Snapshot A 46-year-old obese woman presents to the family practice clinic for her yearly exam. She reports that over the past few weeks, she has had some increased urinary frequency and thirst and recently went to an urgent care center for a urinary tract infection. She denies any fevers or chills. A random blood glucose level is 235 mg/dL and her hemoglobin A1c comes back at 10.0. Introduction Type I vs Type II Diabetes Type I Diabetes Type II Diabetes Pathogenesis Immune-mediated destruction of beta cells leading to ↓ insulin production Sensitive to insulin ↑ End-organ resistance to insulin, leading to pancreatic beta-cell defects Not sensitive to insulin Demographics Onset at younger age Onset at older age Associated with HLA-DR3 and HLA-DR-4 Other autoimmune diseases (e.g., Celiac disease (most common) or autoimmune thyroid disorders) Consider screening for these (e.g., anti-tissue transglutaminase or TSH, respectively) Obesity Hypertension Metabolic syndrome, defined as at least 3 out of 5 of: Abdominal obesity (waist circumference ≥40 inches in men, ≥35 inches in women) Fasting glucose ≥100-110 mg/dL Serum triglycerides ≥150 mg/dL Serum HDL cholesterol <40 mg/dL in men or <50 mg/dL in women Blood pressure ≥130/85 Histology if biopsied Leukocyte infiltrate Amyloid polypeptide deposition Presentation Classic symptoms login to view 7 more bullets Symptoms and Physical Exam in Type I vs Type II Diabetes Type I Diabetes Type II Diabetes Classic Symptoms Common Not as Common Acute manifestations Diabetic ketoacidosis Hyperosmolar hyperglycemic state Signs of complications Candidal infections Acanthosis nigricans Vascular disease examination cold, hairless lower extremities with diminished pulses Fundoscopic examination hemorrhages, exudates, and neovascularization Neuropathy cranial nerve III ischemia Candidal infections Acanthosis nigricans Vascular disease examination cold, hairless lower extremities with diminished pulses Fundoscopic examination hemorrhages, exudates, and neovascularization Neuropathy cranial nerve III ischemia Studies Diagnostic testing login to view 5 more bullets Differential Glucagonoma login to view 4 more bullets Diagnosis Diagnostic criteria login to view 5 more bullets Treatment Management approach login to view 2 more bullets Type I diabetes login to view 3 more bullets Type II diabetes login to view 12 more bullets Complications Complications of diabetes login to view 31 more bullets