Introduction
Diabetes was first documented by the Egyptians and is characterized by weight loss and polyuria. However, it was the Greek physician Aertacus who Coined the term diabetes mellitus (DM) in Greek, diabetes means “To pass through” and mellitus is the Latin word for honey (referring to sweetness) diabetes is an important cause of prolonged ill health and premature mortality, and claims more lives per year than HIV-AIDs with nearly 1 death every 10 seconds. With the advent of industrialization worldwide and the staggering rise in obesity, diabetes has manifested as a global epidemic.
What is diabetes?
Diabetes mellitus (DM) is a group of disease characterized by high level of blood glucose resulting from defects in insulin production, insulin action or both.
Classification of diabetes
- Type 1-Diabetes mellitus
- Type 2-Diabetes mellitus
- Type3-Others {e.g. anti-corticosteroids<NSAIDS> cause by unknown disease condition)
- Type 4- gestational diabetes mellitus (diabetes in pregnancy)
Type 1diabetes
- This was previously called insulin dependent diabetes mellitus (IDDM) or Juvenile- onset diabetes.
- Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormones insulin that regulate blood glucose.
- This form of diabetes usually strikes children and young adults, although disease onset occurs at any age.
- Type 1 diabetes may account for 5% t0 10% of all diagnosed cases of diabetes.
Risk factors for type 1 diabetes may include auto immune, genetic, and environmental factors.
Causes of diabetes
- Destruction of the beta cells of the islet of langarHans of the pancreas due to auto-immune response.
- Hereditary > Antigen-Anti-body reaction > viral infection
Types 2 diabetes mellitus
This is non insulin-dependent diabetes mellitus (NIDDM) or adult onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnose cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually, loses it ability to produce insulin.
Type 2 diabetes is associated with old age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity.
Causes of diabetes mellitus
- Insulin deficiency
- insulin resistant
- Obesity
- chronic pancreatitis.
Pathopysiology of diabetes mellitus
- The deficiency or lack of insulin production hyda- the transport of glucose into the body cells for storage. These leads to accumulation of glucose in the blood stream causing hyperglycemia. The excess glucose is excreted in the urine which is as (glucosuria).
- Excess water needed for the excretion of excess glucose these lead to the excretion of excess urine (polyuria) as a result of excess water lose the patient experience a persisting taste (polydysia) and dehydration.
- Tissue protein may also be broking down into amino acid used in glucose neo-genesis contributing further to hyperglycemia. Both the uptake of amino acid by cells and body, protein are decrease leading to low body resistant to infection. The patient is prone to infection, particularly skin infection, e.g. boil which lead to ulcer that fails to heal.
- Weight lost is attributed to breakdown of protein and fat (there will be increase in appetite which is known as polyphagia) due to stimulation of hunger centre females develop puritor (inching of the vulva) due to fungi that attach to the glucose deposited in the urine the male may also Balanitis (which is inflammation of the penile gland)
Investigation/diagnosis of diabetes mellitus
Run a fasting blood sugar or a random blood sugar.
- FBS 60-180mgldl at 6am-10am
- RGS 60-180mgldl
- Glycated hemoglobin (Aictlest(between 5.7 and 6.4% indicate pre-diabetes below 5-7 is considered normal ).
- Oral glucose tolerance test: This test the individual overnight, and the FBS level is measured. Then helshe is asked to drink a sugary liquid and blood sugar level less than 140mgldl is normal, whilemore than 200 mg/dl after two hour indicate diabetes. A reading between 140 and 199mgldl indicates pre-diabetes.
Signs and symptoms of diabetes mellitus
- Polyuria
- Polydysia
- Polyphagia
- poor wound healing
- hyperglycemia
- loss of weight
- fatigue and weakens
- glucosuria
- dehydration
200mg/dl and above is the threshold and then sugar begins to appear in urine.
Pre-disposed factors of diabetes mellitus
- Age
- Sex(women are more prone compared to men)
- Excess weight
- Lack of exercise
- Excessive carbohydrates
Prevention of diabetes mellitus
- There is no known preventive measure for type 1 diabetes
- Type 2 diabetes which account for 85-90% of all cases can also be prevented or delayed by maintaining a normal body weight, engaging in physical exercise, and consuming a healthful diet. Higher levels of physical activity (more than 90 mm per day) reduce the risk of diabetes by 28% dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fibre, and choosing good fats, such as the poly unsaturated fats found in nuts, vegetable oils and fish.
Limiting sugary beverages and eating less red meat and other source of saturated fat can also help prevent diabetes.
Tobacco and its complications so smoking cessation can be an important preventive measure as well.
Complication of diabetes mellitus
These can be “Acute” (metabolic) complications which are cause by diabetes treatment or lack of it.
- Hypoglycemia (low blood glucose give sugar)
- Damage to the heart muscle, leveling to impaired relaxation and filling of the heart with blood.
- Hyperglycemia (high blood glucose/or ketoacidosis (a serious illness due to lack of insulin.
- Macro-vascular heart attack (M-I) stroke (cerebrovascular accident) amputation (peripheral vascular accident)
- Micro-vascular: Diseases of the small blood vessel in the eyes (retinopathy) heart (cardiomyopathy) kidneys (nephropathy) nerves (neuropathy) skin (demopathy) and sexual organs (erectile dysfunction)
Management of diabetes mellitus
There are three major components of the treatment of diabetes, they are
- Diet and Exercise
- Oral hypoglycemic therapy
- Insulin therapy
In Diet
- Protein intake can range between 10-15% total energy (0.8-1g/kg of desirable body weight. Requirement increase for children and during pregnancy. Protein should be derived from both animals and vegetable sources.
- Carbohydrates provide 50-60% total caloric content of the diet. Carbohydrate should be complex and in fibre
- Excessive salt intake is to be avoided, it should be particularly restricted in people with hypertension are those with nephropathy.
In exercise
- People should, however, be educated about the potential risk of hypoglycemia and how to avoid it.
- Physical activity promote weight reduction and improves insulin sensitivity, this lowering blood glucose levels.
Oral hypoglycemia therapy
Type 2 diabetes mellitus
In oral hypoglycemia therapy,
- Metformin (Glucophage) is the first medication prescribed for type 2 diabetes it works by improving the sensitivity of your body tissue to insulin so that your body uses melformin to lower the glucose production in the liver
- Acarbose and Miglotolslows down digestion of carbohydrate in the intestine.
- Glipizide oral
- Glimepiride oral
- Tolazamide oral
Insulin therapy
In insulin therapy there are different types of insulin.
- Rapid acting insulin
- Short acting insulin
- Long acting insulin
- Pre-mixed short acting with inter-mediate acting (every 5-8 hours) continuous subcutaneous insulin infusion.
References
National Diabetes Fact Sheet (2003).Department of Health and Human Services centres for disease control and prevention.
World Health Organization.Definition, diagnosis and classification of diabetes mellitus and its complications.Report of WHO Department of non-communicable disease surveillance. Geneva 1999.
Academy of Medicine Clinical Practice Guidelines Management of types 2 diabetes mellitus. MOH/P/PAK/87.04(GV), 2004
NHS.Diabetes insulin Initiation-University Hospitals of Leicester.
NHS trust working in partnership with PCTs across Leicestershire and Rutland, May, 2008.