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CURRENT Medical Diagnosis & Treatment 2013
Chapter 27. Diabetes Mellitus & Hypoglycemia
Sections: Diabetes Mellitus, Diabetic Coma, Diabetic Coma: Introduction, Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar State, Lactic Acidosis, The Hypoglycemic States, The Hypoglycemic States: Introduction, Hypoglycemia Due to Pancreatic B Cell Tumors, Nonislet Cell Tumor Hypoglycemia, Postprandial Hypoglycemia, Factitious Hypoglycemia, Hypoglycemia Due to Insulin Receptor Antibodies, Medication-Induced Hypoglycemia.
Topics Discussed: diabetes mellitus; hypoglycemia.
Excerpt:"This form of diabetes is immune-mediated in over 95% of cases (type 1a) and idiopathic in < 5% (type 1b). The rate of pancreatic B cell destruction is quite variable, being rapid in some individuals and slow in others. Type 1 diabetes is usually associated with ketosis in its untreated state. It occurs at any age but most commonly arises in children and young adults with a peak incidence before school age and again at around puberty. It is a catabolic disorder in which circulating insulin is virtually absent, plasma glucagon is elevated, and the pancreatic B cells fail to respond to all insulinogenic stimuli. Exogenous insulin is therefore required to reverse the catabolic state, prevent ketosis, reduce the hyperglucagonemia, and reduce blood glucose.The highest incidence of immune-mediated type 1 diabetes mellitus is in Scandinavia and northern Europe, where the annual incidence is as high as 40 per 100,000 children aged 14 years or younger in Finland, 31 per 100,000 in Sweden, 22 per 100,000 in Norway, and 20 per 100,000 in England. The annual incidence of type 1 diabetes decreases across the rest of Europe to 11 per 100,000 in Greece and 9 per 100,000 in France. Surprisingly, the island of Sardinia has as high an annual incidence as Finland (40 per 100,000)..."
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