Case 1 History: Mr Raju, 49 yrs, banker by profession, presents with c/o fatigue, gradually increasing over last few months. He has also increase frequency of urine, He lives sedentary life. Past History: No major illness in past. Family History: Father was Diabetic of over 25 years, died at age of 72.
Personal History: Not significant, O/E: Weight : 80 kg Height: 148 cm Pulse: 80/min Regular BP : 150/80 mm of hg. Obesity CVS/RS/AS/CNS : Normal Peri Pulse: Normal felt Feet / Nails / Sensation : clinically Normal
Q : 2 In Type 2 DM: 1. Relative Insulin deficiency occurs due to resistance of action of Insulin in muscle, fats, and Liver, and an inadequate response by B cells of Pancreas. 2. IR occurs 3. Pancreatic B cell function declines gradually over time. 4. All of the above.
Analysis: 1. Type 2 DM have IR, and have relative Insulin deficiency 2. Autoimmune destruction of Pancreatic B cell does not occur. 3. Mostly Type 2 DM are Obese ( cause of IR), those who are not by BMI, have increase percentage of body fat distributed predominantly in the abdomen. 4. Hyperglycemic stat develops gradually, so goes undetected in early stages, they have defective insulin secretion which is not sufficient to compensate for IR.
Q. 3: Causes for IR: 1. Obesity 2. Physical Inactivity 3. Genetic factors 4. All of the above.
Analysis: 1.Type 2 DM is complex disease, Multigenic / Polygenic, resulting due to interaction of Environment and Genes. 2. Relative Insulin deficiency, occurs because of resistance of action of Insulin in muscles, fat and liver, so there is inadequate response of B cell of Pancreas. 3. IR is due to Increase FFA level in plasma, so there is Decrease transport of glucose in muscle, Increase hepatic glucose production Increase breakdown of fat
Type 2 DM occurs when diabetogenic lifestyle (environmental factors), like excessive caloric intake, decrease caloric expenditure, leading to Obesity is superimposed on susceptible genotype (genetic factor)
Q: 4 Lab test useful in Diagnosis of DM are: 1. FBG 2. 2 Hr PPBG 3. RBG 4. Hba1c. 5. All of the above.
Conversion: 1. m mol/ L = mg/dL X 18 None > 200 mg/dL Symptoms of Hyperglycemia and RBG 2 > 6.5 % 5.7 – 6.4 % < 5.7 % Hba1c 2 > 200 mg/dL 140 – 199 mg/dL < 140 mg/dL PPBG 2 Hr (75 gm oral glucose) 2 > 126 mg/dL 101 - 125 mg/dL < 100 mg/dL FBG ( 8-10 Hr of zero caloric intake) Confirmation test required DM Risk of DM (Pre Diabetes) Normal Venous sample ADA criteria for diagnosis of DM
Q. 4 Categories with increased risk of DM and CV risk includes: 1. IFG 2. IGT 3. Hba1c : b/n 5.7 % to 6.4 % 4. all of above.