- Definition: Plasma glucose level that meets ADA criteria for DM (see table below)
Normal mg/dL (mmol/L)
Impaired* mg/dL (mmol/L)
Diabetes Mellitus mg/dL (mmol/L)
Fasting plasma glucose
≥200 (11.1) + classic symptoms‡
Age of onset
Days or weeks
Subacute or absent
Obese, acanthosis nigricans, features of PCOS
Less common (∼1/3), very rarely recurrent
- Type 1 DM: ∼65% of pediatric patients with DM; 5% to 10% of adults with DM.
- Mechanism: Absolute insulin deficiency caused by autoimmune β-cell destruction (∼90% of cases); idiopathic (∼10% of cases).
- Presentation: Acute onset (<1 mo) of classic symptoms (weight loss, polyuria, polydipsia ± polyphagia, lethargy, or vaginal yeast infection); 25% present with DKA.
- Diagnosis: See table “Diagnosing Diabetes Mellitus and Impaired Glucose Regulation.”
- Screening: Not recommended (short asymptomatic period; no effective prevention).
- Type 2 DM: ∼35% of pediatric patients with DM; 90% to 95% of adults with DM.
- Mechanism: Insulin resistance and relative insulin deficiency.
- Presentation: Usually subacute; many are asymptomatic, overweight (BMI >85%) or obese; absent or mild polyuria; acanthosis nigricans; glucosuria; usually no ketonuria.
- Diagnosis: Establish hyperglycemia and then differentiate from type 1 (see table ” Characteristics Suggesting Type 1 versus Type 2 Diabetes Mellitus”).
- Screening: See table “Recommendations For Type 2 Diabetes Mellitus Screening”.
- Prevention: Avoid weight gain into the overweight or obese range. If overweight → weight loss and exercise (independent of weight loss) may delay, prevent, or reverse the course of Type 2 DM.
Recommendations for Type 2 Diabetes Mellitus Screening*
Age >10 yr or onset of puberty (whichever is earlier) and overweight (BMI >85th percentile or >120% of IBW for height) and any two of the following:
- Family history of type 2 DM in first- or second-degree relative
- Non-European ethnicity
- Signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)
- Secondary causes of DM: Genetic defects of β-cell function (formerly MODY; AD inheritance, multiple family members with hyperglycemia onset <25 yo), gestational DM, drug- induced (eg, L-aspariginase, steroids, tacrolimus, cyclosporine, β-blockers, phenytoin, protease inhibitors), diseases with pancreatic destruction (eg, CF, trauma, pancreatitis), infections (eg, rubella, CMV), genetic syndromes with insulin deficiency or resistance (eg, Down, Prader-Willi, Turner, Klinefelter syndromes).
- Inpatient management
- DKA: See chapter 9 for DKA management.
- New stable type 1 diabetic (not in DKA):
- Criteria for admission to regular ward (vary by institution): Normal mental status, tolerating PO intake, and serum HCO3 ≥16 mEq/L (≤5 yo) or ≥12 mEq/L (>5 yo).
- Orders: see table “Suggested Orders For The New Diabetic”.
- Insulin management: See table ...
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