Diabetes { Types, causes, treatments, Diagnosis..,}

DIABETES MELLITUS

Definition

                # DM(Diabetes Mellitus) is a group of disease that characterized by high level of blood glucose level which resulting  from defect in insulin production and insulin action to the body.

                 # The effect of DM include long term damage, dysfunction, and failure of various organs of the body.

Types

              # Type 1 DM

               # Type 2 DM

               # Gestational Diabetes

               # Others

1.    MODY {Maturity onset diabetes of youth }

2.    Secondary Diabetes.

NORMAL VAULES

PEROIDS	ADA (American diabetes association)	WHO (World health organization)
FPG(Fasting plasma glucose)	<100mg/dl <5.5mmol/dl	<110mg/dl <6.1mmol/dl
2hrs after plasma glucose	<140mg/dl <7.8mmol/dl	<140mg/dl <7.8mmol/dl

 # Type 1 DM

              Type 1 DM develop when the immune system of our own body affects the pancreatic beta cells which is the only cells produce the insulin hormone to the body, which will regulate the blood glucose level. There is no age category for this type, it will affect all age group and may occurs for 5% to 10% of diagnosed cases of Diabetes.

# Type 2 DM

              Type 2 DM accounts for 90% to 95% of the patients diagnosed cases of Diabetes, in this condition where the pancreas produce the insulin hormones correctly, but there will be the problem where the cells resist insulin or cells can’t use the insulin properly. Where the pancreas gets the single that cells don’t get insulin sufficiently, as the need raises pancreas gradually increases the production continuously and loses its ability of producing insulin.    

RISK FACTORS

·      Older age (~45 years)

·      Obesity

·      Family history

·      History of gestational diabetes           

·      Physical inactivity

·      Unhealthy diets                            

·      Smoking

·      Cardiovascular disease

·      Hypertension

# Gestational Diabetes

               A form of glucose intolerance is diagnosed for some women during pregnancy, and also more common among the obese women and women with the family history of Diabetes. Women with gestational diabetes will have 20% - 50% chance of developing Diabetes type 1 or type 2 in next 5 to 10 years

#Others

     Other types and secondary causes of DM include

·      Acromegaly

·      Cushing syndrome

·      Thyrotoxicosis

·      Chronic pancreatitis

·      cancers

·      Drug induced hyperglycemia

1.    Atypical antipsychotics     = increase insulin resistance

2.    Beta blockers                      = inhibit insulin secretion

3.    Calcium channel blockers = inhibit insulin secretion

4.    Fluoroquinolones                = inhibits insulin secretion

5.    Niacin                                     = increase insulin secretion

6.    Phenothiazines                    = inhibits insulin secretion

7.    Thiazide diuretics                = inhibits insulin secretion

8.    Prolapse inhibitors          = inhibits the conversion proinsulin

9.    Corticosteroid resistance

& gluconeogenesis             = cause peripheral insulin

Diagnosis (4 types)

A.  Fasting plasma glucose

By testing the serum blood we can finalize the value of the plasma glucose.

B.  Oral glucose tolerance test

Blood glucose level is measured 2 hours after 75 gram glucose load (use of anhydrous glucose solution)

C.   Glycate hemoglobin test

Its is the form of the hemoglobin that is bind with glucose, it is formed in a non-enzymatic glycation pathway by hemoglobins exposure to plasma glucose. It is measured primarily to identify the three month average . plasma glucose concentration and thus can be used as a diagnostic test for diabetes for glycemic control in people with diabetes, the test is limited to a three month average because the lifespan of RBC(red blood cell) is 120 days ( 4 months ).

D.  Random plasma glucose

For use in patient with symptoms of hyperglycemia/ hypoglycemia crisis.

Management of DM

·      Life style modification (Diet & Exercise)

·      Medication

·      Self monitoring of blood glucose

·      Control of BP and lipid level

·      Regulates complication of monitoring.

 Diet

           Dietary fat should provide 25-35% of total intake of calories but saturated fat intake should not exceed 10% of energy. Cholesterol consumption should be restricted and limited to 300mg or less daily.

           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 animal and vegetable source

            Carbohydrate provide 50-60% of total caloric content of the diet. Carbohydrates should be complex and high in fiber

            Excessive salt intake is to be avoided it should be particularly restricted in people with hypertension and those with nephropathy.

Exercise

       Physical activity promotes weight reduction and improves insulin sensitivity , thus lowering blood glucose level.

        

         Minimum 150-300 minutes/weeks moderate level

        People should , however be educated about the potential risk of hypoglycemia or hyperglycemia and how to avoid it.  

       

         Uncommunicable disease may arise due to physical inactivity like CARDIVASCULAR DISEASE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, DIABETES MELLITUS, STROKE……

Medications

·      Type 1 DM – Only insulin needed(BASAL or PARENDIAL)

·     

    Type 2 DM – insulin and antidiabetic drugs(eg.,sulfonylureas group)

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