79
H N i Ti t
Map 5.4 Đái tháo đư ng (DM)
What is DM?
This is a metabolic condition in which the patient has hyperglycaemia
due to insulin insensitivity or decreased insulin secretion.
•
Type 1 DM: this is an autoimmune condition, which results in the
destruction of the pancreatic beta cells resulting in no insulin production.
This condition has a juvenile onset and is associated with HLA-DR3 and
HLA-DR4. Patients are at risk of ketoacidosis.
•
Type 2 DM: this occurs when patients gradually become insulin resistant
or when the pancreatic beta cells fail to secrete enough insulin or both.
It usually has a later life onset; however, the incidence is increasing in
young populations due to environmental factors such as increasing
obesity and sedentary lifestyle. Patients are at risk of developing a
hyperosmolar state.
•
Other cause of DM include: chronic pancreatitis, gestational DM and
cystic fibrosis.
Treatment
Treatment
Type 1 DM
Conservative
Dietary advice
BMI measurement
Smoking cessation
Decrease alcohol intake
Regular blood glucose and
HbA1c monitoring
Encourage exercise
See pages 80–82 for
antidiabetic agents
Type 2 DM
Dietary advice: high in
complex carbohydrates,
low in fat
BMI measurement
Smoking cessation
Decrease alcohol intake
Regular blood glucose and
HbA1c monitoring
Encourage exercise
See pages 80–82 for
antidiabetic agents
Medical
Tri u ch ng
•
Chung: ti u nhi u, ăn nhi u, u ng
nhi u, nhìn m , nư c ti u có glucose,
tri u ch ng b nh m ch máu l n và m ch
máu nh .
•
Hay g p hơn type 1 DM: hơi th
mùi ceton, s t cân, th ki u Kussmal,
bu n nôn và nôn.
C n lâm sàng
Xét nghi m ch n đoán bao g m:
•
Đư ng huy t lúc đói: >7 mmol/L (126 mg/dL)
•
Đư ng huy t b t k (kèm theo các tri u ch ng c a DM):
>11,1 mmol/L (200 mg/dL).
•
HbA1c: >6,5% (48 mmol/mol)
Các xét nghi m khác:
•
Nghi m pháp tăng đư ng huy t (cho các trư ng hơp
ranh gi i ch n đoán):
○
Đư ng huy t lúc đói: <7 mmol/L (126 mg/dL) và 2h
sau khi u ng 75g glucose, đư ng huy t:
7.8–11 mmol/L (140–200 mg/dL).
○
Đư ng huy t sau 2h: >11.1 mmol/L (>200 mg/dL).
•
R i lo n đư ng huy t lúc đói: 5.6–6.9 mmol/L
(110–126 mg/dL).
Bi n ch ng
•
M ch máu l n: tăng huy t áp, tăng
nguy cơ đ t qu , nh i máu cơ tim, bàn
chân đái tháo đư ng.
•
Vi m ch: b nh c u th n, b nh th n
kinh ngo i biên (m t c m giác ki u găng
tay và t t), b nh võng m c, r i lo n
cương dương.
•
Tâm th n: tr m c m.
MAP 5.4 Diabetes Mellitus (DM)
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