Differentiating Diabetes mellitus type 1 from other diseases

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Case #1

Diabetes mellitus Main page
Patient Information Type 1 Type 2
Overview
Classification Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes
Differential Diagnosis
Complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Type 1 DM must be differentiated from type 2 DM, MODY-DM, psychogenic polydipsia, diabetes insipidus, transient hyperglycemia, steroid therapy, renal tubular acidosis type-1, glucagonoma, cushing's syndrome, and hypothyroidism.

Differentiating Diabetes mellitus type 1 from other Diseases

Differential diagnosis of type 1 DM, include:

• Type 2 DM
• MODY-DM
• Psychogenic polydipsia
• Diabetes insipidus
• Transient hyperglycemia
• Steroid therapy
• Renal tubular acidosis type-1
• Glucagonoma
• Cushing's syndrome
• Hypothyroidism
• Wolfram syndrome
• Alstrom syndrome

	History and symptoms						Physical examination		Investigations
	Polyuria	Polydipsia	Polyphagia	Weight loss	Weight gain	Positive medical history	General appearance	Skin manifestations	Serum glucose	Urinary Glucose	Urine Ph	Serum Sodium	Urinary Glucose	24 hrs cortisol level	C-peptide level	Auto antibodies	Serum glucagon
Type 1 Diabetes mellitus	✔	✔	✔	✔		✖	Usually patients are young and lean	―	↑	↑	N	N	↑	N	↓	Measurements of IA2 autoantibodies within 6 months of diagnosis can help differentiate between type 1 and type 2 DM Anti-GAD65 usually present Anti-insulin autoantibodies usually present
Type 2 Diabetes mellitus	✔	✔	✔	✖	✔	✖	Usually patients are middle age or elderly and obese	Acanthosis nigricans	↑	↑	N	N	↑	N	N	―	N
MODY	✔	✔	✔		✔	✖	―	―	↑	↑	N	N	↑	N	N	―	N
Psychogenic polydipsia	✔	✔	✖	✖	✖	✖	―	―	N	N	N	↓	N	N	N	―	N
Diabetes insipidus	✔	✔	✖	✖	✖	✖	―	―	N	N		↑	N	N	N	―	N
Transient hyperglycemia	N	✖	✖	✖	✖	✔	―	―	↑	↑		N	↑	N	N	―	N
Steroid therapy	✔	✖	✖	✖	✔	✔	―	Acanthosis nigricans	↑	↑			↑	↑	N	―	N
RTA 1	✖	✖	✖	✔	✖	✖	―	―	N	―	↓		↑	N	N	―	N
Glucagonoma	✖	✖	✖	✖	✖	✖	―	Necrolytic migratory erythema (NME)	↑	―				N	N	―	↑
Cushing disease	✖	✖	✖	✖	✔	✖	Patients can present with moon face, obesity and buffalo hump	Acanthosis nigricans	↑	―		N	N/↑	↑	N	―	N
Hypothyroidism	✖	✖	✖	✖	✔	✖	Patients may present with weight gain and swelling of face	―	N	―		N	N	N	N	Antibodies assocaited with hypothyroidism are: Thyroid Peroxidase Antibody Thyroglobulin Antibody Thyroid Stimulating Hormone Receptor Antibody	N