Chronic syndrome of impaired carb,

protein and fat metabolism due to

absolute insulin deficiency (type 1), or
insulin resistance and relative deficiency
(type 2).
90% of diabetics are DM type 2.
Often asymptomaic and diagnosed
through screening

Diagnosis

Polydypsia and polyuria usually occurs

when pts have a fasting plasma glucose >
300, OR HgA1C > %11, and may not be
initial symptoms
Increased fatigue (can indicate progressive
heart dz)
Recurrent yeast infections, UTIs, skin
infections
Weight loss
Obese patients: pts have a mean BMI of 31
at time of diagnosis of DM2

Diagnosis

Fasting blood sugar > 125, after a minimum

of eight hour fast.
oral glucose tolerance test: 75g load, postprandial blood sugar > 200 two hours later.
A random plasma glucose is not as
accurate as a fasting glucose test, but in a
patient with definite symptoms of
hyperglycemia, a value >200 is positive.
ALL positive results must be confirmed with
a second test (the same or different).

Complications
Tight glucose control does not
decrease risk of macrovascular
complications, only microvascular.
Cardiovascular Dz: 65% of pts with DM2
die due to coronary artery or
cerebrovascular disease. 30% develop
CHF.

To prevent CVD, bp < 130/80, lipid control,

smoking cessation. Use of statins, ACEis,

metformin, aspirin may reduce risk of CVD

Complications

Macrovascular
Eye dz (retinpathy/macular edema)
Neuropathy
Nephropathy

Microvascular
Coronary artery dz
Peripheral arterial dz
Cerebrovascular dz

Other
Dermatologic/infectious
Cataracts/glaucoma
Gastroparesis/diarrhea

Treatment

1.) Medical Nutrition Therapy fruits,

vegetables, fiber, low-fat milk
2.) Oral glucose lowering therapies :

Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones
Sulfonylureas
Dipeptidyl peptidase IV inhibitors

3.) Parenteral glucose lowering therapies:

Insulin
GLP-1 agonists (Exenatide)
Amylin agonist

Treatment goals

Glycemic
A1C< 7.0
Preprandial glucose 90-130 mg/dL
Peak postprandial glucose <180 mg/dL

Blood <130/<80
Lipids

LDL <100 mg/dL

HDL >40 mg/dL
TG <150 mg/dL