endocrine and metabolic disorders
Diabetes Mellitus (DM)
Key Points
Type 1 diabetes is caused by an absence ofinsulinproduction due to autoimmune-mediated inflammation in pancreatic beta cells. Type 2 diabetes is caused by hepaticinsulinresistance (causing an inability to suppress hepatic glucose production) and peripheralinsulinresistance (which impairs peripheral glucose uptake), in combination with a pancreatic beta cell secretory defect. Diagnose by elevated fasting plasma glucose level and/or elevated hemoglobin A1C and/or elevated 2-hour value on oral glucose tolerance test. Do regular screening for complications. Microvascular complications include nephropathy, neuropathy, and retinopathy. Macrovascular complications involve atherosclerosis resulting in coronary artery disease, transient ischemic attack/stroke, and peripheral arterial insufficiency. Treat with diet, exercise, weight loss, andinsulin, and/or oral or injectable antihyperglycemic medications. Often, give renin-angiotensin-aldosterone system blockers, and statins to prevent complications. 