Patients with type 1 diabetes mellitus usually present with classic acute symptoms of hyperglycemia. These include:

• Polyuria (due to osmotic diuresis when blood glucose level exceeds renal threshold)
• Thirst (as a consequence of loss of fluids and electrolytes by osmotic diuresis)
• Postural hypotension (due to reduction of plasma volume by osmotic diuresis)
• Loss of weight (due to depletion of glycogen stores by glycogenolysis and triglyceride stores by lipolysis; and the reduction of muscle mass as a consequence of the diversion of amino acids for gluconeogenesis)
• Blurring of vision (because of the exposure of the lens and retina to hyperosmolar fluids)

Around 25% of the cases of diabetes mellitus present with the acute complication of ketoacidosis.

In contrast, most of the patients of type 2 diabetes mellitus do not have acute symptoms. The disease may be present for an average of 4 to 7 years before it is detected. The patients have a history of increased urination and thirst but most are asymptomatic initially. The presenting complaints of the patients include lack of energy, delayed wound healing, visual blurring and fungal infections such as pruritis vulvae or balanitis [5].

In addition, the following complications may be the initial presenting feature in chronically undetected cases.

• Infections (such as urinary tract infections, tuberculosis and skin infections)
• Deterioration of vision (owing to diabetic retinopathy)
• Paresthesia, pain and atrophy of the leg muscles (due to neuropathy)
• Ulcerations of the foot/feet (caused by a combination of neuropathy, infection and peripheral vascular disease) [6]
• Myocardial infarction (because of atherosclerosis)

• Weight Loss

  Typical weight loss is 1-2 lb per week, 31 and total weight loss tends to be less than that with other procedures. [clinical.diabetesjournals.org]

  In the short term, hyperglycemia causes symptoms of increased thirst, increased urination, increased hunger, and weight loss. [web.archive.org]

  Conclusions: The eating trait of being unsuccessfully dietary restrained is associated with weight-loss failure after a six-month lifestyle intervention in people with T2DM. [ncbi.nlm.nih.gov]

  It remains unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss itself is the main reason behind observed improvements. [doi.org]

• Fatigue

  Myasthenia gravis (MG) is an acquired disease of the neuromuscular junctions characterized by muscular weakness and fatigue, with a prevalence of 50-125 cases per million population in western countries. [ncbi.nlm.nih.gov]

  The signs and symptoms of both types of diabetes include increased urine output and decreased appetite as well as fatigue. [rxlist.com]

• Family History of Diabetes Mellitus

  There was a strong family history of diabetes mellitus. At age 17 months hypoglycemic seizures occured (blood glucose 5 mg/100 ml). An oral glucose tolerance test was abnormal. Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. [pediatrics.aappublications.org]

  Strong risk factors include advanced maternal age (more than 40 years), obesity, personal history of gestational diabetes or macrosomia affecting a previous child, polycystic ovary syndrome, non-white ancestry, and a family history of diabetes mellitus [dermnetnz.org]

  Risk factors for GDM Previous GDM Previously elevated blood glucose level Ethnicity: south and southeast Asian, Aboriginal, Pacific Islander, Maori, Middle Eastern, non-Caucasian African Age 40 years Family history of diabetes mellitus (first degree relative [racgp.org.au]

  Risk factors for type 2 diabetes include Age 45 Overweight or obesity Sedentary lifestyle Family history of diabetes mellitus History of impaired glucose regulation Gestational diabetes mellitus or delivery of a baby 4.1 kg History of hypertension Dyslipidemia [merck.com]

  Multivariate RRs were adjusted for age, alcohol (0, 0.1 to 4.9, 5.0 to 9.9, 10 g/d), physical activity (quintiles), family history of diabetes mellitus, smoking (never, past, current), postmenopausal hormone use (never, ever), oral contraceptive use [doi.org]

• Abdominal Obesity

  Your doctor will examine you to look for: Obesity, especially abdominal obesity—a condition that greatly raises a person's risk for type 2 diabetes. [drugs.com]

  Kenya has seen increases in abdominal obesity, poor dietary habits, excess alcohol consumption and physical inactivity [2,3,5]. Childhood starvation is also associated with TIIDM (relative risk of 2.08) [3]. [southsudanmedicaljournal.com]

  -- A large percentage of patients with DM2 are obese (80%) and obesity, particularly abdominal obesity, generates a resistance to insulin per se and is genetically controlledl. [revespcardiol.org]

  A recent report by the World Health Organization indicates an association between weight gain, abdominal obesity, sedentariness and the development of DM2, stressing eating habits as one of the main modifiable factors related to the development of non-transmissible [scielo.br]

  One study found that abdominal obesity, a condition associated with hyperinsulinemia, is associated with an increased risk of dementia. 39 Insulin could also affect the risk of dementia by direct action on neurons or changes in energy metabolism in the [doi.org]

• Renal Artery Stenosis

  artery stenosis, diabetic nephropathy (kidney disease), or diabetic retinopathy Example of process pictured on the left [4] Diabetic Neuropathy: the most common chronic long-term complication of DM Thought to be from the accumulation of Sorbitol in nerve [physio-pedia.com]

  artery stenosis (unilateral in patient with solitary kidney) ACE inhibitors, angiotensin receptor antagonists Post stroke ACE inhibitors, angiotensin receptor antagonists, low-dose thiazide-like diuretics Type 1 or type 2 diabetes with proteinuria or [australianprescriber.com]

  artery stenosis or history of worsening of renal function with ACE inhibitor/ARB exposure, renal failure, or drug allergy). [doi.org]

• Polydipsia

  Classical features are polydipsia, polyphagia and polyuria, due to hyperglycemia-induced osmotic diuresis. Type II diabetes mellitus normally starts in adulthood and is caused by a lack of sensitivity to the body's own insulin. [uniprot.org]

  With increased thirst, the person now experiences a polydipsia and polyuria cycle. [en.wikipedia.org]

  The characteristic symptoms are excessive urine production (polyuria), excessive thirst and increased fluid intake (polydipsia), and blurred vision; these symptoms may be absent if the blood sugar is mildly elevated. [sciencedaily.com]

  Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. [medscape.com]

  NIDDM patients have autoantibodies but no other features of IDDM Usually chronic (years) Clinical disease when 90% of islet cells are destroyed Clinical features Onset at age 20 years, normal weight (unlike most NIDDM) Characterized by PPP (polyuria, polydipsia [pathologyoutlines.com]

• Abdominal Pain

  pain Types of hospitals included in HCUP HCUP is based on data from community hospitals, which are defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). [hcup-us.ahrq.gov]

  They are more likely to present with nausea, vomiting, and abdominal pain, symptoms similar to food poisoning. DKA may manifest as respiratory distress. [emedicine.medscape.com]

  pain, rapid deep breathing, loss of appetite, reddened and warm skin, headache, drowsiness, fruity-smelling breath, restlessness and ketones in our urine. [nhforsythendocrineconsultants.org]

• Diarrhea

  Abstract Proprotein convertase 1/3 (PC1/3) deficiency is a very rare disease characterized by severe intractable diarrhea in the first years of life, followed by obesity and several hormonal deficiencies later. [ncbi.nlm.nih.gov]

  Key words Aretaeus of Cappadocia Diabetes Galen Soranus of Ephesus Diarrhea urinosa Dipsakon This is a preview of subscription content, log in to check access. Preview Unable to display preview. Download preview PDF. References 1. [doi.org]

  Alpha-glucosidase inhibitors are less effective than other oral drugs in reducing plasma glucose, and patients often stop the drugs because they may cause dyspepsia, flatulence, and diarrhea. [msdmanuals.com]

  Contact your doctor immediately if you develop vomiting or diarrhea and are not able to drink enough fluids. Monitor your blood sugar as advised by your health care team. Report any significant deviations in blood sugar levels. [drugs.com]

  Symptoms of CD include malabsorption and malnutrition, vitamin deficiencies, iron deficiency anemia, failure to thrive, short stature, diarrhea, anorexia, constipation, vomiting, and abdominal distension. [dx.doi.org]

• Constipation

  Symptoms of CD include malabsorption and malnutrition, vitamin deficiencies, iron deficiency anemia, failure to thrive, short stature, diarrhea, anorexia, constipation, vomiting, and abdominal distension. [dx.doi.org]

  If nerve damage strikes your digestive tract, you can have constipation or diarrhea, or bouts of both. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly or not at all. [mayoclinic.org]

  These side effects are: Insomnia Loss of appetite Constipation Weight loss Short temper Stains and bruises on the skin These effects occur due to people taking the same kratom every day without skipping any day. [idsoc.org]

• Delayed Gastric Emptying

  […] of delayed gastric emptying. [doi.org]

  Its physiological effect includes weight loss, delayed gastric emptying, and a reduction in both postprandial glucose and glucagon. The primary side effect is nausea. Pramlintide has a modest effect on A1C reduction of 0.5%. [dx.doi.org]

  When given parenterally, it appears to decrease the glucagon level and delay gastric emptying, thereby facilitating insulin action ( 119, 120 ). It, too, will require caution in its use in patients with gastroparesis. [academic.oup.com]

• Hepatomegaly

  Abstract Glycogenic hepatopathy is a rare condition that causes significant hepatomegaly and elevated liver enzyme levels in uncontrolled type 1 diabetic patients. It develops due to excessive accumulation of glycogen in the hepatocytes. [ncbi.nlm.nih.gov]

  Children with diabetic dwarfism syndrome, which was also known as Mauriac's syndrome, suffered from stunted growth, hepatomegaly, and delayed puberty. 4 In 1936, the first commercially available, extended-action insulin, PZI (protamine zinc insulin), [dx.doi.org]

• Visual Impairment

  Cataract is a common cause of visual impairment in patients with diabetes. [aao.org]

  Diabetologia 2001, 44 Suppl 2:S14–S21. (7) Global data on visual impairments 2010. Geneva, World Health Organization, 2012. (8) Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S et al. [web.archive.org]

  impairment, MMSE, fall in per year before interview, ADLs, physical performance and knee strength Pijpers et al. (2012) [8] The Netherlands Population- based cohort study 1,145 (49.8%) 65 years Self-reported and use of glucose-lowering medication (85 [doi.org]

  The most common cause of visual impairment and blindness in patients aged 25–74 years in the US Symptoms: asymptomatic until very late stages of disease Visual impairment Progression to blindness Ophthalmological findings and classification of diabetic [amboss.com]

  Visual impairment and blindness are common sequelae of uncontrolled diabetes. [medical-dictionary.thefreedictionary.com]

• Background Retinopathy

  Any degree of retinopathy beyond background retinopathy is not allowed. There must be no evidence of neuropathy (sensory, motor or automatic), nor of vascular or microvascular disease beyond the background retinopathy in the eye. [ukdmc.org]

  Follow-up eye examinations should be performed annually in patients with no or minimal background retinopathy. More frequent follow-up examinations are needed in those who have more advanced retinopathy. [clevelandclinicmeded.com]

• Flushing

  Converted to urine, these fluids flush out the wastes that the kidneys filter out. When this system malfunctions, a person’s thirst increases because the body thinks it needs more water to flush out impurities. [diabetesinsipidus.org]

  Signs/symptoms of Diabetic Ketoacidosis: [3] Deep, rapid breathing Fruity breath Dry skin and mouth Flushed face Nausea/vomiting Abdominal pain Hypoglycemia : Blood glucose levels in relation to exercise that a PT should be aware of: 100-250 mg/dL safe [physio-pedia.com]

  The following symptoms may indicate diabetic ketoacidosis:13 breath that smells fruity; very dry mouth; high blood glucose levels; high levels of ketones in the urine; frequent urination; shortness of breath; constant tired feeling; dry or flushed skin [ada.org]

  Antihyperglycemics Generic Name Daily Dosage Duration of Action Comments Acetohexamide* 250 mg once/day–750 mg bid 12–24 h No longer available in US Chlorpropamide * 100 mg once/day–750 mg once/day 24–36 h Chlorpropamide : May cause hyponatremia and flushing [msdmanuals.com]

  The body tries to rid the blood of excess glucose by flushing it out of the system with increased urination. This process can cause dehydration and upset the body's electrolyte balance as sodium and potassium are lost in the urine. [labtestsonline.org]

• Pruritus

  Skin tags Vitiligo — an autoimmune skin problem sometimes associated with type 1 diabetes Acanthosis nigricans — darkening and thickening of skin folds, thought to be due to insulin resistance Necrobiosis lipoidica — yellow, waxy plaques on the shin Pruritus [dermnetnz.org]

  This risk is likely outweighed by the benefits of reducing cardiovascular risk.[8] Presentation Patients with all types of diabetes may present with polyuria, polydipsia, lethargy, boils, pruritus vulvae or with frequent, recurrent or prolonged infections [patient.info]

  They can cause immediate pain or burning followed by erythema, pruritus, and induration—the latter sometimes persisting for days. [msdmanuals.com]

  They can produce immediate pain or burning followed by erythema, pruritus, and induration—the latter sometimes persisting for days. [web.archive.org]

  […] complications may be the first clinical sign of disease Characteristic features Classic Polyuria Secondary enuresis and nocturia in children Polydipsia Polyphagia Nonspecific Fatigue Visual disturbances: blurred vision Calf cramps Poor wound healing Pruritus [amboss.com]

• Delayed Wound Healing

  The presenting complaints of the patients include lack of energy, delayed wound healing, visual blurring and fungal infections such as pruritis vulvae or balanitis. [symptoma.com]

  wound healing, increased incidence and severity of infections, secondary infection with candidiasis; parotid salivary gland enlargement; gingivitis and/or periodontitis.16, 33 Key questions a dentist may want to ask a patient with diabetes follow:33 [ada.org]

  Poor blood circulation in the legs and feet contribute to delayed wound healing. [medical-dictionary.thefreedictionary.com]

  healing and diabetic cachexia. [doi.org]

• Xanthelasma

  The common skin manifestations of diabetes mellitus are erythrasma, xanthomatosis, xanthelasma, phycomycetes and cutaneous infections like furuncolosis, candidiasis, carbuncle, dermatophytosis, etc. [ncbi.nlm.nih.gov]

  Scleroedema — a rare complication of type 2 diabetes causing skin thickening of the neck and upper back Disseminated granuloma annulare Eruptive xanthoma on the hands, arms, feet, legs, and buttocks associated with high levels of cholesterol and triglycerides Xanthelasma [dermnetnz.org]

• Neuropathic Arthropathy

  arthropathy (especially shoulder, hands, or feet) Diabetic Neuropathy Diabetic Ketoacidosis, resulting from high blood glucose levels that are not treated with increased insulin (usually in special circumstances of stress, trauma, surgery, pregnancy, [physio-pedia.com]

  arthropathy ‎ (3 K, 4 D) P People with diabetes mellitus ‎ (1 K, 1 D) W Wolcott–Rallison syndrome ‎ (1 D) World Diabetes Day ‎ (2 K, 7 D) Y Your Health with Joan Lunden and CDC videos ‎ (43 D) Seiten in der Kategorie „Diabetes mellitus“ Diese Kategorie [commons.wikimedia.org]

  Diabetic neuropathic arthropathy (Charcot foot): deformation of joints and bones Tarsus and tarsometatarsal joints most commonly affected Coexisting ulcers common Acute: swelling, warmth, erythema Chronic: painless bony deformities, midfoot collapse, [amboss.com]

• Prayer Sign

  Consider screening with “prayer sign” (unable to approximate fingers and palms while pressing hands together). GI: consider RSI (although not supported by any evidence!!! Regardless, note that gastroparesis occurs in 25% of diabetics). [openanesthesia.org]

• Stroke

  […] or death from stroke). [doi.org]

  Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other [ncbi.nlm.nih.gov]

• Peripheral Neuropathy

  We presented apical healing of the upper central incisor, retrofilled with TSC, in a diabetic patient (type 2 DM) with peripheral neuropathy. [ncbi.nlm.nih.gov]

  The combination of peripheral vascular disease and peripheral neuropathy can cause serious foot pathology. Smoking, hypertension, hyperlipidemia, and poor diabetic control greatly increase the risk of vascular disease. [emedicine.medscape.com]

• Polyuria

  The patient was admitted due to polyuria and weight loss in the past few days. The initial blood glucose level was 1167mg/dL. On the basis of clinical manifestations and laboratory results, she was diagnosed with T1DM and HHS. [ncbi.nlm.nih.gov]

  Classical features are polydipsia, polyphagia and polyuria, due to hyperglycemia-induced osmotic diuresis. Type II diabetes mellitus normally starts in adulthood and is caused by a lack of sensitivity to the body's own insulin. [uniprot.org]

  The characteristic symptoms are excessive urine production (polyuria), excessive thirst and increased fluid intake (polydipsia), and blurred vision; these symptoms may be absent if the blood sugar is mildly elevated. [sciencedaily.com]

  Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. [medscape.com]

• Nocturia

  Polyuria- Passing urine often or waking at night several times to pass urine (nocturia). Fatigue. Hunger. Weight loss. [healthengine.com.au]

  […] majority of patients are asymptomatic Hyperosmolar hyperglycemic state (in elderly especially, signs of dehydration) Symptoms of complications may be the first clinical sign of disease Characteristic features Classic Polyuria Secondary enuresis and nocturia [amboss.com]

  Polyuria may manifest as nocturia, bed-wetting, or daytime incontinence; in children who are not toilet-trained, parents may note an increased frequency of wet or heavy diapers. [merckmanuals.com]

The following investigations are helpful in establishing the diagnosis of diabetes mellitus.

• Random blood sugar: Diabetes is labelled if the random blood sugar is found to be greater than 200 mg/dL. It is not sufficient for diagnosing diabetes and fasting blood sugar should always be checked subsequently.
• Fasting blood sugar: Diabetes is confirmed if the fasting blood sugar is more than 126 mg/dL on more than one occasion.
• Glucose tolerance test: Glucose tolerance test is required for the confirmation of diabetes when the fasting blood sugar is more than normal but less than the diabetic range.
• Glycosylated hemoglobin: Level of glycosylated hemoglobin reflects the state of glycemia over the preceding 8 to 12 weeks.
• Serum fructosamine: Serum fructosamine reflects the state of glycemic control for the preceding 2 weeks.

• Glycosuria

  He attributed the decrease in urinary sugar to a ‘temporary toxic renal effect’ (he had been expecting a compensating increase in glycosuria). [dx.doi.org]

  Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. Serum immunoreactive insulin following intravenous tolbutamide rose, suggesting endogenous insulin production. [pediatrics.aappublications.org]

  […] polyuria, polydipsia, polyphagia) and ketoacidosis (DKA) Polyphagia combined with weight loss is specific for IDDM; type 2 patients rarely have either Severe fasting hypoglycemia is due to cessation of glycogen storage in fat and muscle Glycosemia causes glycosuria [pathologyoutlines.com]

  Initial clinical manifestations include hyperglycemia, glycosuria, intrauterine growth retardation, osmotic polyuria, severe dehydration, and failure to gain weight. The subsequent course of the disease depends on the genetic defect underlying DM. [orpha.net]

• Ketonuria

  Although neither ketoacidosis nor ketonuria was detected, the markedly acute onset of the hyperglycemia was consistent with the typical clinical course of fulminant type I diabetes mellitus, and this diagnosis was supported by clinical data. [ncbi.nlm.nih.gov]

  Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. Serum immunoreactive insulin following intravenous tolbutamide rose, suggesting endogenous insulin production. [pediatrics.aappublications.org]

  […] population Characteristics/Clinical Presentation [1] [2] Polyuria (increased urination) Polydipsia (increased thirst) Polyphagia (Increased appetite) Glycosuria (glucose in urine) Weight loss despite polyphagia Hyperglycemia (increased blood glucose) Ketonuria [physio-pedia.com]

  Patients with type 1 diabetes may also present with weight loss, dehydration, ketonuria and hyperventilation. Presentation of type 1 diabetes tends to be acute with a short duration of symptoms. [patient.info]

  For obese women (BMI 30 kg/m 2 ), a 30–33% calorie restriction (to 25 kcal/kg actual weight per day) has been shown to reduce hyperglycemia and plasma triglycerides with no increase in ketonuria ( 2 ). [care.diabetesjournals.org]

• Hypercholesterolemia

  At baseline, no patients in the DCCT had hypertension or hypercholesterolemia, on the basis of the standards at the time, and only 5 percent had microalbuminuria (urinary albumin excretion of at least 40 mg per 24 hours). [doi.org]

• Glucose Increased

  Oral antihyperglycemic drugs may Enhance pancreatic insulin secretion (secretagogues) Sensitize peripheral tissues to insulin (sensitizers) Impair GI absorption of glucose Increase glycosuria Drugs with different mechanisms of action may be synergistic [msdmanuals.com]

  Regular exercise lowers blood glucose, increases the body's sensitivity to insulin, and increases circulation. Type 1 diabetics must self-check their glucose levels and inject themselves with insulin several times a day. [labtestsonline.org]

  Oral antihyperglycemic drugs may Enhance pancreatic insulin secretion (secretagogues) Sensitize peripheral tissues to insulin (sensitizers) Impair gastrointestinal absorption of glucose Increase glycosuria Drugs with different mechanisms of action may [merckmanuals.com]

• Hyponatremia

  In this T1D case with CKD, severe hyperglycemia in conjunction with other metabolic insults, such as uremia, hyponatremia, and hypocalcemia, probably provoked his seizure despite the severe ketonemia. [ncbi.nlm.nih.gov]

  Characteristics of Oral Antihyperglycemics Generic Name Daily Dosage Duration of Action Comments Acetohexamide* 250 mg once/day–750 mg bid 12–24 h No longer available in US Chlorpropamide * 100 mg once/day–750 mg once/day 24–36 h Chlorpropamide : May cause hyponatremia [msdmanuals.com]

  especially in older patients Efficacy may wane after 5 years of use Acetohexamide* 250 mg once a day–750 mg twice a day 12–24 hours No longer available in US Chlorpropamide* 100 mg once a day–750 mg once a day 24–36 hours Chlorpropamide: May cause hyponatremia [merckmanuals.com]

• Insulin Increased

  Intranasal insulin increases rapidly in cerebrospinal fluid and binds to receptors along trigeminal and autonomic pathways in the frontal lobe, limbic system, hypothalamus, and other areas ( 14, 15 ). [ncbi.nlm.nih.gov]

• Nodular Glomerulosclerosis

  Renal glomerulus, nodular glomerulosclerosis, microscopic. Renal glomerulus, nodular glomerulosclerosis, hyaline arteriolosclerosis, PAS stain, microscopic. Kidney, acute pyelonephritis, microscopic. [library.med.utah.edu]

  […] and increased renal size worsening of filtration capacity Pathology Three major histological changes occur: Mesangial expansion Glomerular basement membrane thickening Glomerulosclerosis (later stages): may be diffuse (most common) or pathognomonic nodular [amboss.com]

• HLA-DR3

  Compared with nonautoimmune T2D patients, autoimmune T2D patients are reportedly more commonly positive for HLA-DR3 and -DR4 and their associated DQβ1 alleles 0201 and 0302, which are haplotypes strongly linked to a predisposition to childhood T1D ( 29 [clinchem.aaccjnls.org]

  Associated with HLA DR3 and DR4 and islet cell antibodies around the time of diagnosis. Patients always need insulin treatment and are prone to ketoacidosis. The most at-risk population for type 1 diabetes is Caucasian of northern European ancestry. [patient.info]

  There is around 30 to 35% concordance in monozygotic twins. 95% of the patients carry HLA-DR3, HLD-DR4 or both genes. [symptoma.com]

  GENETIC SUSCEPTIBILITY Many studies have reported an association of type I DM with high risk genes, HLA-DR3, -DR4 and their alleles DQB1*0302 and DQB1*0201 HLA[ 17 - 20 ]. The prevalence of these genes has been linked with age of onset of diabetes. [dx.doi.org]

• HLA-DR4

  Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Heterozygotes for those haplotypes are at significantly greater risk for DM than homozygotes. HLA-DQs are also considered specific markers of type 1 DM susceptibility. [emedicine.com]

  HLA-DR3 and HLA-DR4 positive; patients are 4–6 times more likely to develop type 1 diabetes. [amboss.com]

  Susceptibility genes include those within the major histocompatibility complex (MHC)—especially HLA-DR3,DQB1*0201 and HLA-DR4,DQB1*0302, which are present in 90% of patients with type 1 diabetes mellitus—and those outside the MHC, which seem to regulate [merck.com]

The treatment methods available for diabetes mellitus include:

• Diet alone
• Diet and insulin
• Diet and oral hypoglycemic drugs

Diet

Around 60% of the patients can be treated adequately with diet alone. A proper diet regimen should be prepared based upon the age, sex, weight and caloric requirements of the patient. Readily absorbable carbohydrates such as sugars should be avoided. Non-nutritive sweeteners such as asparmate, saccharine or sucramate should be used if needed.

Oral hypoglycemic drugs

Oral hypoglycemic agents are useful for the treatment of type 2 diabetes mellitus. A wide number of oral hypoglycemic agents are available. They are prescribed individually or in combinations according to the patient. Common oral hypoglycemic agents include sulphonylureas (e.g. glimepride and glipizide), biguanides (e.g. metformin), alpha glucosidase inhibitors (e.g. acarbose and migitol), thiazolidinedions (e.g. pioglitazone and rosiglitazone), D-phenylalanine derivatives (e.g. nateglinide) and insulin stimulators (e.g. repaglinide) [7][8].

Insulin

Insulin is used in the treatment of all patients of type 1 diabetes mellitus and in those patients of type 2 diabetes whose hyperglycemia is not controlled by diet and oral hypoglycemic agents. Various preparations of insulin are available and are selected according to each patient.

Diabetes mellitus is a chronic disease that disturbs the quality of life of all the patients [4]. The patients are forced to take daily insulin injections and/or oral hypoglycemic drugs. Lifestyle and diet modifications also become essential. However, with early diagnosis and proper control of the disease, the risk of development of associated diseases and complications can be reduced and the patients enjoy a life expectancy that approaches those without the disease. Untreated diabetes mellitus is associated with a high mortality and morbidity rate.

Diabetes mellitus may be primary or secondary.
Primary diabetes mellitus has two types [2].

• Insulin dependent diabetes mellitus (Type 1)
• Non-insulin dependent diabetes mellitus (Type 2)

Type 1 diabetes mellitus usually results from an autoimmune disease process. It is associated with a positive family history. The child of a patient having type 1 diabetes has a greater risk of developing the disease. The risk is greater with diabetic father as compared to the diabetic mother. There is around 30 to 35% concordance in monozygotic twins. 95% of the patients carry HLA-DR3, HLD-DR4 or both genes. Infection with coxsackievirus B4

Type 2 diabetes mellitus has a 100% concordance in identical twins, implying a much stronger genetic association. Around 25% of the patients have a first degree relative suffering from this disease. Overeating combined with obesity acts as a diabetogenic factor.

Type 1 diabetes mellitus is the most common metabolic disease in childhood. It is present in around 1 in every 500 child or adolescent.

Type 2 diabetes mellitus is very common worldwide, particularly the US because of the high caloric diet. Its incidence is on the rise and it is said that type 2 diabetes is rapidly becoming a global “epidemic”. It is estimated that around 552 million people worldwide will be suffering from it by the year 2030.

Type 1 diabetes mellitus is caused by an autoimmune process in which there is lymphocytic infiltration and subsequent destruction of the beta cells in the pancreas. These cells are responsible for the production of insulin and their destruction causes the level of insulin to fall leading to hyperglycemia.

In type 2 diabetes mellitus, there is both reduced secretion of insulin as well as insulin resistance in the peripheral tissues [3]. As a result, hyperglycemia develops.

There is no effective preventive measure against type 1 diabetes mellitus as it is an autoimmune disease that occurs early in childhood.

Type 2 diabetes mellitus can be prevented by adopting a healthy lifestyle. Eating a healthy diet, avoiding overeating, controlling obesity and performing daily exercise greatly reduce the risk of development of type 2 diabetes mellitus [9] [10].

Diabetes mellitus is a clinical syndrome that is characterized by chronic hyperglycemia along with disturbances in the metabolism of carbohydrates, lipids and proteins [1]. It is of two main types, type 1 and type 2 diabetes mellitus. The former is also referred to as insulin dependent diabetes mellitus while the latter is also known as non-insulin dependent diabetes mellitus.

Diabetes mellitus is a disease in which the level of sugar in the blood is raised. It is of two types, one usually affecting people since childhood and the other appearing late in adulthood. Diabetes is associated with many diseases and complications and should be diagnosed and treated early to ensure better expectancy and quality of life.

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