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1. Type 1 DM.
2. Type 2 DM.
3. Impaired Fasting Glucose (IFG) and Impaired
Glucose Tolerance (IGT).
4. Gestation Diabetes/IGT.
5. Maturity Onset Diabetes of the Young
(MODY).
Criteria for diagnosing DM
Insulin Yes No No
dependence
• Pancreatectomy
• Acromegaly
• Cushing syndrome .
• Glucoganoma.
• Primary aldosteronism.
• Severe stress.
• Hyperthyroidism.
• Drugs (thyroxin, phenytoin)
Glycosuria
• It is the excretion of glucose in urine. Appears when:
→ Blood glucose exceeds the renal threshold for
reabsorption.
• Normally lies at about 170 mg/dL, but it may be:
– Lower in renal tubular disease.
– Elevated in diabetics to above 300 mg/dL.
• High glucose concentration increases the urinary specific
gravity.
• Glycosuria usually measured by semi-quantitative tests +1,
+2… (As in routine urinalysis). Quantitative urinary glucose
determinations are seldom necessary (usually between 0.5 to
2.0 g/dL).
Non-diabetic causes of glycosuria
Glycosuria not associated with hyperglycemia ( due to decreased
renal reabsorption):
• Pregnancy.
• Fanconi’s syndrome.
• Renal glycosuria (true renal diabetes).
• Nephrotic syndrome.
• C-peptide and insulin are not used for the initial diagnosis of diabetes.
• Proinsulin à Insulin + C-peptide .
• t1/2 of C-peptide is longer than that of insulin.
• Serum insulin and C-peptide are measured by radioimmunoassay to:
1. Differentiate between MODY disease and type 1 DM (very low level of C-
peptide in type 1 DM)
2. Measure the insulin secretory capacity in individuals who had developed
antibodies to the hormone following treatment with non-human insulin,
since C-peptide do not react with insulin antibodies → (C-peptide >>
insulin level).
Microalbuminuria
• It is a persistent albuminuria 2/3 of urine samples
within 3-6 months:
– 20-200μg/min or 30-300mg/24h or 4h overnight
– Albumin-creatinine ratio= ≥300mg/24h, >200μg/min, or ≥300μg/mg
• DM cause progressive insult to the kidney ultimately
results over years in diabetic nephropathy
• Annual measurement is recommended
• Diabetic lead to increased urinary excretion and
clearance of proteins with a MW >40,000→ this can
become non-selective for the larger proteins and may
progress to several grams of protein loss/24 hour.
Anti-Insulin Antibodies
In the past beef or pork insulin were used in DM treatment → IgG
antibodies was demonstrated in nearly all patients after few weeks.
• The extent of antibody formation is a function of:
(1) Immune response.
(2) Insulin source (beef is more immunogenic than pork).
(3) Insulin type (long-acting preparations are more immunogenic than
regular).
(4) Purity of the insulin preparation.
• The clinical significance is not completely known (Increased titers of IgG
antibodies directed against beef insulin may be associated with
resistance).
• With the currently increasing use of purified pork insulin and human
insulin preparations, problems of immunologic resistance to insulin are
quickly disappearing.