Diabetes mellitus

Diabetes mellitus is a metabolic disease characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. When food is digested it eventually enters our bloodstream in the form of glucose. Cells utilize the glucose for growth and energy. However, without the help of insulin, the glucose cannot enter our cells. Insulin, a hormone, is produced by Beta cells in the Islets of Langerhans, which are in the pancreas. After eating, the pancreas automatically releases an adequate amount of insulin to transport the blood glucose into the cells, which results in lower blood sugar levels. If you have diabetes, the glucose in the bloodstream does not enter the cells (at all or not enough), so glucose builds up until levels are too high, resulting in a condition called hyperglycemia. This happens for one of two main reasons: The body is producing no insulin - as is the case in Diabetes Type - 1 The cells do not respond correctly to the insulin - as occurs in Diabetes Type -2 Types of diabetes 1. Type - 1 Diabetes or Insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus 2. Type 2 Diabetes or Non-Insulin dependent diabetes mellitus (IDDM) 3. Malnutrition Related Diabetes Type 1 Diabetes Type 1 occurs suddenly and develops most often in children and young adults. In this type the pancreas is unable to produce adequate amount of insulin. This might be due to virus of autoimmunity. The child is often underweight Acidosis is common Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the bodys system for fighting infectionthe immune systemturns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas becomes incapable of making insulin.

Causes Infections : like viral infections Acute stress: physical injury, surgery and emotional distress may cause increase in secretion of catabolic hormones which may increase the disorder. Diet: wheat and milk shown to have the strongest diabetic effect.

Type 2 Mostly occur in adults and the person is usually obese. It develops slowly and more stable. In this type the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The release of insulin by the pancreas may also be defective and suboptimal.

Causes Heredity Life style: obese people, inactive life style. Age: middle age and elderly Abdominal fat: people with high waist/hip ratio i.e. fat in the abdominal cavity has a greater risk Pregnancy : women genetically disposed to both type of diabetes

Malnutrition Related Diabetes MellitusIn this type of diabetes there is a history of childhood malnutrition and calculi are formed in the pancreas leading to inflammation and destruction of the cells. Gestational diabetes Blood sugar elevation during pregnancy is called gestational diabetes Gestational diabetes usually resolves once the baby is born. However, 35% to 60% of women with gestational diabetes will eventually develop type 2 diabetes over the next 10 to 20 years, especially in those who require insulin during pregnancy and those who remain overweight after their delivery. Patients with gestational diabetes are usually asked to undergo an oral glucose tolerance test about six weeks after giving birth to determine if their diabetes has persisted beyond the pregnancy, or if any evidence (such as impaired glucose tolerance) is present that may be a clue to the patient's future risk for developing diabetes.

Clinical Symptoms Hyperglycaemia: increased bold glucose level. As glucose cannot enter the cells in the absence of insulin and builds up in the blood leading to hyperglycemia. Glucosuria: When the level of glucose in blood exceeds the renal threshold of 180mg/dl, it spills over into the urine leading to glucosuria Dehydration as glucose is excreted in the urine it takes water along with it, leading to dehydration. Polyuria frequent and abnormal out flow of urine is seen and Nocturia is more common. Polydipsia Excessive thirst because water is being lost through the kidneys. Polyphagia increased hunger as the cells are not receiving the glucose for their energy needs. Blurred vision, skin irritation/infection as well as a feeling of weakness If the blood glucose levels are not checked and controlled even at this stage, it leads to more complications likeFluid and electrolyte imbalances Keto acidosis occurs as fats are broken down for energy. This is more commonly seen in type I diabetes. Acidosis is not common in type II diabetes. Coma occurs if the acidosis become severe and it may be fatal. If severe hyperglycaemia is not detected or if stress or illness occurs, the individual may go into coma. Individuals with type I diabetes are vulnerable to diabetic ketoacidosis characterised by hyperglycaemia and ketonemia which occur either in insulin deficiency or from stress. Hyperglycaemia with keto acidosis or in non ketotic state can be fatal. Vigorous therapy in the form of insulin, fluids and electrolytes is given. Adults with type II diabetes are likely to develop the hyperglycaemic, non ketotic state with glucose values exceeding 750g/dl without significant ketonemia. This hyperglycaemic, non ketonic state can be precipitated by excessive sugar intake, dehydration, heat exposure, illness or drug therapy. Diagnosis: The guiding principles for treating diabetes are early detection and prevention of complications. The glucose tolerance test is used for diagnosis. The WHO has proposed a change in the original GTT. In the modified GTT, 75g of glucose is given orally after checking the fasting levels in blood. Two hours after giving the glucose load, the blood glucose is checked. The diagnosis may be made as follows:

Category Non diabetic Diabetic Impaired glucose tolerance (IGT) Gestational diabetes

Fasting glucose < 110mg/dl > 140mg/dl 120-140mg/dl 120-140mg/dl

After 2 hrs glucose < 140mg/dl > 200mg/dl 140-200mg/dl > 180mg/dl

Persons with impaired glucose tolerance tend to progress to diabetes at a rate four times that of normal persons.