{"id":9910,"date":"2022-01-06T13:55:19","date_gmt":"2022-01-06T11:55:19","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/metabolism\/special-forms-of-diabetes-mellitus-and-their-treatment-gestational-diabetes-mellitus\/"},"modified":"2022-01-16T02:38:56","modified_gmt":"2022-01-16T00:38:56","slug":"special-forms-of-diabetes-mellitus-and-their-treatment-gestational-diabetes-mellitus","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/metabolism\/special-forms-of-diabetes-mellitus-and-their-treatment-gestational-diabetes-mellitus\/","title":{"rendered":"Special forms of diabetes mellitus and their treatment. Gestational diabetes mellitus"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Special forms of diabetes<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>98% of DM patients suffer from either type 1 or 2 DM. <\/li><li>The rest, suffer from rare forms of diabetes:<ul><li>Monogenic diabetes (previously known as mature onset diabetes of the young or <strong>MODY<\/strong>)<\/li><li>Cystic fibrosis-related diabetes<\/li><li>Diabetes caused by rare syndromes<ul><li><strong>Wolfram syndrome<\/strong> (T1-like DM, diabetes insipidus, vision disorders, deafness, renal disease).<\/li><li><strong>Alstr\u00f6m syndrome<\/strong> (T2DM, obesity, cardiomyopathy, skeletomuscular disorders, vision disorders, deafness, renal disease).<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Monogenic diabetes<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Monogenic diabetes occurs due to autosomal dominant defects, resulting in hyperglycemia due to impaired insulin secretion or glucose handling.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>No insulin resistance<\/li><li>No pancreatic beta cell destruction<\/li><li>Appear before the age of 25<\/li><li>Diagnosed using genetic testing<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><thead><tr><th>MODY type<\/th><th>Gene<\/th><th>Treatment<\/th><th>Comments<\/th><\/tr><\/thead><tbody><tr><td>MODY 1<\/td><td>HNF4-alpha <\/td><td>Sulfonylureas<br>Later on, insulin<\/td><td><\/td><\/tr><tr><td>MODY 2<\/td><td>Glucokinase<\/td><td>Usually none<\/td><td>Generally asymptomatic<\/td><\/tr><tr><td>MODY 3 <\/td><td>HNF1-alpha<\/td><td>Sulfonylureas<\/td><td>Most common<\/td><\/tr><tr><td>MODY 5 <\/td><td>HNF1-beta <\/td><td>Antidiabetics and insulin <\/td><td>Associated with renal cysts, gout, uterine, and high risk of diabetic complications<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 1. Common forms of monogenic diabetes.<\/strong><\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Cystic-fibrosis related diabetes<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Patients with CF may develop a special form of diabetes known as CF-related diabetes.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Caused due to pancreatic destruction that occurs in CF.<\/li><li>Has both T1 and T2 featues.<\/li><li>Treatment involves lifestyle modifications, and insulin therapy.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Gestational diabetes<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Gestational diabetes mellitus (GDM) is defined as hyperglycemia first appearing during pregnancy.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Usually, GDM develops in one of two settings:<ul><li>Overweight, hyperinsulinemic women<\/li><li>Normal or underweight, hypoinsulinemic (insufficient insulin secretion) women<\/li><\/ul><\/li><li>GDM increases the risk for preeclampsia and pregnancy-related complications, as well as increased risk for the child to develop diabetes.<\/li><li><strong>Over diabetes<\/strong> is defined as symtomatic diabetes diagnosed in the first trimester before 13 weeks of gestation (meaning it developed before the pregnancy).<ul><li>It has increased risk for spontaneous abortion and congenital anomalies.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Screening for GDM is highly recommended and is done using an <strong>oral glucose tolerance test<\/strong>, done between weeks 24 and 28 of gestation.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Single-step method (non-US)<ul><li>75gr oral glucose are given, and blood glucose levels are measured within 2 hours<\/li><\/ul><\/li><li>Two-step method (US)<ul><li>The patient is given 50g oral glucose, and blood glucose levels are measured within 1 hour. <\/li><li>Values between 7.2 to 7.8mmol\/L require a second step in which 100g are used and glucose levels measured within 3 hours.<\/li><\/ul><\/li><li>Any sample above 11mol\/L is diagnosed as GDM, and possibly, overt diabetes.<\/li><li>Fasting sample above 5.2mmol\/L is diagnosed as GDM<\/li><li>Fasting sample above 6.9mmol\/L is diagnosed as overt diabetes<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Tight glucose control<ul><li>Dietary changes<\/li><li>Insulin (does not cross the blood-placental barrier)<\/li><li>Glyburide (sulfonylurea)<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Special forms of diabetes<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Monogenic diabetes<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Cystic-fibrosis related diabetes<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Gestational diabetes<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Special forms of diabetes 98% of DM patients suffer from either type 1 or 2 DM. The rest, suffer from rare forms of diabetes: Monogenic diabetes (previously known as mature onset diabetes of the young or MODY) Cystic fibrosis-related diabetes Diabetes caused by rare syndromes Wolfram syndrome (T1-like DM, diabetes insipidus, vision disorders, deafness, renal [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":9852,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9910","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Special forms of diabetes mellitus and their treatment. 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