Diabetes Mellitus

    By Dr. Chakshu
    “The International Diabetes Foundation estimates there are 246 million adults worldwide suffering from diabetes today; by 2025, the figure is expected to reach 380 million.” Recent WHO calculations indicate that worldwide almost 3 million deaths per year are attributable to diabetes.

    Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share common phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics and environmental factors, Depending upon etiology of DM. factors contributing to hyperglycemia include reduced insulin secretions, decreased glucose utilization and increased glucose production.

    The metabolic disorder associated with DM causes secondary pathophysiological  changes in multiple organ systems that impose a tremendous burden on individuals with diabetes. DM is the leading cause of end stage kidney disease, non traumatic lower extremity amputations and adult blindness. It also predisposes to cardio vascular disease.

    DM is classified on the basis of pathogenic process that leads to hyperglycemia, as opposed to earlier criteria like age of onset or type of therapy. Two broad categories of DM are designated as type 1 and type 2. Type-1 DM is the result of complete or near total insulin deficiency. Type-2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production.

    Insulin is the hormone produced by pancreas and is the main regulator of glucose metabolism in the body. Other etiologies for DM include genetic disorders, gestational diabetes, drug induced etc.

    Risk factors for developing type 2 DM include high cholesterol levels, high BP, high fat diet, high alcohol consumption, sedentary lifestyle, overweight, giving birth to a baby weighing 9 pounds and above. Ageing is significant risk factor for type 2 DM.

    Diagnosis – Criteria for diagnosis of DM are (1) symptoms of diabetes + RBS equal to or greater than 200 mg/dl or (2) FBS equal to or grater than 126 mg/dl or (3) two hour plasma glucose equal to or greater than 200 mg/dl during an oral glucose tolerance test.

    Symptoms of type – 1 are often dramatic and comes on very suddenly in childhood often in association with some illness like viral infection or urinary tract infections. But in case of type – 2 DM, symptom could be present a decade ago in the form of impaired glucose tolerance.

    Common symptoms of diabetes are – fatigue, unexplained weight loss, excessive thirst, excessive urination, excessive eating, poor wound healing, infections, altered mental status, blurred vision etc.

    Complications – both forms of DM ultimately lead to high blood sugar level, a condition called hyperglycemia. Over a long period of time, it damages the retina of the eye (diabetic retinopathy), which is the leading cause of blindness, the kidneys (diabetic nephropathy), a leading cause kidney failure, the nerves (diabetic neuropathy), leading cause of wounded foot ulcers which frequently lead to foot and leg amputations and the blood vessels because of usually associated high cholesterol levels and leads to increased risk of heart disease, raised blood pressure and stoke. Damage to nerves in autonomic nervous system can lead to gastro paresis or chronic constipation or chronic diarrhea and inability to control heart rate and blood pressure during postural changes.

    Hypoglycemia or low blood sugar occurs from time to time in most people with diabetes who are on treatment. It may result from over treatment, missing a meal, doing excessive exertion, any acute illness. Common symptoms are headache, dizziness, poor concentration, tremors of hands and sweating.

    Diabetic ketoacidosis is a serious acute complication in which uncontrolled hyperglycemia causes build up of waste products called ketones  in blood which can cause nausea, vomiting, altered mental state or even weakness of whole body. It is precipitated by infection, stress, trauma, other medical emergencies like stroke or heart attack.

    Hyperosmolar hyperglycemic non ketosis syndrome is also an acute complication associated with very high level of blood glucose with severe dehydration.

    Diabetes prevention – There is no proper way to prevent DM – 1 but DM – 2 can be prevented by controlling weight (normal/near normal weight), regular exercise for 20 minutes three times a week, quitting smoking and alcohol, decreased oil consumption. This is called lifestyle modification. Also some new drugs help in prevention up to some extent. If DM – 2 is diagnosed then 1st line of treatment is medical nutrition therapy I. E. diet as advised by a dietician and regular exercise. 2nd line of treatment is oral hypoglycemic agents like metformin, glimiperide etc.

    3rd line is Insulin which is the 1st line of treatment for DM, type – I. Usually insulin are ultra short acting, short acting, intermediate, long and ultra long acting. Nowadays newer preparations are available which can be given once a day rather than 3 – 4 times a day.

    Newer advancements – new drugs which may stop damage to insulin secreting cells and newer insulin like intranasal/oral. If patient has complications of diabetes (eye, kidney or nerves),it should be dealt accordingly. The skin should be taken care of by keeping it supple, hydrated to avoid sores and cracks that can become infected. See a dentist regularly to prevent gum disease. The feet should be washed and examine daily looking for small cuts, sores or blisters that may cause problems later. If you or someone you know already have diabetes, your focus should be on preventing the complications which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation and death. Mainstay of treatment will be regular blood glucose monitoring and regular follow up with your physician.                                                            

    Author is an MD (General Medicine)
    Consultant Physician,
    Shija Hospitals and Research Institute.



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