Written report/script

Diagnosis: Type 2 diabetes

Basis
 Diagnosis of Type 2 Diabetes couple of months ago
 Metformin intake (500 mg PO 2x a day)
 BMI = 30.3 kg/m2 (Obese class 1)
 Labs: Glu=153 mg/dl; HbA1c=7.2%
 Polyuria
 Hypertension

Diabetes Mellitus
 Syndrome with disordered metabolism and
inappropriate hyperglycemia due to one or combination
the following pathology: 
o No/Reduced insulin secretion
o Decreased glucose utilization
o Increased glucose production
 Metabolic dysregulation associated with DM causes
secondary pathophysiology changes in multiple organ
systems that impose tremendous burden on the
individual and the health care system
o DM is the leading cause of ESRD, non traumatic
lower extremity amputation and adult blindness
 Several types exist and are caused by a complex
interaction of genetics and environmental factors
 Two broad categories: (that are based on the pathogenic
process that leads to hyperglycemia)
o Type 1 – results from complete or near-total insulin
deficiency (patient’s pancreas are unable to produce
sufficient insulin)
 Previously known as “insulin dependent DM”
and juvenile diabetes
o Type 2 – heterogenous group of disorders
characterized by variable degrees of insulin
resistance, impaired insulin secretion and increased
glucose production
 Previously known as “non-insulin dependent
DM”, insulin resistant diabetes and adult
onsent diabetes
*Because many individuals with type 2 DM eventually
require insulin treatment for control of glycemia, the use
of the term NIDDM generated considerable confusion.
*Both type 1 and type 2 diabetes are preceded by a
period of progressive worsening of glucose homeostasis,
followed by the development of hyperglycemia that
exceeds the threshold for clinical diagnosis.
Diagnosis of Diabetes

A - Random is defined as without regard to time since the last meal.

B - Fasting is defined as no caloric intake for at least 8 h.
C - Hemoglobin A1c test should be performed in a laboratory using a method approved by the National
Glycohemoglobin Standardization Program and correlated to the reference assay of the Diabetes
Control and Complications Trial. Point-of-care hemoglobin A1c should not be used for diagnostic
purposes.
D - The test should be performed using a glucose load containing the equivalent of 75 g anhydrous
glucose dissolved in water, not recommended for routine clinical use.

Note: In the absence of unequivocal hyperglycemia and acute metabolic

decompensation, these criteria should be confirmed by repeat testing on a
different day.
  Person may have IFG and IGT which are both substantial risk of developing diabetes and have
increases risk of cardiovascular disease (25% - 40% risk of overt diabetes over the next 5 years)
 Fasting glucose – most reliable and convenient test for identifying DM in asymptomatic
individuals

screening test are only available for type 2 DM why? Because type 2 DM can already alter some
laboratory results such as FGT and HBA1c even without any clinical diabetes-specific manifestations or
mga asymptomatic since ang onset ng type 2 is gradual. Unlike sa type 1 since sudden ang onset ng type
1, more likely, symptomatic na ang patient before mag seek ng consultation. And siguro hindi na for
screening test ang FGT and HBA1c, it will be for therapeutic goals na. some clinical manifesations naman
na will be specific sa type 1. Like yung weight…. Pag obese ang patient, specifically truncal obesity, its
more like type2, pero pag payat or normal its type 1. And so on…
however Ifthe physician choose not to use those clinically significant symptoms, he may request for
antibody tests. (islet of Langerhans)
DB and PTB
https://www.hindawi.com/journals/trt/2017/1702578/
https://www.slideshare.net/cetdmgh/tuberculosis-and-diabetes-mellitus-double-trouble