Medical Degree Program in China - Diabetes Mellitus ( DM)
1. Introduction
Diabetes Mellitus is a group of metabolic diseases characterized by hyperglycemia. Hyperglycemia is caused by the defective insulin secretion or its impaired biological effects, or by both. The long-term existence of hyperglycemia of diabetes patients results in chronic damage, dysfunction of various tissues, especially the eyes, kidneys, heart, blood vessels, nerve.
2. Etiology
1). Genetic Factors
Type 1 or type 2 diabetes mellitus has obvious genetic heterogeneity. There is a family history of diabetes, 1/4 ~ 1/2 patients have a family history of diabetes. Clinically, there are at least 60 or more genetic syndromes associated with diabetes. Type 1 diabetes mellitus has a number of DNA sites to participate in the pathogenesis, which is the most closely related to the DQ locus polymorphism in the HLA antigen gene. A variety of clear gene mutations has been found in type 2 diabetes, such as insulin gene, the insulin receptor gene, glucokinase gene, mitochondrial genes, etc.
2). Environmental Factors
Obesity resulted from eating too much, physical activity reduction is the most important environmental factor of type 2 diabetes, so individuals with genetic susceptibility of type 2 diabetes are easy to be attacked. Patients with type 1 diabetes have immune system abnormalities and produce autoimmune reaction after being infected in some viruses such as Coxsackie virus, rubella virus, the virus of parotid gland, leading to destruction of the insulin beta cells.
3. Clinical Manifestations
1). more drinking, more urine, more food and weight loss
Typical “three more and one little” symptoms occur in severe hyperglycemia, more often in type 1 diabetes. “Three more and one little” symptoms are more obvious in ketosis or ketoacidosis.
2). fatigue and weakness, obesity
More common in type 2 diabetes, type 2 diabetes is always with obesity before the morbidity; weight will gradually decline if not diagnosed timely.
4. Check
1). Blood sugar
Blood sugar is the only standard for the diagnosis of diabetes.
2) Urine sugar
Often positive
3) Urine ketone
The urine ketone is positive when ketosis or ketoacidosis.
4) Glycosylated hemoglobin (HbA1c)
5) Glycosylated serum protein
6) Serum insulin and C peptide level
7) Blood lipids
8) Immunity index
9) Urinary albumin excretion, free or enzyme linked method
5. Diagnosis
Diabetes is generally not difficult to diagnose, fasting blood glucose is greater than or equal to 7 mmol / L, and / or after meal two hours blood sugar is greater than or equal to 11.1 mmol / l can be diagnosed. Classification of the diagnosis of diabetes:
Type 1.diabetes mellitus
Age at onset of light, mostly less than 30 years old, sudden onset, drink more and polyuria, weight loss food symptoms and high levels of sugar in the blood, many patients with ketosis acid toxic as the first symptom, serum insulin and C peptide level is low, ICA, IAA or GAD antibody can be positive. Single oral medicine is invalid, need to be treated with insulin.
Type 2.diabetes mellitus
Common in the elderly, the high incidence of obesity, often accompanied by hypertension, dyslipidemia, atherosclerosis and other diseases. Onset insidious, early without any symptoms, or only mild fatigue, thirst, blood glucose increased not obvious who need to do sugar tolerance test to diagnose. Serum insulin level was normal or higher in the early stage.
6. Differential Diagnosis
1) Liver disease
2) Chronic renal insufficiency
3) Stress state
4). A variety of endocrine diseases
7. Treatments
(a) General treatment
Education
Self monitoring of blood glucose
(b) Drug therapy
Oral drug therapy
Insulin therapy
(c) Exercise therapy
(d) Diet therapy
Total heat
Carbohydrate
Protein
Fat
