Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Key Features ++ Essentials of Diagnosis ++ Typically > 40 years of age Obesity Polyuria and polydipsia Candidal vaginitis sometimes an initial manifestation Often few or no symptoms After an overnight fast, plasma glucose ≥ 126 mg/dL (7 mmol/L) more than once After 75 g oral glucose, diagnostic values are ≥ 200 mg/dL (11.1 mmol/L) 2 h after the oral glucose Hemoglobin A1c (HbA1c) ≥ 6.5% Often associated with hypertension, dyslipidemia, and atherosclerosis ++ General Considerations ++ Circulating endogenous insulin is sufficient to prevent ketoacidosis but inadequate to prevent hyperglycemia from tissue insensitivity Strong genetic influences Prevalence of obesity in type 2 diabetes mellitus 30% in Chinese and Japanese 60–70% in North Americans, Europeans, and Africans Nearly 100% in Pima Indians and Pacific Islanders from Nauru or Samoa Abdominal fat, with an abnormally high waist–hip ratio, is generally associated with obesity in type 2 diabetes. This visceral obesity correlates with insulin resistance, whereas subcutaneous fat seems to have less of an association ++ Demographics ++ ~28 million Americans have type 2 diabetes Traditionally occurred in middle-aged adults but now more frequently encountered in children and adolescents No gender predominance ++ Clinical Findings ++ Symptoms and Signs ++ Polyuria Increased thirst (polydipsia) Weakness or fatigue Recurrent blurred vision Vulvovaginitis or anogenital pruritus or balanoposthitis Peripheral neuropathy Obesity Often asymptomatic ++ Differential Diagnosis ++ Hyperglycemia ++ Endocrinopathies Type 1 diabetes mellitus Cushing syndrome Acromegaly Pheochromocytoma Glucagonoma Somatostatinoma Drugs High-dose corticosteroids Thiazides Phenytoin Niacin Oral contraceptives Pentamidine Pancreatic insufficiency Subtotal pancreatectomy Chronic pancreatitis Hemochromatosis ("bronze diabetes") Hemosiderosis Other Gestational diabetes Cirrhosis Schmidt syndrome (polyglandular failure: Addison disease, autoimmune thyroiditis, diabetes) ++ Polyuria ++ Diabetes insipidus ++ Hypercalcemia ++ Psychogenic polydipsia ++ Nondiabetic glycosuria (benign) ++ Genetic Fanconi syndrome Chronic kidney disease Pregnancy ++ Diagnosis ++ Laboratory Tests ++ Fasting plasma glucose ≥ 126 mg/dL (7 mmol/L) or ≥ 200 mg/dL (11.1 mmol/L) 2 h after glucose load (Table 27–4) HbA1c of at least 6.5% Urine glucose (Clinistix, Diastix) Ketonuria on occasion without ketonemia (Acetest, Ketostix) HbA1c reflects glycemic control over preceding 8–12 weeks Serum fructosamine Reflects glycemic control over preceding 2 weeks Helpful in the presence of abnormal hemoglobins and in ascertaining glycemic control at time of conception among diabetic women Lipoprotein abnormalities in obese persons with type 2 diabetes include High serum triglyceride (300–400 mg/dL) Low high-density lipoprotein (HDL) cholesterol (< 30 mg/dL) A qualitative change in low-density lipoprotein (LDL) particles These abnormalities differ from type 1 diabetes, which is associated with only slight elevation of LDL cholesterol and serum triglycerides and minimal change in HDL cholesterol ++ Treatment ++ Medications +... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options