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Introduction

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High-Yield Terms

  • Polyuria: excessive urine output as is typical in most forms of diabetes

  • Polyphagia: excessive hunger typically associated with Type 1 diabetes

  • Polydipsia: excessive thirst as is often associated with diabetes

  • Oral glucose tolerance test, OGTT: a test to measure the plasma responses to intake of a bolus of glucose; used to determine insulin function and the potential for diabetes

  • Type 1 diabetes, T1D: insulin-dependent diabetes mellitus (IDDM); insulin-deficient form diabetes most often manifesting in children as a result of autoimmune destruction of the β-cells of the pancreas

  • Diabetic ketoacidosis, DKA: a potentially life-threatening condition of excess ketone production by the liver in response to uncontrolled fatty acid release from adipose tissue resulting from excess glucagon secretion

  • Type 2 diabetes, T2D: noninsulin-dependent diabetes mellitus (NIDDM); a form of the disease associated with peripheral insulin resistance progressing to loss of insulin production

  • Gestational diabetes mellitus, GDM: a specific form of diabetes mellitus characterized by glucose intolerance first appearing during pregnancy

  • Maturity-onset type diabetes of the young, MODY: a class of T2D caused by inherited or somatic mutations in any of several genes involved in pancreatic function

  • Neonatal diabetes: hyperglycemia resulting from dysfunction in insulin action within the first 6 months of life and thus, not Type 1 diabetes

  • HbA1c: designates the glycosylated form of adult hemoglobin; is a measure of the level of glucose in the plasma

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Diabetes Defined

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Diabetes is any disorder characterized by excessive urinary output. The most common form of diabetes is diabetes mellitus, a metabolic disorder in which there is an inability to completely dispose of glucose due to disturbances in insulin function resulting in glucosuria and hyperglycemia. Additional symptoms of diabetes mellitus include polydipsia (excessive thirst), polyuria (excessive urine output), polyphagia (excessive hunger), and lipemia.

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Two primary criteria are used to clinically establish an individual as suffering from diabetes mellitus. One is a fasting plasma glucose (FPG) level in excess of 126 mg/dL (7 mmol/L) where normal levels should be less than 100 mg/dL (5.6 mmol/L). The second is defined by the results of a glucose tolerance test where having plasma glucose levels in excess of 200 mg/dL (11 mmol/L) at 2 time points during an oral glucose tolerance test (OGTT), one of which must be within 2 hours of ingestion of glucose (Figure 47-1).

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FIGURE 47-1:

Glucose tolerance curve for a normal person and one with noninsulin-dependent diabetes mellitus (NIDDM, Type 2 diabetes). The dotted lines indicate the boundaries for the range of glucose concentration expected in a normal individual. Reproduced with permission of the medical biochemistry page, LLC.

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The earlier a person is diagnosed with diabetes (principally type 2), the better chance the person has of staving off the primary negative consequences which are renal failure, blindness and limb amputations due to ...

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