A 20 years of age female patient, came to the medical OPD for the management of her Diabetes.
She was diagnosed with Diabetes 6 months back by her GP when she reported symptoms of polyuria and polydipsia. Her blood sugars at that time were in the range of 300 to 400 mg/dl and A1C was 11.6%.
She was put on premixed insulin at that time.
On examination, she is obese with a BMI of 32. Her BP is 120/85 mmHg.
She is currently on 36 units of premixed insulin in the morning and 24 units in the evening.
There is no family history of diabetes.
The patient was concerned about her diagnosis and wanted to switch to oral antidiabetic medicines.
Can we switch her to oral diabetes medicines?
How do we differentiate between Type 1 and Type 2 Diabetes Mellitus?
|
Features |
Type 1 DM |
Type 2 DM |
|
Age of onset |
Any age |
Mostly in adults |
|
Time of onset |
sudden |
gradual development |
|
Body habitus |
thin lean |
Mostly obese |
|
Auto antibodies |
Present |
absent |
|
Endogenous Insulin levels |
Low to absent |
Low normal or increased(insulin resistance) |
|
Ketoacidosis |
Common/ frequent |
Uncommon |
In this case diagnosis of type 1 or type 11 shall be made after knowing serum insulin levels and detection of autoantibodies cause rest of pic is mixed as obesity points towards type 11 while age of presentation, sudden onset and no family hx goes in favour of type 1 DM .
Also look for other autoimmune conditions that can be present in association e type 1 DM
What about Insulin requirements?
No clear idea about this sir
type 1 DM is insulin dependannt as there is autoimmune destruction of pancreatic beta cells so exogenous insulin is required to reverse catabolic states ( prevent ketosis, hyperglycemia)
in type 2 DM is non immune causes
with variable degree of tissue insenstivity to insulin i.e IR remaining beta cells do function to lrevent ketoacidosos but not hyperglycemia so this type is treated first with oral hypoglycemics if still HBaic target is notachieved then shift to insulin with or withoit other non insulin agents
Insulin requirement is very minimal in T1DM. Patients with T2DM requires high doses.
Furthermore, minute adjustments in insulin dose can result in greater fluctuations in T1DM. This is not the case in T2DM.
So, how do we initiate insulin in T1DM vs T2DM?