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Texto
HOSPITAL JUREZ DE MXICOUNIDAD DE ENSEANZA
JORNADAS DE MEDICOS INTERNOS
Diabetes Mellitus 2
Dr Pavel Gonzlez Guzmn
Mdico residente de 3er ao
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Caso clnico
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Quienes estnexpuestos a
desarrollar DM2?
Cmo se desarrollala DM 2?
Cmo se diagnostica ?
Cul es el manejo?
Existencomplicaci
ones?
Existe solo untipo de paciente
con DM2?
Por qu yo?
Dnde esta el
interno?
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Objetivos1.-Factores de riesgo
2.-Fisiopatologa de la Diabetesmellitus tipo 2
3.-Clasificacin y diagnostico
4.-Tratamiento inicial
antidiabeticos vs Insulina
5.-Consideraciones especiales
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Factores de riesgo/
tamizaje
IMC>25 kg/m2Familiares de 1er
gradoInactividad fsica
LatinoMadres de productos
macrosomicos o diabetes
gestacional
Hipertensin
HDL< 35 mg/dLTrigliceridos > 250
mg/dLSndrome de ovario
poliquistico
Intolerancia a la
glucosa
Glucosa alterada en
ayuno A1C> 5.7%
Datos de resistencia ala insulina
Historia de eventoscardiovasculares
MIP
Diabetes Care Volume 38, Supplement 1, January 2015
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I
|
A M E R I C A N D I A B E T E S A S S O C I A T I O N
STANDARDS OF
MEDICAL CARE
IN DIABETES2015
SU
PPLEMEN
T
1
O t r o s p a c i e n t e s(particularmente los
obesos) a partir de los45 aos
Si los resultados son
normales repetir almenos cada 3 aos
Factores de riesgo/
tamizaje
Diabetes Care Volume 38, Supplement 1, January 2015
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CLASSIFICATION
Diabetes can be classied into the following general categories:
1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin
deciency)
2. Type 2 diabetes (due to a progressive insulin secretory defect on the background
of insulin resistance)
3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or thirdtrimester of pregnancy that is not clearly overt diabetes)
4. Specic types of diabetes due to other causes, e.g., monogenic diabetes syndromes
(such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), dis-
eases of the exocrine pancreas (such as cysticbrosis), and drug- or chemical-induced
diabetes (such as in the treatment of HIV/AIDS or after organ transplantation)
Diabetes Care Volume 38, Supplement 1, January 2015
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Fisiopatologa
Resistencia perifrica del Hgadoy el msculo
Insuficiencia de las clulas BetaDETERMINANTE
Primeros planteamientos: Eltriunvirato, DeFronzo (1987)
Secrecin de insulina disminuida
Aumentode laproduccin
de glucosa
Hiperglicemia
Disminucindel consumode glucosa
From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus,Ralph A. DeFronzo,Diabetes care Vol 58,2009
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Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24.edicin
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From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus,Ralph A. DeFronzo,Diabetes care Vol 58,2009
OCTETO OMINOSO
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Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24. edicin
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Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24. edicin
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Diagnostico
Criterios ADA se revisancada ao
Glucosa en ayuno
Curva de tolerancia a laglucosa
Hemoglobina glicosilada
Glucosa aleatoria
Diabetes Care Volume 38, Supplement 1, January 2015
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Texto
Diabetes Care Volume 38, Supplement 1, January 2015
NORMAL Intolerancia a la glucosa DIABETESGlucosa alterada en ayuno
Prediabetes
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Tratamiento
Table 6.2Summary of glycemic recommendations for nonpregnant adults with
diabetes
A1C ,7.0%*
Preprandial capillary plasma glucose 80130 mg/dL* (4.47.2 mmol/L)
Peak postprandial capillary plasma glucose ,180 mg/dL* (,10.0 mmol/L)
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Diabetes Care Volume 38, Supplement 1, January 2015
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COMPLICACIONES
Microvasculares:Enfermedades oculares
Retinopata (no proliferativa y proliferativa) Edema de la mcula
Neuropatas
Sensitivas y motoras (mono neuropatas y poli neuropatas)
Vegetativas
Nefropatas
Macrovasculares:Artropata coronaria Enfermedad vascular perifrica
Enfermedad vascular cerebral
Otras
Del tubo digestivo (gastroparesia,diarrea)
Genitourinarias (uropatas y disfuncin sexual)DermatolgicasInfecciosas
Oftalmologicas:Cataratas,glaucoma Enfermedad periodontalHipoacusia