Chapter 218

Diabetes mellitus (DM) is a group of metabolic diseases characterizedby hyperglycemia resulting from defects in insulin secretion,insulin action, or both.1 Hyperglycemia further results in acute and chronic complications of the disease, leading to significant morbidity and mortality. Per the Centers for Disease Control and Prevention,2 20.8 million people, or 7% of the U.S. population, have diabetes, of which 6.2 million are undiagnosed. One in every 400 to 600 children and adolescents has type 1 diabetes. It has been estimated that direct and indirect costs of diabetes in the U.S. exceeded $132 billion in 2002.3 Complications of DM can be acute, life-threatening emergencies or chronic complications that serve as confounders in management of other emergency conditions. The classification of diabetes has evolved as we have gained understanding of the etiology and pathogenesis of the disease. Classifications into insulin-dependent versus non–insulin-dependent DM, or juvenile-onset versus maturity-onset DM or type 1 versus type 2 diabetes, are less commonly used now. Table 218-0.1 explains the etiologic classification of diabetes as used by the American Diabetes Association (ADA).1 Table 218-0.1 Etiologic Classification of Diabetes Mellitus Type 1 diabetes is characterized by almost no circulating insulin and the failure of β-cells to respond to insulinogenic stimuli. This accounts for only 5% to 10% of all cases of diabetes and is mostly diagnosed in children and young adults, with peaks before school age and at puberty. Immune-mediated destruction of β-cells causes 90% of these cases, and the remainder have no known etiology for insulinopenia. Spontaneous ketoacidosis almost always develops in untreated cases, and insulin is required for survival. In contrast, type 2 diabetes is much more common, comprising 80% to 90% of all diabetics in the U.S. Here the defect includes a failure of circulating insulin to act on various tissues (“insulin resistance”), a relative insulin deficiency, or a combination of both (i.e., a secretory defect ... ### MyAccess Sign In Username Password Want remote access to your institution's subscription? Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access. Ok ### About MyAccess If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. ## Subscription Options ### AccessMedicine Full Site: One-Year Subscription Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.$995 USD

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