Type 1 or Type 2 DM

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ype 1 or ype 2 DM

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2015 .|

BMI?Body weight loss for kgpolydipsia, polyphagia,nocturia for months

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4

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5

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Can !pa"e e#e" $e ee#a%

e& !n

D'( )!%*o+% pan,rea%!%!"-

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What we already know=> 95% of serum lipase comes from the

pancreas as opposed to 4050% of amlase !ipase is considered a more speci"c mar#er

for pancreatitis. $leation of lipase to leelsmore than three times the upper limit ofnormal is considered dia&nostic of acutepancreatitis.

'ia&nostic criteria for AcutePancreatitis .

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Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence

and correlation with biochemical abnormalities Amylase and Lipase in DiabeticKetoacidosis|Yadav et al, The American Journal of Gastroenterology 95, (November !!!"

Hyperlipasemia in diabetic ketoacidosis => !ipase eleations (ithout )* eidence ofpancreatitis (ere noted in 24%+,-150/ of' cases.

!ipase leels (ere less than three timesnormal in !"#%+2,150/ of the cases andmore than three times normal in $"%+1,150/ of the cases.

onspeci"c eleation of lipase leels (asnoted to 3e more common than nonspeci"celeation of amlase leels +1-.-%/ in thisstud.

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D!a$e%!, 'e%oa,!&o"!" /D'(0

Hyperglycemia

Acidosis Ketosis

DKA

DefinitionMetabolic emergency of type 1 DMorsevere stress in type 2 DM

250~900mg/dl

pH !"#9~$#2%&' ()en dil*tion +,-

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ypero"oar yper3y,e!, 4%a%e /40

De5!n!%!on . /10Me%a$o!, eer3en,y !n +n,on%roe& %ype 2 DM /65%e

n pre#!o+"y +n&!a3no"!"e&0

/204e#ere *yper3y,e!a )!%*o+% "!3n!5!,an% 7e%o"!"

Hyperosmolality

.evere )yperglycemia

De)ydration

ffective osmolality

1a&3 4 2 & l*cose %mg/dl' / ,-

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Endocrine Emergencies. Springer. 2014.

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Discussion HH. is associated (it) relative ins*lin deficiency6 ()e

re resid*al ins*lin prevents significant 7etosis and acidosis

DKA involves absol*te ins*lin deficiency6 leading to 7e

tonemia and metabolic acidosis

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Discussion HH. and DKA form a spectr*m of disease involving v

arying severity of ins*lin deficiency

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Discussion 8atients (it) DKA mostly )ave type , diabetes mellit*

s6 ()ic) is associated (it) absol*te ins*lin deficiency#Ho(ever6 patients (it) advanced or severe type 2 dia

betes can also be at ris7

HH. occ*rs almost e4cl*sively in type 2 diabetes mell

it*s6 ()o contin*e to demonstrate some degree of ins*lin secretion

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Discussion

DKA and HH. )ave differing diagnostic criteria6 b*tn*mero*s individ*als )ave overlapping feat*res

ffective osmolality 2 4 a & l*cose / ,-

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Discussion

nitial eval*ation of )yperglycemic emergency s)o*ld incl*de a s*rvey of etiology

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Differential diagnosis

*mero*s conditions may mimic DKA and HH.

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