Diabetes Mellitus (DM)

Etiology

  • Type 1: Autoimmune (no insulin production); typically presents as child or early adulthood; can present later on; linked to family history and also exposures/other events
  • Type 2: Insulin resistance; presents later in life; in particular, related to obesity, family history
  • Latent Autoimmune Diabetes in Adults (LADA): Autoimmune (like type 1) DM w/decreased insulin production; features include age onset < 50, often symptoms (polyuria, polydipsia, wt loss), BMI < 25, normal lipids, personal or fam hx autoimmune dz.

Risk Factors

  • Type 1: Family history; Other autoimmune diseases: Thyroid d/o: Hashimotos, Graves; celiac dz, vitiligo, addisons, autoimmune hepatitis
  • Type 2: elevated BMI; first degree relative w/DM; Age > 45; Ethnicity: African-American, Pacific Islander, Native American, Filipino, Hispanic; HTN, known CVD, low hdl/elevated TGs; Hx PCOS

Symptoms

  • Fatigue
  • When poorly controlled (or undiagnosed) associated with polyuria, polydypsia,
  • Can cause severe illness from hypovolemia
  • Weight loss w/type 1, weight gain w/type 2
  • Type 2 often asymptomatic for years
  • Presenting sx can relate to target organ dysfxn (e.g. MI, PAD/foot ulcer, neuropathy, kidney disease, retinopathy)

Physical Exam Findings

  • Tachycardia and hypotension if volume depleted
  • Hypertension often if chronic type 2
  • May have distal neuropathy (painful or painless)
  • Peripheral arterial disease (ulcers, decreased pulses)
  • Lower extremity and pulmonary edema w/CHF and/or renal disease
  • Impaired vision w/retionpathy

Tests