aboriginal and Torres Strait Islanders age 35 and over, or younger if they are overweight Certain ethnic groups with high risk, age 35 and over (specifically Pacific Islander people and people from the Indian subcontinent or of Chinese origin) Clinical cardiovascular disease Polycystic ovary syndrome in women who are also obese.

In all asymptomatic people whose initial result suggests a diagnosis of diabetes, a confirmatory test must be performed on a separate day.
Periodic retesting for undiagnosed type 2 diabetes is recommended by measuring fasting plasma glucose according to the following schedule: Each year for people with impaired glucose tolerance or impaired fasting

glucose Each year for people with an initial plasma glucose consistent with a diagnosis of diabetes, impaired glucose tolerance or impaired fasting glucose, which is not confirmed on subsequent testing Every three years for people at risk with a negative screening blood test.

acute intercurrent illness (eg infective, traumatic, circulatory, surgical or other stress) or by high-dose corticosteroids. In an acute
Hyperglycaemia can be precipitated by an event it may be difficult to distinguish between hyperglycaemia from these causes and previously undiagnosed diabetes.

Dietary modification and exercise to achieve a weight loss of 5% to 7% can be beneficial in people with prediabetes and delay the progression of prediabetes to diabetes. Key recommendations should be to increase consumption of and/or canola oil as the primary source of fat.

fish, fresh

fruit, and fresh and cooked vegetables, and to use only olive

Management plan for people diagnosed with diabetes:

A management plan should be prepared in consultation with each patient, and should include:

Treatment targets A healthy eating plan An exercise program Ways to reduce cardiovascular risk factors (eg smoking, blood pressure, lipids) Use of oral anti-diabetic drugs, if required use of insulin. Education in self-monitoring, adjusting treatment and how to cope with emergencies that affect the patient's blood glucose Screening for, and treatment of, complications of diabetes.

Every 3 mo Review symptoms and self blood glucose conc

Every 6 mo HbA1C

Blood pressure

Foot Exam

Weight and waist measurement

Every 12 mo Lipids Kidney functionmicro albuminuria and plasma creatinine / glomerular filtration rate (GFR) Eye review-every 2 years in the absence of retinopathy Review: Management goals Smoking Healthy eating plan Physical activity Self-care education Medications immunisation schedule

Foot exam