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 | | Diagnosis | |
- Focus the history on acute and chronic symptoms of the disease.
- Examine for signs of dehydration, autonomic neuropathy, and vascular complications.
- Use laboratory studies to confirm the diagnosis and document metabolic and end-organ complications.
- Differentiate type 1 diabetes from other forms of diabetes.
| | Laboratory and Other Studies for Diabetes Mellitus, Type 1 (table)
| | Differential Diagnosis of Diabetes Mellitus, Type 1 (table)
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Focus the history on acute and chronic symptoms of the disease.  |
- Ask about:
- Polyuria, polydipsia, or unexplained weight loss
- History of complications of diabetes or infections
- Current medications
- Habits that may affect glycemic control, such as exercise and alcohol use
- History of eating disorders
- History of other autoimmune syndromes, for example, thyroid disorders, which may be more common among patients with diabetes
- Growth failure in children with a fasting plasma glucose and electrolytes
- Symptoms of autonomic nervous system dysfunction, such as:
- Resting tachycardia and orthostatic dizziness
- Early satiety, bloating, nausea, vomiting
- Sexual dysfunction
- Urinary retention
| Background | Back to top
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Examine for signs of dehydration, autonomic neuropathy, and vascular complications.  |
- Look for:
- Acute manifestations of hyperglycemia, such as dehydration
- Chronic manifestations of microvascular and macrovascular disease, such a retinopathy, nephropathy, peripheral neuropathy, and peripheral vascular disease
- Signs of autonomic nervous system disease, such as resting tachycardia and orthostasis
- Look for signs of acute events (such as infection, pregnancy, or MI) that may precipitate onset of type 1 diabetes.
- Check blood pressure and heart rate at every visit.
| Background | Back to top
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Use laboratory studies to confirm the diagnosis and document metabolic and end-organ complications.  |
- Measure plasma glucose in symptomatic patients.
- Consider a random (done without regard to the time of the previous meal) plasma glucose concentration
 200 mg as sufficient for diagnosis in the presence of classic symptoms of diabetes.
- Consider using HbA1C assay for diagnosis of diabetes, although it may not be accurate in the presence of hemoglobinopathies or in cases of very acute onset of diabetes.
- Confirm all results on a subsequent day in stable patients.
- Obtain additional tests to document the presence and severity of potential complications of diabetes, such as serum electrolytes, BUN, creatinine, and urinalysis.
- Perform appropriate laboratory testing to document autonomic nervous system complications as needed:
- Prolonged QTc interval, loss of RR-variability on physical exam, and ECG testing
- Solid-phase gastric-emptying study
- Urodynamics and nocturnal tumescence studies
- See table Laboratory and Other Studies for Diabetes Mellitus, Type 1.
- See table Criteria for the Diagnosis of Diabetes Mellitus.
| Background | Back to top
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Differentiate type 1 diabetes from other forms of diabetes. |
- Classify patients as having type 1 diabetes based on clinical factors when possible.
- Consider further testing in select patients to distinguish type 1 diabetes from other forms of diabetes.
- In special situations, differentiate type 1 diabetes from other rarer forms of diabetes.
- See table Differential Diagnosis of Diabetes Mellitus, Type 1.
| Background | Back to top
| | | FAQs |
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| Abd A. Tahrani, MD, MRCP, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Maureen D. Passaro, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Robert E. Ratner, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. |
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Diabetes Mellitus, Type 1
