Classification of Hypoglycemia

Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes. Recommendations from the International Hypoglycaemia Study Group regarding the classification of hypoglycemia considers a blood glucose <54 mg/dL (3.0 mmol/L) detected by self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM) (for at least 20 min), or laboratory measurement of plasma glucose as sufficiently low to indicate serious, clinically significant hypoglycemia that should be included in reports of clinical trials of glucose-lowering drugs for the treatment of diabetes. However, a glucose alert value of </=70 mg/dL (3.9 mmol/L) can be important for therapeutic dose adjustment of glucose-lowering drugs in clinical care and is often related to symptomatic hypoglycemia. Severe hypoglycemia is defined as severe cognitive impairment requiring assistance from another person for recovery.

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Diagnostic Criteria of Latent Autoimmune Diabetes in Adults (LADA)

Latent autoimmune diabetes in adults (LADA) accounts for 2%-12% of all cases of diabetes. Patients are typically diagnosed after 35 years of age and are often misdiagnosed as type II Diabetes Mellitus (DM). Glycemic control is initially achieved with sulfonylureas but patients eventually become insulin dependent more rapidly than with type II DM patients.

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Criteria for Testing for Diabetes or Prediabetes in Asymptomatic Adults

“Prediabetes” is the term used for individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and indicates an increased risk for the future development of diabetes. IFG and IGT should not be viewed as clinical entities in their own right but rather risk factors for diabetes and cardiovascular disease (CVD). IFG and IGT are associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.

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American Diabetes Association Recommendations for the Screening of Asymptomatic Persons for Diabetes

The American Diabetes Association (ADA) and the Veterans Health Administration (VHA) recommend diabetes screening beginning at 45 years of age; the ADA advises earlier screening in patients with risk factors.

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Wagner and the University of Texas Wound Classification Systems of Diabetic Foot Ulcers

Wagner Classification of Diabetic Foot Ulcers

Grade 0: No ulcer in a high risk foot.

Grade 1: Superficial ulcer involving the full skin thickness but not underlying tissues.

Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation.

Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis.

Grade 4: Localized gangrene.

Grade 5: Extensive gangrene involving the whole foot.

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Diagnosis of Gestational Diabetes Mellitus (GDM)

Screening for gestational diabetes mellitus

  1. 50-g oral glucose load, administered between the 24th and 28th weeks, without regard to time of day or time of last meal. Universal blood glucose screening is indicated for patients who are of Hispanic, African, Native American, South or East Asian, Pacific Island, or Indigenous Australian ancestry. Other patients who have no known diabetes in first-degree relatives, are under 25 years of age, have normal weight before pregnancy, and have no history of abnormal glucose metabolism or poor obstetric outcome do not require routine screening.
  2. Venous plasma glucose measure 1 hour later.
  3. Value of 130 mg/dL (7.2 mmol/L) or above in venous plasma indicates the need for a full diagnostic glucose tolerance test. Continue reading