Type 1 diabetes
(1) autoimmune type 1 diabetes mellitus (type 1A-RRB- : the clinical manifestations vary widely at diagnosis, ranging from mild nonspecific symptoms to typical triple plus plus plus plus plus plus plus plus plus minus symptoms or coma, depending on the stage of disease development. Most adolescents suffer from acute onset of symptoms; without prompt diagnosis and treatment, DKA can occur when insulin is severely deficient or the disease progresses rapidly, endangering life (see “Diabetic ketoacidosis”below for details) . Some adult patients, onset slow, early clinical performance is not obvious, go through a period of long or short diabetes without insulin treatment stage, there is called “Adult hidden Alltotoetes ~ LNE diabetes in adults, Lada”. Although the onset varies rapidly, diabetes usually progresses quickly and requires insulin to control blood sugar or maintain life. These patients are rarely obese, but obesity does not rule out the possibility of this disease. The plasma basal insulin level was lower than normal, and the insulin secretion curve was low after glucose stimulation. Islet B cell autoantibody test can be positive.
(2) idiopathic type 1 diabetes (type 1B-RRB- : usually acute onset, islets 13 cell function obvious decline or even failure, clinical performance for diabetic ketosis or even acidosis, but during the course of the disease, the function of the 8 cells can be improved so that insulin therapy does not need to be continued for some time. Islet J3 cells were negative for autoantibodies. Clinical manifestations may vary among different ethnic groups. The etiology is unknown, and the differences in clinical phenotype reflect the heterogeneity of etiology and pathogenesis. The diagnosis should exclude diabetes mellitus with a single gene mutation.
2. Type 2 diabetes is generally considered to be T2DM in 95% of patients with diabetes. This estimate is currently considered to be on the high side, of which about 5% may belong to “Other types”. This disease is a heterogeneous group of diseases, including many different causes. Can occur in any age, but more common in adults, often after the age of 40 onset; most slow onset, relatively mild symptoms, more than half without any symptoms; many patients because of chronic complications, accompanied by disease or only found in health check. DKA rarely occurs spontaneously, but it can also occur under stress conditions such as infection. IGR of T2DM and early stage of diabetes without insulin treatment are generally long, as the disease progresses, a considerable number of patients need insulin to control blood sugar, prevent complications or maintain life. There’s always a family history. Clinical obesity, dyslipidemia, fatty liver, hypertension, coronary heart disease, IGT or T2DM and other diseases often occur at the same time or successively, accompanied by hyperinsulinemia, these are now thought to be related to insulin resistance, known as metabolic syndrome. Some early patients after eating insulin peak delay, 3 ~ 5 hours postprandial inappropriate increase in plasma insulin levels, resulting in reactive hypoglycemia, can become the first clinical manifestations of these patients.
3. Certain specific types of diabetes
(1) adult-onset diabetes in youth (Mody) : a highly heterogeneous group of monogenic disorders. Main clinical features: 1 with three or more generations of family history, and consistent with autosomal dominant inheritance; 2 younger than 25 years of age; 3 ketosis tendency, at least 5 years do not need insulin treatment.
(2) mitochondrial gene mutation diabetes: the first discovery was that the 324.3 site of mitochondrial tRNA leucine gene mutated into a type G site, which caused oxidative phosphorylation disorder of islet B cells and inhibited insulin secretion. The clinical features are: 1 maternal inheritance, 2 early onset, P cell function gradually decreased, negative autoantibody, 3 body weight loss (BMI < 24) , 4 often accompanied with neuromuscular deafness or other neuromuscular manifestations.
4. Gestational diabetes mellitus (GDM) can be considered GDM if any degree of abnormal glucose tolerance is found for the first time during pregnancy. GDM does not include pre-pregnancy diabetes known as “Diabetes with pregnancy”. But both of them need to be treated effectively in order to reduce the morbidity and mortality of perinatal diseases. Women with GDM can return to normal blood glucose after delivery, but there is a high risk of developing T2DM several years later. In addition, there may be various types of diabetes in patients with GDM. Therefore, a 6-week follow-up should be conducted after delivery to confirm their classification and classification, and follow it up for a long time.
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