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MDCalc is a free online medical reference for healthcare professionals that provides point-of-care clinical decision-support tools, including medical calculators, scoring systems, and algorithms. [1]
Pre-gestational diabetes can be classified as Type 1 or Type 2 depending on the physiological mechanism. Type 1 diabetes mellitus is an autoimmune disorder leading to destruction of insulin-producing cell in the pancreas; type 2 diabetes mellitus is associated with obesity and results from a combination of insulin resistance and insufficient insulin production.
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. [1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. [1] A person's breath may develop a specific "fruity" or acetone smell. [1]
Blood tests for the diagnosis of diabetic ketoacidosis measure glycemia (sugar level), pH (blood acidity), and ketone bodies. As urgent medical treatment is often required when DKA is suspected, the tentative diagnosis can be made based on clinical history and by calculating the anion gap from the basic metabolic panel , which would demonstrate ...
MODY accounts for at least 1-5% of all diagnoses of diabetes mellitus, though 50-90% of cases are estimated to be misdiagnosed as type 1, or type 2 diabetes [4].Estimated prevalence rates indicate 1 per 10,000 in adults, and 1 per 23,000 in children [5]. 50% of first-degree relatives will inherit the same mutation, giving them a greater than 95% lifetime risk of developing MODY themselves. [6]
The most common causes of high anion gap metabolic acidosis are: ketoacidosis, lactic acidosis, kidney failure, and toxic ingestions. [3]Ketoacidosis can occur as a complication of diabetes mellitus (diabetic ketoacidosis), but can occur due to other disorders, such as chronic alcoholism and malnutrition.
The most pressing complication of type 1 diabetes are the always present risks of poor blood sugar control: severe hypoglycemia and diabetic ketoacidosis. Hypoglycemia – typically blood sugar below 70 mg/dL (3.9 mmol/L) – triggers the release of epinephrine, and can cause people to feel shaky, anxious, or irritable. [93]
Oppositely, the prevalence of HHS is common in individuals with T2D. Furthermore, it showcases approximately ten times greater mortality rate than the observed in DKA. [17] Both DKA and HHS occur when insulin becomes less effective, either due to a shortage of insulin secretion ( as in DKA), or lack of proper insulin action (as in HHS). [8]