Diabetes Mellitus | features | management |

 

                                                           Diabetes Mellitus

This article discusses different types of diabetes mellitus. Here, learn about the diagnosis, types, indications of treatment, and more.

Keywords:  Hyperglycemia | Glycosuria |Polyuria | Polydipsia | Siphon | insipidus|  etiology | symptoms and signs | lab investigations | diet | prevention| complications | treatment | in children | in pregnancy| 

About' totalphysiology.com.'

This article is part of my mission to provide trustworthy recent health information to support the general public, patients, and professionals globally.

Here you will find human Physiology, Anatomy, and health-related topics.

Table of content
1.	Definition
2.	Types
3.	Pathophysiology
4.	Sign & symptoms
5.	Investigation
6.	Management and Research

Diabetes Mellitus is a prevalent disease. According to W.H.O., 415 million people are suffering from Diabetes Mellitus. In other words, 8.3% of the adult population suffers from this disease globally. Therefore, our country may become the diabetic capital of the world, with an estimate of around 80% of all diabetics in the world. So this article seems very important.

Definition: Diabetes mellitus is commonly known as diabetes. It is a complex metabolic syndrome (disorder) characterized by carbohydrate, protein, and fat metabolism disturbance. In which blood sugar is high. This is usually characterized by -

Hyperglycemia –increased blood sugar level.

Glycosuria  means the presence of sugar in urine and

Three "P"-

Polyphasia increases food intake,

Polydipsia increases thirst excessive and persistent thirst and

Polyuria increases the frequency of urination and the passing of large volumes of urine.

Charaka and Sushruta, well-known physicians of ancient India, were aware of this disease. They named it 'Madhumeha,' i.e., 'rain of honey.' 'Madhu' means sweet, and 'meha'is rain 

In the 2^nd century A.D., a Greek physician, Aretaeus of Cappadocia, called this disease diabetes" siphon" or running through. The classical Latin word Mellitus means 'mellite' honey /sweet.

Diabetes mellitus v/s Diabetes insipidus -

Diabetes insipidus is not related to diabetes mellitus. It is a different condition and not a common disease. In this case, secretion of ADH hormone is reduced or absent, causing less water absorption from the distal convoluted tubule of the nephron, leading to more excretion of fluid from the body. A nephron is the functional unit of the kidney.

Pathophysiology of diabetes mellitus –Insulin is secreted from the 'beta cells of Langerhans', which is responsible for cell carbohydrate utilization. When Insulin is reduced in amount or its function is decreased by any cause. It will cause carbohydrate accumulation in the body and derange protein and fat metabolism. This will affect the operations of all systems of the body.

Islet of Langerhans is present in the Pancreas gland. This is the endocrine part of the pancreas gland.

There are five types of  cells are present in 'Islet of  Langerhans':

1. beta cells-secrete Insulin

2. alpha cells- secrete Glucagon

3. delta cells- secrete Somatostatin

4. epsilon cells- secrete ghrelin

5. P.P. cells – secrete pancreatic polypeptide.

Types:  Different types of diabetes are

1.      Type I diabetes or juvenile diabetes or Autoimmune diabetes –about 10% of people suffer from this type of diabetes. In this 'the beta cells of Langerhans'are destroyed by the immune body. The exact mechanism is not known. This occurs below the age of 40 yrs.

 In type II diabetes, in this case, the body becomes resistant to Insulin, and insulin production is not sufficient. This occurs above the age of 40 yrs.

3.      Gestational diabetes occurs during pregnancy in non-diabetes females. Insulin-blocking hormones produced by the placenta are responsible for gestational diabetes.

Stages in the development of diabetes mellitus

1.        1. Prediabetes or potential diabetes: In this condition, blood sugar is higher than average but not high enough for a diagnosis of type II diabetes.

2. Latent diabetes

3. Chemical or clinical diabetes

4. Overt diabetes mellitus

5. Secondary diabetes mellitus

Each type of diabetes has a different etiology, symptoms, signs, diet treatment, and outcome, i.e., prognosis. Signs and symptoms of diabetes mellitus.

Clinical examination of the patient

General history-family history, occupational history, lifestyle- exercise yoga. Habits –smoking another disease, treatment history, Nerve and vessel tests must be made.

Signs and Symptoms: -are mild at first and generally overlooked by the patient.

Polyphasia increases food intake associated with weight loss. In addition, low glucose utilization by glucostat cells of the ventromedial nucleus in the hypothalamus results in no inhibition of the lateral nucleus in the hypothalamus, eventually producing increased hunger.

Polydipsia, excessive and persistent thirst, and Polyuria increase the frequency of urination and passing of large volumes of urine, which may cause dehydration.

Hyperglycemia: it predisposes to infections like boils and urinary tract infections.

Poor resistance to infections causes recurrent urinary tract infections, delayed wound healing, tiredness, weakness, and dry, itchy skin may be associated symptoms.  

Loss of weight: in the absence of intracellular glucose, which is a significant energy source, there is a mobilization of fats and breakdown of proteins, especially in the muscles causing poor muscle strength.

In addition, men may have decreased sex drive and erectile dysfunction.

Blood sugar level:

Fasting blood sugar level :

Standard -A fasting blood sugar level less than 100 mg/dl(5.6 mmol/l).  

Prediabetes- A fasting blood sugar level from 100 mg to 125 mg//dl(5.6 –6.9mmol/l).

Diabetes- A fasting blood sugar level of more than 126 mg/dl(7 mmol/l). Or higher on two separate tests. 

Postprandial blood sugar level :

Regular when the blood glucose level is less than140 mg/dl(7.8 mmol/l)

Diabetes: when the blood glucose level is less than180 mg/dl(10.0 mmol/l)

Oral Glucose Tolerance Test (G.T.T.):

1.      Normal: when the blood glucose level is less than140 mg/dl(7.8 mmol/L).   

2.      Prediabetic: when the venous blood glucose level is between  140 mg and 199/dl(7.8 mmol/L -11.0 mmol/L).

3.      Diabetes: after two hours, the venous blood glucose level is more than 200 mg/dL(11.1mmol/L.).

Glycated hemoglobin: A1C or HgbA_1C-is a form of hemoglobin chemically linked to sugar.

This is measured mainly to determine the three-month average blood sugar level and assess glycemic control in people suffering from diabetes.

The International Diabetes Federation and the American college of endocrinology recommend  HgbA_1C values below 48 mmol( 6.5%) as reasonable control of diabetes. But American Diabetes Association recommends HgbA_1C  values below 53 mmol( 7%) as reasonable control of diabetes.

High levels of HgbA_1C are found in people with persistently elevated blood sugar in diabetes mellitus.  

Risk Factors

Type I diabetes mellitus is due to the autoimmune destruction of insulin-synthesizing beta cells of Langerhans.

Genetic –Type II runs in families. Both genes and environmental factors play a  role in triggering diabetes.

Family members share genes that make them more likely to suffer from Type II diabetes mellitus and be overweight. 'American Diabetes Association states that genetics plays a vital role in developing diabetes.

 The most typical form of diabetes is hereditary idiopathic diabetes mellitus.

Obesity: a reliable indicator for body fat is body mass index in meters. Individuals with values of 25-30 are adipose tissues in obese persons are more resistant to insulin actions than normal adipose tissue, a decrease in the ability of Insulin to move glucose into the cells and block the glucose release from the liver. It was also known as 'rich man's disease since overnourished persons suffer from it.

Lack of exercise, sedentary lifestyle tension, etc.

High level of cholesterol.

Risk increases with age.

Diet –A diet high in calories, fat, and cholesterol increases resistance to Insulin and the chance of developing Type II diabetes.

Some drugs may cause diabetes mellitus. 

It may be associated with Hyperthyroidism, Acromegaly, and Cushing syndrome.

Complications of diabetes: Diabetes affects all tissues, and if not managed effectively, diabetes will cause many complications. All organs and systems are affected.

(1 The acute complications of diabetes mellitus are based on metabolic and functional disturbances in the body and are summarized in. in addition, poor control of the disease predisposes to the development of chronic complications, which include: Atherosclerosis: deposition of lipids underneath the tunica intima of blood vessels. The common sites are:

 Micro angiopathy is a vascular lesion in which the capillary basement membrane is thicker than average.

Neuropathy is the degeneration of sensory and motor nerves in the lower part of the body.

Retinopathy scarring of the retina leading to blindness, and

Nephropathy renal disease leading to renal failure

Common organs and systems are:

Cardiovascular  –microvascular complications-heart failure, myocardial infarction-heart attack.

Cerebrovascular accident-Paralysis

Kidney –leading to renal failure

Nerve and vessel –leading to morbidity.

The eye- especially the retina –leads to blindness.

Sexual –loss of libido, erectile dysfunction, infertility, increased fetus weight.

Lab. Investigation: To diagnose diabetes

Routine urine examination will show sugar in urine –glycosuria and more leucocytes pus cells. In ketoacidosis, ketone bodies are present in blood and urine.

The urine culture and sensitivity (C/S) test may show recurrent urinary tract infections.

Blood sugar estimation Fasting and postprandial.

GTT

Glycated hemoglobin

To diagnose complications of diabetes or comorbidity with diabetes:

Renal function test

Liver function test

Eye test

E.C.G.

Prevention- by diet, change of lifestyle in type II diabetes.

Diet- Diet in diabetes: Changing eating habits is essential for managing diabetes.

Diabetes type II may be controlled only by diet change.

When we take a diet, it is digested by many digestive enzymes, glucose level rises in the blood, and rapidly Insulin is secreted, which causes glucose utilization by cells of the body, reducing the sugar level in the blood. 

In diabetes, Insulin is reduced in amount or function due to any cause, leading to an increase in blood glucose level. When blood glucose level increases above 180 mg%, glucose is filtered from the kidney and comes in urine, i.e., glycosuria. Reduction in the carbohydrate content of the diet and frequent small diet help control diabetes.

A  healthy diet is essential for type I diabetes management. There is no standard diet for all cases of type I diabetes. Calculate your calorie demand  which is like that:

Rough working formulae are

Sr.no.	Age (years)	Sex male /Female	Sedentary Calorie needs	Moderately active Calorie needs	Active Calorie needs
1	19-30	Male Female	2400-2600 1800-2000	2600-2800 2000-2200	3000 2400
2	31-50	Male Female	2200-2400 1800-2000	2400-2600 2000-2200	2800 2400
3	51 and above	Male Female	2000-2200 1600-1800	2200-2400 1800-2000	2800 2400

 Type of food providing calories per gram:-

Carbohydrates provide 4 calories per gram,

Protein provides  4 calories per gram and

Fat provides  9 calories per gram.

Water, vitamins, and minerals have no calories.

A general guideline is to cut down on unnecessary sugar, carbohydrates, sodium, and fat that can cause a rapid rise in blood sugar. It is crucial to include nutritious food rich in vitamins and fibers. A significant factor for any diabetic diet is consistency. To maintain consistency

Take a regular small diet and same time each day, don't skip meals and drugs.

The Keto diet is a low-carb diet and protein and highly saturated, fat-rich foods. It also includes non-starchy vegetables and leafy green.

The Mediterranean diet emphasizes plant-based food, fruits, vegetables, whole grains, etc. The primary source of fat is olive oil. The  Mediterranean diet contains vitamins, minerals, fiber, and healthy fats. It's low in cholesterol, saturated fat, trans fat, and added sugars. The Mediterranean diet is also helpful in reducing weight, blood cholesterol, and blood pressure.

 The DASH ( dietary approach to stop hypertension.) is also helpful in type II diabetes.

A  dietitian will help to plan such a diet.

Treatment of diabetes: Many drugs are used to treat diabetes-some are given orally and some by injections according to the type and conditions of the patient.

Type I diabetes: Insulin is not produced in this type of diabetes, so Insulin is used. Oral drugs are not effective. Four kinds of Insulin are used that differ in their onset of action and how long their effects last.

Name	Starts to work within	Last for
Rapid-acting Insulin	15 Minutes	3-4 hours.
Short-acting Insulin	30 Minutes	6-8 hours
Intermediate-acting Insulin	1-2 hours	12-18 hours
Long-acting Insulin	After few hours	24- hours or more

 

Type II diabetes:

Lifestyle change –diet, habit, exercise, yoga. If they are not enough to control blood sugar, medicine is added. Nowadays, six classes of oral antidiabetic drugs (O.A.D.) are available. Their actions are different and may be used alone or in combination to reduce blood sugar. They are broadly classified into:

1.      Biguanides

2.      Sulfonylureas

3.      Meglitinides

4.      Thiazolidinediones

5.      Dipep peptidase IV inhibitors

6.      Alpha-glucosidase inhibitors.

Many other drugs are under trial. 

 Insulins /Drugs you must take under the supervision of a doctor.

History of the development of diabetic drugs:

In 1955, Franke and Fuchs introduced oral antidiabetic drugs.

In 1955, Frederrick Sanger identified the structure of Insulin.

In 1970, blood glucose meters to know blood sugar were quickly discovered, and Insulin pumps to inject Insulin were found in the same year.

In 1983, for the first time, biosynthetic Insulin was introduced.

In 1986, an insulin pen delivery system was introduced to easily inject Insulin.

In 1989 "St. Vincent "Declaration" was the result of an international effort to improve the quality of life & life expectancy of persons suffering from diabetes.

The National Diabetes program is functioning in many countries, including ours. In 1993, knowing the grave situation of Diabetes Mellitus,  Diabetic control, and complications. A trial (DCCT) was published to aware the public about Diabetes Mellitus. A study estimated that from 2012 to 2015, 1.5 to 5 million people died yearly from this disease.

 Diabetes at least doubles a personal risk of death. One person worldwide

dies of diabetes mellitus every 10 seconds, and new diabetic cases are identified every ten

 seconds². The global economic cost of diabetes was estimated to be 612 billion USD. As a mark

of the awareness program, we celebrate World Diabetic day on 14 November every year. World

Diabetic day was created in 1991 by International Diabetes Federation (I.D.F.) and World Health

 Organization in response to growing concerns about the rising health problem posed by

Diabetes. World Diabetic day became an official United Nations Day in  2006 with the passage of

 United Nations Resolution 61/225. Blue circle, the logo was adopted in 2007. The blue process signifies the

 unity of the global diabetes community in response to the diabetes epidemic.

In 1998, United Kingdom Prospective Diabetes Study (UKPDS) also published its report on

 prevention of complications of diabetes Mellitus.

Inhalable Insulin was developed but was withdrawn due to its side effects. But the

 investigation was going on, and in June 2014, the Inhalable insulin "Arezza" of pharmaceuticals company Mankind Corporation was approved by the F.D.A. for general sale. This inhaled Insulin is more convenient and easy to use.

Research is in progress to improve the management of Diabetes Mellitus.

This blog may be helpful for the population suffering from diabetes and those who care for them. However, this does not provide medical advice, diagnosis, or treatment.

This article will be helpful for you.

Like to meet again? Sign up to get an email when I publish.

Question? Email me bkp337390@gmail.com

 Follow me on Instagram @ bijaykprasad

                                                @bkpdphysiology

  Follow us on Twitter@ at bijaykrishnapr3

                                  @BijayPr60250287

And don't forget to follow me on learn and fly.co.in

I am more enthusiastic, and you can get new insights from my articles later.

Thank you.

Learn More :

1. About us

2. Contact us

3. Disclaimer

4. Privacy Policy

Please submit any comments about this article. The team will work hard to evaluate the statement and make appropriate corrections.

Help to improve the content.

Question: Hi! Got any questions? I can help you.

Have a comment about this article, please let me know.

Your name:

Your Email address

Hashtags: Hyperglycemia # Glycosuria # Polyuria #Polydipsia #Siphon # insipidus  #cause # symptoms and signs# lab investigations# diet # lack of exercise #prevention #complications# treatment # children# pregnancy# govt. actions# research work#

References –

1. WHO Diabetes program,2011 Jan, Fact sheet no.312.

2. Sarah Wild et al., Global prevalence of diabetes, Diabetes Care,275(5),2005 May:1047-1053.

3.^a b "Update  2014". I.D.F.International Diabetes Federation.Retrieved 29 November 2014.

4. G Varghese PJ, AK Abraham, AP Abraham. History of diabetes, Insulin & oral pills. Handbook of Diabetes.Ch2,1984:3^rd ed,pg3.

5. Maxine A.Papadakis and Stephen J. Mcphee, Current Medical Diagnosis & Treatment. Ch 27,2015 ed.Pg. 1184-1186.

6. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes care 1997:20:1183-1197.

7." Press Announcement," F.D.A. Retrieved 11 February 2016.

8. Inhaled Insulin clears Hurdle Towards F.D.A. Approval".New York Times. Retrieved 12 April 2014.

9.Dubois ,HFW and Bankauskaite ,V (2005) “Type 2 Diabetes programmes in Europe”.(PDF).Euroobserver 7 (2)):5-6.

10.www.webmed.com

11.en.m.wikipedia.org

12. my. clevelandclinic.org

13.www.healthline.com

This blog may be helpful for the population suffering from diabetes and those who care for them. However, this does not provide medical advice, diagnosis, or treatment.

This article will be helpful for you.