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Diabetes refers to a condition in which there is elevated blood sugar. It is a chronic disorder of metabolism where the body is not able to effectively utilize the blood sugar. Diabetes can be classified as follows:

  • Type 1 Diabetes (or)Insulin Dependant Diabetes Mellitus (IDDM)
  • Type 2 Diabetes (or) Non-insulin DependantDiabetes Mellitus (NIDDM)
  • GDM-Gestational Diabetes Mellitus.
  • There are other rare conditions of diabetes associated with genetic syndromes.
  • Drugs and toxic metabolites can also induce secondary diabetes.

Type 1 Diabetes (IDDM)

This type of diabetes results from complete destruction of beta cells of the pancreas due to auto immunity which results in the absence of insulin secretion. Such patients need insulin treatment for their survival. On withdrawal of insulin, they end up with high blood sugar finally resulting in diabetic ketoacidosis.
Type 1 diabetes is generally found in young children, adolescents and adults under the age of 40 years. The onset of symptoms is usually sudden, In some cases, patients present with keto-acidosis or coma especially during recurrent illness or surgery.

Genetic factors, autoimmune and environmental factors play a role in the causation of this kind of diabetes.

Type 2 Diabetes ( NIDDM)

This type is very common and is widely known as Non- insulin Dependant Diabetes. It develops in later stages of life. Often patients are overweight, (some may be lean due to loss of weight because of uncontrolled diabetes) and have family history of diabetes. They may respond to diet, exercise and oral hypoglycemic drugs. Their symptoms develop gradually and many have insulin resistance.

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  • Genetic factors (family history).
  • Environmental factors such as obesity lack of physical activity, stress and drugs such as steroids.

Differences between Type 1 and Type 2 Diabetes

Type 1 Diabetes or IDDM

  • Life long dependency on insulin
  • Usually detected below 20 years of age
  • Negative family history of diabetes
  • Diabetic coma occurs if insulin is stopped

Type 2 Diabetes or NIDDM

  • Can be treated with diet,exercise and oral drugs
  • Usually detected above 25 years of age.
  • About 60% have a positive family history
  • Diabetic coma is rare

 

Gestational Diabetes (GDM)

GDM is a condition where the diabetes sets in during pregnancy. The assessment for GDM should be undertaken at the first prenatal visit. Women with obesity, previous history of GDM, glycosuria or family history of delivering big babies should undergo a spot random glucose screening. If they are found to have elevated blood sugars during the initial screening, they should undergo a glucose tolerance test. If they are normal, they can be retested between 24 and 28 weeks of their gestation.
Patients can be treated with diet control in mild cases and insulin may be needed if the sugars are high. Oral hypoglycemic drugs are contraindicated during pregnancy 5 % of patients may continue to have diabetes after delivery.

Clinical Profile Type 1 DM (IDDM) Type 2 DM (NIDDM) GDM (NIDDM)
Age of onset <40 yrs >40 yrs Women of child bearing age
Body weight Non-Obese Usually obese variable
Prone to ketoacidosis Yes No Variable
Treatment Insulin is Essential Diet – Tablets or insulin Life-style modification with or without insulin
Symptoms Acute Gradual onset or may be asymptomatic Gradual onset or may Be asymptomatic
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