Public - Diabetes Mellitus, Type 1

Diabetes Mellitus, Type 1

Author: Maureen D. Passaro, MD; Robert E. Ratner, MD
Editorial changes - 2009-10-30
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

	Tables
	Figures
	References
	Glossary
	What's New
	Patient Information
	Additional Resources
	Tools

	Quality Measures

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.
History and Physical Exam Elements for Patients Without History of Type 1 Diabetes (table)
Laboratory and Other Studies for Diabetes Mellitus, Type 1 (table)
Differential Diagnosis of Diabetes Mellitus, Type 1 (table)


Focus the history on acute and chronic symptoms of the disease.
Ask about: Polyuria, polydipsia, or unexplained weight loss 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
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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 macrovasular disease, such a retinopathy, peripheral neuropathy, and peripheral vascular disease Signs of autonomic nervos 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. See table History and Physical Exam Elements for Patients Without History of Type 1 Diabetes. See table History and Physical Elements for Patient With Known History of Diabetes.
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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. 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 Urodynamocs and nocturnal tumescence studies See table Laboratory and Other Studies for Diabetes Mellitus, Type 1. See table Criteria for the Diagnosis of Diabetes Mellitus.
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Differentiate type 1 diabetes from other forms of diabetes.
Differentiate maturity-onset diabetes of the young, Flatbush diabetes, and latent autoimmune diabetes in adults. See table Differential Diagnosis of Diabetes Mellitus, Type 1.
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FAQs

Abd Tahrani, MD, 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, is a consultant for Amylin Pharmaceuticals, AstraZeneca, GlaxoSmithKline, Lifescan, Inc., NovoNordisk, Sanofi-Aventis, Takeda, owns stocks in Merck, Johnson & Johnson, Abbott, received grants from Amylin, AstraZeneca, Bayhill Therapeutics, Boehringer Ingelheim, Conjuchem, Inc., Eil Lilly, GlaxoSmithKline, Merck, NovoNordisk, Pfizer, Sanofi-Aventis, Takeda.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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