Comparative clinical features of iddm and niddm

Clinical features	IDDM	NIDDM
Age of onset	<40 years	>50 years
Genetic prediposition	Moderate, requires envi-ron-mental for expression	Strong -80-100%
Family history	No	Yes
Duration of symptoms	Weeks	Months - years
Precipitating factors	Viral, other trigger autoimmune disease	Obesity, age
Autoantibodies	Yes	No
Insulin resistance	No	Yes
Ketonuria	Yes	No
Response to stress withdrawal of insulin	Ketoacidosis	Hyperglycemia without ketoacidosis
Treatment	Diet, insulin	Diet, oral antidiabetic drugs
Rapid death without treatment with insulin	Yes	No

Typically, the early stage of type 2 diabetes is characterized by insulin resistance and decreased ability for insulin secretion causing excessive post-prandial hyperglycemia. This is followed by a gradually deteriorating first-phase insulin response to increased blood glucose concentration. Type 2 diabetes, comprising over 90% of adults patients are often obese or have been obese in the past and have typically been physically inactive. Ketoacidosis is uncommon, but may occur in the presence of severe infection or severe stress.

COMPLICATIONS OF DIABETES

Acute complications

• Hypoglycemia

• Diabetes ketoacidosis (DKA)

• Non- ketotic hyperosmolar coma

Chronic complications

• Vascular disorders

• Infections

• Diabetic neuropathy

• Diabetic foot

• Diabetic nephropathy

• Diabetic retinopathy

Hypoglycemia

Causes:

• Imbalance between injected insulin and patients normal diet, activity and basal insulin requirement.

• Irregular eating habits, unusual exertion and alcohol excess may precipitate episodes.

• Impaired ability to counter - regulate glucose levels after hypoglycemia in diabetic patient is also responsible for episode. Glucagon response is lost. Adrenaline response may also fail in patients with a long duration of diabetes.

Clinical features

Symptoms of hypoglycemia begin at plasma glucose 60mg/dl; brain impairment develops at approximately 50mg/dl. Brain damage after prolonged severe hypoglycemia is not reversible.

Features of hypoglycemia are:

• Pallor, tachycardia, palpitation, sweating, nausea and tumor (due to stimulation of sympathetic system as a counter regulatory mechanism which increases blood glucose by increasing glycogenolysis);

• Hunger due to parasympathetic stimulation;

• Mental confusion, aggression or convulsion;

• Some patients with long duration of diabetes have not such symptoms and go into severe hypoglycemia. Patients become pale, drowsy. Mental confusion or convulation rapidly occurring hypoglycemic coma (due to decreased supply of glucose to the brain).

Diabetic ketoacidosis

Diabetic ketoacidosis is a medical emergency with mortality rate about 5%. It may be the initial manifestation of type I diabetes or may result from increased insulin requirement in type I diabetes patients during the course of stress such as infection, trauma, surgery or myocardial infarction. Type II diabetics may develop ketoacidosis under severe stress such as infection or trauma.

Precipitation factors:

Acute infection: bacterial or viral;

Omission or drastically reduction the dose of insulin;

New onset type I diabetes (about 25% patients of type I are first time diagnosed when they present with ketoacidosis).