Source: Triplitt CL, Reasner
CA. Diabetes Mellitus. In: DiPiro JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM, eds. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://www.accesspharmacy.com/content.aspx?aid=7990956.
Accessed July 7, 2012.
- Juvenile-onset diabetes mellitus (DM)
- Insulin-dependent DM
- Disorder of carbohydrate regulation caused by markedly
reduced or absent insulin production by pancreas.
- Autoimmune disorder usually developing in childhood or
early adulthood probably initiated by exposure of genetically susceptible
individual to unknown environmental agent.
- Idiopathic type 1 DM is nonimmune form often seen in minorities,
especially Africans and Asians, with intermittent insulin requirements.
- Immune-mediated destruction of pancreatic β-cells
usually resulting in absolute deficiency of insulin.
- β-cell destruction thought to occur
during long preclinical period (9–13 years) associated
with presence of immune markers.
- Hyperglycemia occurs when 80–90% of β-cells
- A transient remission (“honeymoon phase”)
may precede established disease with associated risks for complications
- Factors initiating the autoimmune process unknown, but process
mediated by macrophages and T lymphocytes with a utoantibodies
to β-cell antigens (e.g., islet cell antibody, insulin
- Approximately 1 million Americans have disease.
- About 15,600 young people diagnosed each year.
- Affects 1 in every 400–600 children and adolescents.
- Accounts for 5–10% of all cases of DM.
- Constitutes about 5% of diabetes cases in adults.
- Presently no means of prevention.
- Routine screening not recommended; screening for islet autoantibody
status in high-risk family members may be appropriate in context
of clinical trials.
- Parent or sibling with type 1 DM
- Mother who had preeclampsia during pregnancy
- Respiratory infection shortly after birth
- Patients often thin and prone to develop diabetic ketoacidosis
(DKA) if insulin withheld or under conditions of stress.
- 20–40% of patients present with DKA several
- Weight loss
- Criteria for diagnosis of DM include any one of the following:
- A1C ≥6.5%
- Fasting plasma glucose ≥126 mg/dL (7.0 mmol/L)
- 2-hour plasma glucose ≥200 mg/dL (111.1 mmol/L)
during oral glucose tolerance test (OGTT) using 75 g anhydrous glucose
- Random plasma glucose concentration ≥200 mg/dL (111.1
mmol/L) with symptoms of hyperglycemia
- In absence of unequivocal hyperglycemia, confirm criteria
1 through 3 by repeat testing.
- Normal fasting plasma glucose (FPG) <100 mg/dL
- Impaired fasting glucose defined as FPG of 100–125
mg/dL (5.6–6.9 mmol/L).
- Impaired glucose tolerance diagnosed when 2-hour postload
sample of OGTT is between 140–199 mg per dL (7.8–11.0
- Type 2 DM
- Other endocrine disorders
- Medications (e.g., corticosteroids, pentamidine)
- Nondiabetic glycosuria (renal glycosuria)
- Ameliorate symptoms of hyperglycemia.
- Reduce risk of microvascular and macrovascular complications.
- Reduce mortality.
- Improve quality of life.
- Achieve desirable plasma glucose and A1C levels (Table 1).
Table 1. Glycemic Goals of Therapy |Favorite Table|Download (.pdf)
Table 1. Glycemic Goals of Therapy
ACE and AACE
Preprandial plasma glucose