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Excerpt from Diabetes Mellitus, Type 1 - A ReviewSynonyms, Key Words, and Related Terms: DM, diabetes, type 1 DM, insulin-dependent diabetes, IDD, insulin-dependent diabetes mellitus, IDDM, type I diabetes, childhood diabetes, childhood diabetes mellitus, childhood-onset diabetes, childhood-onset diabetes mellitus, diabetes in childhood, diabetes mellitus in childhood, juvenile-onset diabetes, juvenile-onset diabetes mellitus, ketosis-prone diabetes, autoimmune diabetes mellitus, brittle diabetes mellitus, diabetic ketoacidosis, DKA, maturity-onset diabetes of the young, MODY, gestational diabetes mellitus, GDM, chamber-pot dropsy, thirst disease, sugar disease, sugar sickness, latent autoimmune diabetes of the adult, LADA, hemochromatosis, pancreatitis, cystic fibrosis, pancreatic cancer, acromegaly, Cushing syndrome, pheochromocytoma, gestational diabetes mellitus, GDM, hypoglycemia, hyperglycemia, microvascular complications, diabetic retinopathy, diabetic nephropathy, diabetic neuropathic complications, macrovascular disease, blindness, nontraumatic lower-extremity amputation, end-stage renal disease, ESRD, hypertension, coronary artery disease, CAD, peripheral vascular disease, cerebrovascular accident, transient ischemic attack, hyperlipidemia, peripheral neuropathy, autonomic neuropathy, diabetic foot, foot ulcers, Kussmaul respiration Please click here to view the full topic text: Diabetes Mellitus, Type 1 - A ReviewBackground: Diabetes mellitus is a chronic disease that requires long-term medical attention both to limit the development of its devastating complications and to manage them when they do occur. It is a disproportionately expensive disease; patients with diabetes accounted for 6.2% of the US population in 2002, or 18.2 million people. In that year, the per-capita cost of healthcare was $13,243 for people with diabetes, while it was $2560 for those without diabetes.This article focuses on the ED evaluation and treatment of the acute and chronic complications of diabetes other than those directly associated with hypoglycemia and severe metabolic disturbances, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic coma (HNKS). (Please see Hypoglycemia, Diabetic Ketoacidosis, and Hyperosmolar Hyperglycemic Nonketotic Coma for more information on these disorders.)
Pathophysiology: Type 1 diabetes mellitus can occur at any age and is characterized by the marked inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells. It commonly occurs in children, with a fairly abrupt onset; however, newer antibody tests have allowed for the identification of more people with the new-onset adult form of type 1 diabetes mellitus called latent autoimmune diabetes of the adult (LADA). The distinguishing characteristic of a patient with type 1 diabetes is that, if his or her insulin is withdrawn, ketosis and eventually ketoacidosis develop. Therefore, these patients are dependent on exogenous insulin. Type 2 diabetes mellitus is discussed in Diabetes Mellitus, Type 2 - A Review. A variety of other types of diabetes, previously called secondary diabetes, are caused by other illnesses or medications. Depending on the primary process involved (eg, destruction of pancreatic beta cells or development of peripheral insulin resistance), these types of diabetes behave similarly to type 1 or type 2 diabetes. The most common are diseases of the pancreas that destroy the pancreatic beta cells (eg, hemochromatosis, pancreatitis, cystic fibrosis, pancreatic cancer), hormonal syndromes that interfere with insulin secretion (eg, pheochromocytoma) or cause peripheral insulin resistance (eg, acromegaly, Cushing syndrome, pheochromocytoma), and diabetes induced by drugs (eg, phenytoin, glucocorticoids, estrogens). Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is a complication of approximately 4% of all pregnancies in the United States. Untreated GDM can lead to fetal macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. In addition, mothers with GDM have increased rates of cesarean delivery and chronic hypertension. To screen for GDM, a 50-g glucose screening test should be done at 24-28 weeks of gestation. This is followed by a 100-g, 3-hour oral glucose tolerance test if the patient’s plasma glucose concentration at 1 hour after screening is greater than 140 mg/dL. Frequency:
Mortality/Morbidity: The morbidity and mortality associated with diabetes are related to the short- and long-term complications.
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