1. DIABETES CASE PRESENTATIONS 1st - diagnosis

2. Case 1 • Male, 24 yrs old • Presents in the ER for nausea, vomiting, abdominal pain, shortness of breath • No known medical conditions, BMI = 21kg/m2 • In the last month has noticed increased thirst and passing water and lost almost 15 kg • Clinical examination: dehydration, BP = 125/65 mmHg, HR = 110/min ?

3. Case 2 • Female, 39 yrs old • Presents at the GP accusing fatigue and frequent urination • No known medical conditions, BMI=29 kg/m2, has 5 children (healthy, normal birth weight) • Has an aunt with diabetes ?

4. Case 3 • Male, 34 years old • Presents at the dermatologist for reccurent Staphyloccocus infection • Does not present other symptoms • Smoker, sedentary lifestyle, BMI = 32 kg/m2 • Father with diabetes and hypertension ?

5. Case 4 • Female, 65 yrs old • Presents to the ophthalmologist for decreased eyesight • Fundoscopy shows microaneurisms, hemorrhages and macular edema • BP = 155/90 mmHg, BMI = 35 kg/m2 • Has a sister and mother with diabetes ?

6. Case 5 • Male, 51 yrs old • Needs surgery for disc herniation • Tests before surgery find: blood glucose level = 176 mg/dl • BMI = 33 kg/m2, TA = 160/80 mmHg • Sedentary due to chronic back pain ?

7. Case 6 • Female, 41 yrs old • Presents at the GP for the annual check-up; at the age of 37 she had gestational diabetes and she checks her blood glucose level annually • BMI = 29,5 kg/m2 • Fasting blood glucose level = 118 mg/dl ?

8. Diagnosis of diabetes • Symptomatically: • Classic symptoms (polyuria, polydipsia, polyphagia, weight loss) • Ketoacidosis • Acute infectious complication • Chronic complication: • Eyes • Kidneys • Neurological • Macrovascular • Asymptomatically: • Random tests • Active screening

9. Criteria for the diagnosis of diabetes mellitus • Symptoms of diabetes plus casual plasma glucose concentration ≥200 mg/dl (11.1 mmol/l). Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss. or • FPG ≥126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h. or • 2-h post-load glucose ≥200 mg/dl (11.1 mmol/l) during an OGTT. The test should be performed as described by WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.

10. Classification of diabetes mellitus (1) • Type 1 • beta-cell destruction, usually leading to absolute insulin deficiency • Autoimmune • Idiopathic • Type 2 • may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance

11. Classification of diabetes mellitus (2) • Other specific types • Genetic defects of beta-cell function • Genetic defects in insulin action • Diseases of the exocrine pancreas • Endocrinopathies • Drug- or chemical-induced • Infections • Uncommon forms of immune-mediated diabetes • Other genetic syndromes sometimes associated with diabetes • Gestational diabetes

12. Pre-diabetes • Impaired fasting glycaemia (IFG): • Blood glucose level (fasting) = 110 – 125 mg/dl • Impaired glucose tolerance (IGT): • Blood glucose level (2 hrs at OGTT) = 140 – 199 mg/dl

13. Risk factors for type 2 diabetes (screening) • Age ≥45 years • Overweight (BMI ≥25 kg/m2) • Family history of diabetes (i.e., parents or siblings with diabetes) • Habitual physical inactivity • Race/ethnicity (e.g., African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders) • Previously identified IFG or IGT • History of GDM or delivery of a baby weighing > 9 lbs • Hypertension (≥140/90 mmHg in adults) • HDL cholesterol ≤35 mg/dl (0.90 mmol/l) and/or a triglyceride level ≥250 mg/dl (2.82 mmol/l) • Polycystic ovary syndrome • History of vascular disease

14. Definition of Metabolic Syndrome

15. Initial evaluation of the diabetic patient • History taking – personal and family history • Clinical examination • Height, weight (BMI), waist circumference • Tests

16. Definition and classification of obesity

17. Types of obesity • Abdominal (central) obesity • Men ≥ 94 cm • Women ≥ 80 cm • Gluteo-femoral obesity • Men < 94 cm • Women <80 cm

18. Dyslipidemia