Malnutritionassociated Diabetes

Diabetes associated with malnutrition usually presents in young individuals between the ages of 10 and 40. These patients do not get diabetic ketoacidosis but require insulin for glycemic control.

Three different approaches can be used for glucose testing in order to diagnose diabetes:

1. Oral glucose tolerance test.

2. Random plasma glucose measurements.

3. Fasting plasma glucose measurements.

The fasting plasma glucose test is the most popular choice and is currently used to diagnose approximately 90% of all individuals with type 2 diabetes. However, it is important to understand that postprandial hyperglycemia will precede fasting hypergly-cemia and should be strongly considered to screen patients, particularly those at risk.

An oral glucose tolerance test can serve this purpose by giving excellent postprandial data and can also be used to concomitantly measure insulin levels to ascertain the patient's insulin sensitivity. It is recommended that, regardless of the type of test used, laboratory values that are abnormal should be documented at least twice to avoid missed diagnoses by laboratory errors, unless the values are extremely high or associated with classic symptoms.

It is only with a high index of suspicion and comprehensive examination that patients at risk can be identified and the risk of macrovascular disease be reduced (8).

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