Diabetes Mellitus

What is Diabetes Mellitus?

Diabetes mellitus is a chronic disease of absolute or relative insulin deficiency or resistance. It's characterized by disturbances in carbohydrate, protein, and fat metabolism. Insulin transports glucose into the cells for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage in the adipose tissues. Insulin deficiency compromises the body tissues' access to essential nutrients for fuel and storage.

Diabetes mellitus occurs in two primary forms: type 1, characterized by absolute insufficiency, and the more prevalent type II, characterized by insulin resistance with varying degrees of insulin secretory defects.

Onset of type I usually occurs before age 30, although it may occur at any age; the patient usually is thin and requires exogenous insulin and dietary management to achieve control. Type II usually occurs in obese adults after age 40, although it's commonly seen in North American youths. It's often treated with diet and exercise, in combination with antidiabetic drugs; treatment may include insulin therapy.

Diabetes mellitus is thought to affect about 8% of the population of the United States (16 million people); about half are undiagnosed. Incidence is higher in males than in females and increases with age.

Causes of Diabetes Mellitus

The effects of diabetes mellitus result from insulin deficiency. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency compromises the body tissues' access to essential nutrients for fuel and storage.

The etiology of both type I and type II diabetes remains unknown. Genetic factors may play a part in the development of all types. Autoimmune disease and viral infections may be risk factors in type I.

Other risk factors include:

• obesity, which contributes to the resistance to the dogenous insulin
• physiologic or emotional stress, which can cause prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon, and growth hormone); this increases blood glucose levels, which, in turn, places increased demands on the pancreas
• pregnancy, which causes weight gain and increases levels of estrogen and placental hormones, which antagonize insulin
• some medications that can antagonize the effects of insulin, including thiazide diuretics, adrenal corticosteroids; and oral contraceptives.

Signs & Symptoms of Diabetes Mellitus

The Signs and symptoms of type 1 diabetes.

• Excessive urination
• High levels of glucose in the blood and urine
• Excessive intake of water and/or food
• Loss of bladder control in children after they had already been trained
• Weakness and excessive fatigue
• Increased susceptibility to infection, such as vaginitis and other yeast infections
• Unintended weight loss over several days (people with type 1 diabetes tend to be thin)

However, a person with type 2 diabetes may experience symptoms listed below, which tend to appear slowly over time:

• Blurred or poor vision
• Poor wound healing
• Impotence
• Fatigue
• Burning or numbness sensation of the feet, legs, and ankles

1. Diabetes can sometimes feel like a viral illness, with fatigue, weakness and loss of appetite. Sugar is your body's main fuel, and when it doesn't reach your cells you may feel tired and weak.
2. Diabetes affects your body's ability to heal and fight infection. Bladder and vaginal infections can be a particular problem for women.

Diagnostic tests

In nonpregnant adults, diabetes mellitus is diagnosed when they present with:

• at least two occasions of fasting plasma glucose level greater than or equal to 126 mg/dl
• typical symptoms of uncontrolled diabetes and a random blood glucose level greater than or equal to 200 mg/dl
• blood glucose level greater than or equal to 200 mg/dl 2 hours after ingestion of 75 g of oral dextrose.

Two of the above tests are required for diagnosis; they can be the same two tests or any combination and may be separated by more than 24 hours.

An ophthalmologic examination may show diabetic retinopathy.

Other diagnostic and monitoring tests include urinalysis for acetone and blood testing for glycosylated hemoglobin, which reflects glucose control over the past 2 to 3 months.

Treatment

For patients with type I diabetes, treatment includes insulin replacement, diet, and exercise. Current forms of insulin-replacement include single-dose, mixeddose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may include use of an insulin pump.

Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultra­lente), or a combination of rapid-acting and intermediate-acting (70/30 or 5O/50 of NPH and Regular) mixed together.

Insulin Lispro may be used in place of Regular insulin. It's rapid in onset (15 minutes) and waiting to eat after injection isn't necessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.

Pancreas transplantation is available and requires chronic immunosuppression.

Patients with type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.

A patient with either type of diabetes requires a diet that is planned to meet nutritional needs, control blood glucose levels, and reach and maintain appropriate body weight.

For the obese patient with type II diabetes, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently, with meals eaten at regular times.

Prevention Tips

• Learn the Signs and symptoms of ketoacidosis and always be aware
• Eat regularly scheduled meals and snacks
• Take supplements to help your body better utilize blood sugar
• Stay on a healthy diet and avoid processed and refined foods, alcohol and excessive sugar in your diet.
• Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.