Building Competency in Diabetes Education THE ESSENTIALS

3-22 | CHAPTER 3

Seldom ketosis, except with major stress of another illness Hyperosmolar hyperglycemic state more common, if dehydrated

•

Ketoacidosis/ hyperosmolar states

Prone to ketosis

• •

DKA with insulin omission or intercurrent illness

•

First-line treatment

Insulin therapy

Noninsulin antihyperglycemic agents; gradual dependence on insulin may occur

•

•

Chronic complications

Microvascular (retinopathy, nephropathy, neuropathy) Macrovascular (CAD, PVD, CVA, amputations) Depends on degree of hyperglycemia, duration, hypertension, smoking and other risk factors Identifying immune abnormalities in high-risk people (those with first degree relatives): e.g. ICAs is recommended in research protocols Experimental at present

Same risks as type 1 diabetes

•

•

Depends on degree of hyperglycemia, duration, hypertension, smoking and other risk factors In UKPDs, 50% had one complication present at diagnosis (3)

•

•

•

•

Intensive diet and exercise interventions with/without

•

Prevention

•

•

pharmacological agent; intervention trials may be effective in delaying onset of diabetes

A1C = glycated hemoglobin; BG = blood glucose; CAD = coronary artery disease; CVA = cerebrovascular accident; DKA = diabetic ketoacidosis; ICA = islet cell antibodies; OHA = oral hypoglycemic agent; PVD = peripheral vascular disease; UKPDS = United Kingdom Prospective Diabetes Study Adapted from CPG 2018 (1) and ISPAD 2018 (34)

Key points • Causes and types of diabetes can be confusing, and it may be impossible to determine the actual type. A single diagnostic test does not exist, however, there are criteria that we utilize to determine diabetes type. • C-peptide may be a useful indicator of beta cell function. Thus, testing C-peptide to determine the amount of endogenous insulin being produced is possible, but is not generally necessary or cost-effective in determining appropriate treatment (33,34).