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Diabetes Mellitus

Characterized by derangement in the metabolism of glucose as well as abnotmalities in the met


abolism of fat, protein, and other substances.

Endocrine System Overview

-endocrine glands release hormones in to the bloodstream.

The Pancreas

-is an elongated, tapered gland thatvis located behindvthe stomach and secretes digestive enzy
mes and the hormones insulin ang glucagon.

- it secretes insulin and glucagon directly into the bloodstream.

Glucagon (a alpha cells)

-glucagonnis produced in the a cell as and is released when the glucose level in the blood is l
ow.

-the liver then convert stored glycogen into glucose and release it to the bloodstream.

Insulin (b beta cell)

-beta cells within the islets of langerhans produce insulin which is needed to metabolize glucose
within the body.

-insulin is a hormone that helps the body tissue absorb glucose so it can be utilized as a sourc
e of energy to fuel cellular function.

Pathogenesis of DM

In diabetes the microscopic islets of langerhan of the B cells of the pancreas produces little insu
lin or no insulin. The condition may also develop insulin resistance; muscle and fat cells reapond
poorly to insulin. Because of the problem in insulin amount and fuction, glucose level build up
in the blood and urine causing various manifestations.

Risk factors which predispose to diabetes

-Obesity

-Family history
-Delivered a baby greater than 9 pounds

-Has been diagnosed to have gestational diabetes or previously impared glucose tolerance

Classification of DM

Type 1 Diabetes Mellitus

-Develops if the body is unable to produce any insulin.

-this type of diabetes usually appears before the age of 40.

-accounts for between 5-15% of all people with diabetes

Type 2 Diabetes Mellitus

-a form of diabetes that results from the body's inability to make enough or properly use, (insul
in resistance)

-usually appears after the age of 40.

-it is the most common accounting for 90-95% of diabetes.

Gestational diabetes Mellitus

-is a carbohydrate intolerance of variable severity with onset of recognition during the present p
regnacy.

-typically diagnosed during the 3rd trimester andvisbrelated to the metabolic changes duringvpre
gnancy.

Complications

Metabolic Complication

Hypoglycemia or insulin shock

- there is increase in availbale glucose due to delay in eating, omission of food, or loss of food
by vomiting and diarrhea.

Hyperglycemia/diabetic ketoacidosis
- occurs when the person with diabetes has inadequate insulin due to omission of insulin consu
mption of more food than the insulin prescribed.

Degenerative Vascular Disease

-atherosclerosis is commonly associated with diabetes among elderly.

- any damage to the skin of the diabetic patient who has atherosclerosis either heals very slowl
y or never heals.

Diabetic nephropathy

- may cause protenuria, hyperstension, and a decline in glomerular filtration rate, leading to ren
al failure.

Diabetic Neuropathy

- may present with sensory orvdeficits, moror abnormalities or autonomic dysfunction.

Diabetic Retinopathy

- disease in the retina

- inbdiabetic it is frequent cause if blindness.

Infection

- carbohydrate tolerance is lowered which intensifies the diabetic condition.

- insulin is often orescribed temporarily bybthe physician when patient develops infection until th
e infection subsides.

Diabetic foot

- combination of neuropathy and vascular disease, whuch may be severe aneough to cause tiss
ue damage in the legs and feet.

- the number 1 reason for amputation.

Diagnostic and Monitoring test

Fasting Blood Sugar Test

- made after extracting venous blood from the patient who has fasted at least 12 hours.

Glucose Tolerance
- is a measure of the abilitybif the patient to utilze a specific amount og glucose.

- used ti establish a diagnosis of diabetes or impaired glucose tolerance in asymptomatic individ


uals whos FBS is between 110 and 140 mg/dL of plasma.

Glycosylated hemoglobin A1c (Hb A1c)

- thus test provides good index for monitoring overall diabetes control and therapeutic decisions
can be based on this value.

Self - monitoring Blood Glucose (SMBG)

- allows person who has diabetes to measure their blood glucose level at home, adjust treatme
nt regimens as needed, and achieve near normal blood glucose level.

Management of Diabetes mellitus

3 important Factors

-insulin or oral hypoglycemic agents

-healthy eating

-exercise

Insulin therapy

- Discovered by Banting and Best of Toronto Canada in 1921.

- it is protein in nature and identidication of its chemical structure has established thtbit cintains
naturally occuring amino acids.

- it is prepared in cystalline form from beef, pork, and sheep pancreas and more recently, hum
an insulin are also available

Oral Hypoglycemic Drugs

- useful in management of type 2 diabetes that cannot be controlled by diet alone.

Diet for Diabetic

- diet for diabetic patients should be individualized to meet the patient's specific needs, andvto
be effective, he must be made fully aware of the rationale for the dietarybrestrictions. Like other
therapeutic diets, the diabetic diet is a modification and should be based on an adequate nor
mal diet. It should consist of sufficient calories for the patient's activity, maintain desirable body
weight, and shoul be adequate in macronutrients and micronutrients.

Exercise

- people with diabetis are encourage to participate in either recreational or competitive physical
activities because of potential to improve cardiocascular fitness and physiological well-being and
fir social interaction and revreation as well.