According to American institute of Diabetes Association screening for all for diabetes should begin at age of 45 yr and earlier for younger age group if indication is there.
Sign and symptoms of diabetes in patients usually present with polyuria (increased frequency of urination), polydipsia (increased thirst) and polyphagia (increased food intake)
Type I diabetes is caused by β cell destruction which leads to insulin deficiency, due to autoantibodies to glutamic acid decarboxylase, pancreatic islet β cell or insulin. It can also be caused in autoimmune disorders like Graves disease, Hashimoto,s thyroiditis , Addison,s disease.
Risk factor include physical inactivity, history of familial disease, Gestational diabetes with baby weight more than 4 kg, female diagnosed with polycystic ovarian syndrome, severe obesity, BMI >=23 kg/m2 , waist circumference >=80 cm women and >=90 cm for men.Work up for Type I diabetes on first visit and subsequent visit includes, Complete physical examination: Height, weight, BMI,Waist, blood pressure, thyroid, skin examination, neurological examination, cardiovascular system, Chest and abdominal examination organ dysfunction like kidney (ketoacidosis ), dilated fundoscopic examination and foot examination. Severe bipolar disease or on antipsychotic therapy,those receiving antiretroviral therapy or long term steroid therapy
Laboratory investigations consist of array of tests like hemoglobin A1c >=5.7 %,stronger predictor of cardiovascular disorder and diabetes. Impaired IGT, 2 hr glucose level of 75 gm glucose administered >=200 mg/d L.Impaired IFG ) on previous testing. >=126 mg/d L with no caloric intake for 8 hrs.HDL level (High density lipoprotein) <35mg/d L, Triglyceride (TG )>250 mg/ d L
Hypertension >=140/90 Liver Function tests (LFT), spot urine albumin to creatinine ratio .Renal function test Sodium /potassium /urea creatinine with e GFR (glomular filtrate rate ) Urinalysis for ketones, glucose, proteins, sediments ECG and TSH > 50 yrs old.
Treatment is by standardized Insulin therapy and if required anti-diabetic drugs, according to blood glucose monitoring. Kindly note Treatment of diabetes and management is advisable under Strict Medical supervision and guidelines according to established and new research data. Goal is to treat and match insulin to carbohydrate intake, premeal blood glucose and anticipated physical activity and exercise.
Follow up for assessment of glucose control is done by testing every 3 year if result are normal and every year if patient is in prediabetic condition which is defined as IFG levels between 100-125mg/d L ,IGT with 75 gm sugar (140-199 mg/d L ) , HbA1c (6.0-6.5 % ) 5 year risk of developing Diabetes mellitus
Patient education for Lifestyle modification includes MNT (eating habits protein rich , fibre rich diet, physical activity, nutritional status, weight loss .Diabetes self-management education (DSME ), Dental examination, Continuous Mental health assessment to prevent this lifestyle disorder due to poor self-management under lack of guidance.
