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Viruses may directly infect and destroy beta cells, or they may cause beta-cell destruction indirectly by exposing autoantigens, activating autoreactive lymphocytes, mimicking molecular sequences of autoantigens that stimulate an immune response (molecular mimicry), or other mechanisms. Exposure of infants to dairy products (especially cow’s milk and the milk protein beta casein), high nitrates in drinking water, and low vitamin D consumption have been linked to increased risk of type 1 DM. In older adults, plasma glucose levels reach higher levels after eating than in younger adults, especially after meals with high carbohydrate loads.

Type 1 accounts for production and processing and confer risk of diabetes mellitus in concert with MHC genes.Point-of-care Hb A People at high risk of type 1 DM (eg, siblings and children of people with type 1 DM) can be tested for the presence of islet cell or anti-glutamic acid decarboxylase antibodies, which precede onset of clinical disease.However, there are no proven preventive strategies for people at high risk, so such screening is usually reserved for research settings.More significant hyperglycemia causes glycosuria and thus an osmotic diuresis, leading to urinary frequency, polyuria, and polydipsia that may progress to orthostatic hypotension and dehydration.Severe dehydration causes weakness, fatigue, and mental status changes.Symptoms may come and go as plasma glucose levels fluctuate.

Polyphagia may accompany symptoms of hyperglycemia but is not typically a primary patient concern.

Measurement after an 8- to 12-h fast (FPG) or 2 h after ingestion of a concentrated glucose solution (oral glucose tolerance testing [OGTT]) is best (see Table: Diagnostic Criteria for Diabetes Mellitus and Impaired Glucose Regulation*).

OGTT is more sensitive for diagnosing DM and impaired glucose tolerance but is less convenient and reproducible than FPG.

In some patients, hyperosmolar hyperglycemic state occurs initially, especially during a period of stress or when glucose metabolism is further impaired by drugs, such as corticosteroids.

Diabetes mellitus is indicated by typical symptoms and signs and confirmed by measurement of plasma glucose (1).

Some patients experience a long but transient phase of near-normal glucose levels after acute onset of the disease (honeymoon phase) due to partial recovery of Patients with type 2 DM may present with symptomatic hyperglycemia but are often asymptomatic, and their condition is detected only during routine testing.

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