Renal function tests
● If the patient is otherwise healthy, renal function tests are typically    not required.

Islet cell antibodies
● Islet cell antibodies may be present at diagnosis but are not     needed to diagnose IDDM.
● Islet cell antibodies are nonspecific markers of autoimmune      disease of the pancreas and have been found in as many as 5% of   unaffected cases.

Thyroid function tests
● Because early hypothyroidism has few easily identifiable clinical    signs in patient with IDDM may have undiagnosed thyroid disease.
● Untreated thyroid disease may interfere with Diabetes    management. Check thyroid function regularly (every 2-5 years or   annually if thyroid antibodies are present).

Antithyroid antibodies
● This test indicates risk of potential thyroid disease.

Antigliadin antibodies
● Positive antigliadin antibodies, especially specific antibodies (eg. antiendomysial, antitransglutaminase) are important risk markers.

Other Tests
● Oral glucose tolerance test (OGTT)
While unnecessary to diagnose IDDM, an OGTT can exclude the diagnosis of Diabetes when hyperglycemia or glycosuria is recognized in the absence of typical causes (eg, intercurrent illness, steroid therapy) or when the patient's condition includes renal glucosuria.

● Lipid profile
Lipid profiles are usually abnormal at diagnosis because of increased circulating triglycerides caused by gluconeogenesis. Desired lipid profile is given in the table 5.

● Urinary albumin
Perform an annual urinalysis to test for a slightly increased albumin excretion rate (AER), which is an indicator of risk for diabetic nephropathy.

DIAGNOSIS
● iagnosis of Diabetes is made when any three of these tests is    positive, followed by a second positive test on a different day:
● Fasting plasma glucose of greater than or equal to 126 mg/dl    withsymptoms of Diabetes.
● Casual plasma glucose (taken at any time of the day) of greater    than or equal to 200 mg/dl with the symptoms of Diabetes.
● Oral glucose tolerance test (OGTT) value of greater than or equal    to 200 mg/dl measured at a two-hour interval. The OGTT is given    over a three-hour time span.
● Glucose Challenge test, which involves drinking a 50 gm glucose    drink followed by measurement of glucose levels after a one-hour    interval.

MANAGEMENT OF DIABETES
Type I Diabetes
Virtually everyone with Type I Diabetes must inject insulin to make up for their deficiency. Until recently, insulin came only from the pancreases of cows & pigs. While beef, pork and beef/pork combinations are still widely used, there are now two types of Human insulin available: semi synthetic (converting pork insulin to a form identical to human) & recombinant (using genetic engineering). All insulin helps glucose levels remain near normal (about 70 to 120 mg/dl).

Type II Diabetes
Diet & regular physical activity is the first line of treatment for Type II Diabetes. If normal glycemic levels are not achieved within 3 months, drug treatment is recommended (Table 6). Currently there are four classes of prescription drugs available for the treatment of Type II Diabetes:
          ●   Sulfonylureas q Biguanides
          ●   Alpha-glucoside inhibitors q Thiazolidinediones

Clinical trials suggest that oral antidiabetic agents - particularly the new noninsulin secretagogues - may be useful in delaying or preventing development of Type II Diabetes. Both agents, acting primarily by different mechanisms of action, also have demonstrated potential beneficial effects on serum lipid profiles.
Although these oral medications work in different ways, they can be combined to work more effectively to manage Type II Diabetes. When these combinations of oral treatments are no longer effective, the doctor will start a regimen of insulin alone or in combination with an oral medication.

THERAPEUTIC OPTIONS
There are six main classes of oral medications for the treatment of Type II Diabetes. Their site of action is given in the figure 3.
● Sulfonylureas ● Biguanides ● Alpha-glucosidase inhibitors ● Thiazolidinediones ● Meglitinides ● D-phenylalanine derivatives ● Combination oral medicines

Sulfonylureas
Sulfonylureas is the first widely used oral hypoglycemic medications. They are insulin secretagogues, triggering insulin release by direct action on the KATP channel of the pancreatic b cells. They work best with patients over 40 years old, who have had Diabetes Mellitus for under ten years. They can not be used with type I Diabetes, or Diabetes of pregnancy. They can be safely used with metformin or-glitazones.

First-generation agents
● Tolbutamide ● Acetohexamide ● Tolazamide ● Chlorpropamide

Second-generation agents
● Glipizide ● Glibenclamide ● Glimepiride ● Gliclazide

Meglitinides
Meglitinides are related to sulfonylureas and of often called short-acting secretagogues. The amplification of insulin release is shorter and more intense and they are taken with meals to boost the insulin response to each meal.
● Repaglinide ● Nateglinide