Diabetes Mellitus
Diabetes Mellitus or simply diabetes is a group of metabolic Diseases, where a person who has high Blood Sugar either because the body does not produce. The high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
Type 1 Diabetes Mellitus, is as a result of body’s failure to produce insulin. And presently requires the person to inject insulin or wear an insulin pump. Though was previously referred to as “insulin-dependent diabetes mellitus” (IDDM) or “juvenile diabetes”.
Type 2 Diabetes Mellitus, can be caused by insulin resistance, a condition in which cells fail to use insulin properly, sometimes combine with absolute insulin deficiency. The form was previously referred to as non-insulin dependent diabetes mellitus (NIDDM) or “adult onset diabetes”
GESTATIONAL DIABETES. “GD” occurs when a pregnant woman without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development to non-insulin dependent diabetes mellitus.
OTHER FORMS OF DIABETES MELLITUS INCLUDE:
CONGENITAL DIABETES. Occurs due to genetic defects of insulin secretion.
CYSTIC FIBROSIS-RELATED DIABETES. This is basically due to genetic disorder of the lungs, pancreas etc. (liver and intestine)
STEROID DIABETES: This is induced by high doses of glucocorticoids.
MONOGENIC DIABETES. Also known as onset diabetes of the young. (MODY) which refers to any of the several hereditary forms of diabetes caused by mutation in an autosomal dominant gene. (sex independent, i.e. inherited form. From any of the parents) disrupting insulin production.
Al forms of diabetes have been treatable since insulin became available in 1921, and Type 2 diabetes can be controlled with medications. Both type1 and 2 are chronic condition that cannot be cured. Pancreas transplants have been tried with limited success in type1 Diabetes mellitus. Gastric bypass surgery (the procedures in any of a group of similar operations that first divides the stomach into small upper pouch and a much larger lower” remnant” pouch and rearranging the small intestine to connect to both), has been successful in many with morbid obesity and type 2 Diabetes Mellitus. Gestational Diabetes usually resolves after delivery.
Diabetes without proper treatments can cause many complications. Acute complication which is one of the complications arising from improper treatment of diabetes includes the following; hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma, peripheral vascular diseases, angina and myocardial in farcie. Serious long term complication include; cardiovascular diseases, chronic renal failure and diabetic retinopathy (retinal damage), diabetic neuropathy. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessations and maintaining a healthy body weight. Note that globally as of 2012, an estimated 346million people have type2 diabetes.
| FEATURES | TYPE1 DIABETES | TYPE2 DIABETES |
| onset | Sudden | Gradual |
| Age at Onset | Mostly in children | Mostly in adults |
| Body habitus | Thin or Normal | Often Obese |
| Ketoacidosis | Common | Rare |
| Autoantibodies | Usually present | Absent |
| Endogenous Insulin | Low or Absent | Normally decreased or Increased. |
| Concordance in Identical twins | 50% | 90% |
| Prevalence | 10% | 90% |
The term “diabetes”, without qualification usually refers to diabetes mellitus. The disease diabetes insipidus has similar symptoms as diabetes mellitus, but without disturbances in the sugar metabolism (insipidus means “without taste” in Latin).
The term “Type 1 diabetes” has replaced several formal terms, including childhood–onset diabetes, juvenile diabetes and insulin-dependent diabetes mellitus (IDDM). Likewise, the term “Type 2 diabetes” has replaced several former terms, including adult diabetes; obesity related diabetes and non-insulin dependent diabetes and beyond these two types, there is no agreed upon standard nomenclature.
Type 1 diabetes mellitus is the characterized by loss of insulin producing better cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type1 diabetes is the immune mediated nature; in which batter cell loses is a t-cell mediated autoimmune attack. There are no known preventive measures against type1 diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type1 diabetes can affect children or adults, but was traditionally termed “Juvenile diabetes” because a majority of the diabetes cases were in children.
Brittle Diabetes also known as unstable or labile diabetes is a term that was traditionally used to use to describe dramatic and recurrent swings in glucose level, often occurring for apparent reason in insulin dependent diabetes. This term however has no biologic basic and should not be used. There are many reasons for type1 diabetes to be accompanied by irregular and unpredictable hyperglycemia. Frequently with ketosis and sometimes serious hypoglycemia’s including an impaired counter regulatory response to hypoglycemia, occult infection gastro paresis (which leads to erratic absorption of dietary carbohydrates) and endocrinopathies (eg. Addison’s disease). The phenomena are believed to occur not more frequently than in 1% to 2% of persons with type1 diabetes.
Type2 diabetes mellitus is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defection responsiveness of body tissues to insulin is believed to involve the insulin receptor. In early stage of type2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage, hyperglycemia can be reversed by a variety of measure and medications that improve insulin sensitivity or reduce glucose production by the liver. Medication include; exenatide, liraglutide and pramlintide.
Gestational diabetes mellitus resembles type2 diabetes in several aspects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2% – 5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable. Hence, it requires careful medical supervision throughout the pregnancy. About 20% to 50% of affected women develop type2 diabetes later in life.
Untreated Gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), Congenital cardiac, central nervous system anomalies and skeletal muscle malformations. Their’s also Increase surfactant (i.e. compounds that lower the surface tension of a liquid. Hence, the interfacial term between two liquid. Or that between a liquid and a solid e.g. detergents and emulsifiers) production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur. Most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A caesarean section may be performed if there is marked fatal distress or an increased risk of injury associated with macrosomia such as shoulder dystocia.
Pre-diabetes: It indicates a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type2 diabetes mellitus. Many people destined to develop type2 diabetes mellitus spend many years in a state of pre-diabetes which has been termed.
Latent Auto-Immune Diabetes of Adults (LADA): LADA is a condition in which type1 diabetes mellitus develops in adults. Adults with Latent Auto-immune Diabetes of Adults are frequently initially misdiagnosed as having type2 diabetes mellitus, based on age rather than etiology.
The classical symptoms of untreated diabetes are; loss of weight, polyuria (constant urinating), polydipsia (increased thirst) and polyphagia (increased hunger). Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Blurred vision is a common complaint leading to a diabetic prognosis. Type1 should always be suspected in cases of rapid vision change. Whereas with type 2, change is generally more gradual. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
| CONDITION | 2HOURS GLUCOSE mmol/L (mg/dl) | FASTING GLUCOSE mmol/L (mg/dl) |
| Normal | 7.8 140) | 6.1 (110) |
| Impaired fasting glycaemia | 7.8 140) | ≥6.1 (≥110) And () |
| Impaired glucose tolerance | ≥7.8 (≥140) | 7.0 126) |
| Diabetes mellitus | ≥11.1 (≥200) | ≥7.0 (≥126) |
Diabetes Mellitus is a chronic disease that cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal (“euglycemia”) as possible without causing hypoglycaemia. This can usually be accomplished with diet, exercise and use of appropriate medications (insulin in the case of type1 diabetes, oral medications and possibly insulin in type2 diabetes). Patient education, understanding and participation is vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. Attention is also paid to other health problems that may accelerate the deleterious effect of diabetes e.g. Smoking, elevated cholesterol level, obesity, high blood pressure and lack of exercise.
Oral medications. Anti-diabetic medication Metformin is generally recommended as first line of treatment for type2 diabetes. their is good evidence that it decreases mortality. Routine use of aspirin however, has not been found to improve outcomes in uncomplicated diabetes. Insulin use: Type1 diabetes is typically treated with Insulin or Synthetic Insulin analogs. When Insulin is used in type2 diabetes, a long acting formulation is usually added initially with continuing Oral Medications. Doses of Insulin are then increased to effect.