Diabetes Mellites ; valuable Facts know it all

Dr. S. Khurram Pasha

1 year ago

Introduction:

Diabetes mellitus, commonly referred to as diabetes, is a chronic metabolic disorder characterized by elevated blood sugar levels over an extended period. It occurs when the body either does not produce enough insulin or is unable to effectively use the insulin it produces. Insulin is a hormone produced by the pancreas that regulates blood sugar (glucose) and allows it to enter the body’s cells to be used as energy.

Types ;

There are three main types of diabetes:

Type 1 Diabetes: It is an autoimmune condition where the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, individuals with type 1 need to take insulin daily to survive. This type is typically diagnosed in childhood or early adulthood and comprises around 5-10% of all diabetes cases.
Type 2 Diabetes: This is the most common form , accounting for around 90-95% of all cases. It occurs when the body becomes resistant to insulin or does not produce enough insulin to meet its needs. Type 2 diabetes is closely linked to lifestyle factors such as poor diet, lack of physical activity, obesity, and genetic predisposition. It is often diagnosed in adults but can also develop in children and adolescents.
Gestational Diabetes: This type of diabetes occurs during pregnancy in women who did not have diabetes before. It usually resolves after childbirth, but women who have had gestational diabetes have an increased risk of developing type 2 later in life.

Maturity onset diabetes of young ( MODY) : It is a rare and hereditary form of diabetes that typically develops in young people. Unlike Type 1 or Type 2 , which can affect individuals of any age, MODY is characterized by a specific genetic mutation that impairs the body’s ability to regulate blood sugar levels.

Causes ;

Here are the primary causes and risk factors associated with each type:

1. Type 1 Diabetes:

a. Autoimmune Response :

In Type 1 , the immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. The exact cause of this autoimmune response is not fully understood, but it is believed to involve genetic and environmental factors.

b. Genetics:

There is a genetic predisposition to Type 1 . Individuals with a family history of the condition have a higher risk of developing it.

c. Viral Infections:

Some viral infections, such as certain enteroviruses, have been linked to the onset of Type 1 diabetes, potentially triggering the autoimmune response.

2. Type 2 Diabetes:

a. Insulin Resistance:

The main cause of Type 2 diabetes is insulin resistance, a condition in which the body’s cells do not respond efficiently to insulin. This leads to an increased demand for insulin production by the pancreas.

b. Obesity:

Excess body weight, especially abdominal obesity, is a major risk factor for Type 2 diabetes. Fat cells release chemicals that contribute to insulin resistance.

c. Physical Inactivity:

A sedentary lifestyle can lead to weight gain and insulin resistance, increasing the risk of Type 2 .

d. Poor Diet:

Diets high in sugar, saturated fats, and processed foods can contribute to obesity and insulin resistance, increasing the likelihood of developing Type 2 .

e. Genetics:

Family history plays a role in Type 2 diabetes risk, indicating a genetic predisposition. However, lifestyle factors often interact with genetics in its development.

f. Age:

The risk of Type 2 increases with age, particularly after the age of 45.

g. Gestational Diabetes:

: Women who have had gestational diabetes during pregnancy are at higher risk of developing Type 2 later in life.

h. Polycystic Ovary Syndrome (PCOS):

PCOS is a hormonal disorder that can lead to insulin resistance and an increased risk of Type 2 in affected women.

i. High Blood Pressure:

Hypertension is often associated with Type 2 and can contribute to its development.

j. Ethnicity:

Certain ethnic groups, such as African Americans, Hispanic Americans, Native Americans, and Asian Americans, have a higher risk of developing Type 2 diabetes.

Diagnosis ;

The diagnostic criteria established by the American Diabetes Association (ADA) include the following :

A fasting plasma glucose (FPG) level equal to or higher than 126 mg/dL (7.0 mmol/L), or
A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or
A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis

Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion or an optional criterion remains a point of controversy.

Signs and Symptoms ;

Here are common signs and symptoms associated with diabetes:

1. Common Signs and Symptoms for Both Type 1 and Type 2 Diabetes:

a. Frequent Urination (Polyuria):

Hyperglycemic people often urinate more frequently, as the kidneys work to eliminate excess sugar from the blood.

b. Excessive Thirst (Polydipsia):

Increased urination can lead to dehydration, causing a persistent feeling of thirst.

c. Increased Hunger (Polyphagia):

Despite eating regularly, these people may experience extreme hunger due to the body’s inability to effectively use glucose for energy.

d. Unexplained Weight Loss:

Individuals with uncontrolled high blood glucose may lose weight despite eating more, as the body breaks down muscle and fat for energy.

e. Fatigue:

High blood sugar levels can lead to fatigue and a general sense of tiredness.

f. Blurred Vision:

Elevated blood sugar levels can cause temporary changes in the shape of the lens of the eye, leading to blurry vision.

g. Slow Healing:

Wounds, cuts, or sores may take longer to heal in these individuals.

h. Frequent Infections:

Diabetes can weaken the immune system, making individuals more susceptible to infections, especially yeast and urinary tract infections.

2. Specific Symptoms for Type 1 Diabetes:

a. Sudden Onset:

Type 1 diabetes often develops rapidly, with noticeable symptoms appearing over a short period.

b. Ketoacidosis:

In severe cases, untreated Type 1 diabetic patients can lead to diabetic ketoacidosis (DKA), characterized by nausea, vomiting, abdominal pain, and a fruity odor on the breath.

3. Specific Symptoms for Type 2 Diabetes:

a. Gradual Onset:

Type 2 diabetes tends to develop more slowly, and some people may not experience noticeable symptoms for years.

b. Tingling or Numbness:

Peripheral neuropathy can cause tingling, numbness, or pain in the hands and feet.

c. Darkened Skin Patches

: A condition called acanthosis nigricans can cause dark, velvety skin patches, often in skin folds like the neck, armpits, and groin.

d. High Blood Pressure:

Hypertension is frequently associated with Type 2 and may present as a symptom.

Management ;

There is no cure for diabetes, but it can be managed with lifestyle modification and medication. Blood glucose monitoring to keep track of sugar levels and make necessary adjustments.

Type 1 Diabetes ,

Type 1 diabetes is an autoimmune condition where the body doesn’t produce insulin. Managing it requires lifelong insulin therapy and careful monitoring:

Insulin Therapy:
- Individuals with Type 1 must take insulin to replace the hormone their body cannot produce.
- Multiple daily injections or insulin pumps are common delivery methods.
- The type, timing, and dosage of insulin may vary and should be tailored to individual needs.
Blood Sugar Monitoring:
- Regularly check blood sugar levels throughout the day, typically before meals and at bedtime.
- Adjust insulin doses based on blood sugar readings and anticipated activities.
Carbohydrate Counting:
- Learn to count carbohydrates to match insulin doses with meals.
- Calculate insulin-to-carbohydrate ratios for precise dosing.
Healthy Eating:
- Follow a balanced diet that includes carbohydrates, proteins, fats, and fiber.
- Seek advice from a registered dietitian for personalized guidance on meal planning.
Regular Exercise:
- Incorporate physical activity into your daily routine to improve insulin sensitivity.
- Monitor blood sugar before, during, and after exercise..
Blood Pressure and Cholesterol Management:
- Control blood pressure and cholesterol levels to reduce the risk of complications.
Continuous Glucose Monitoring (CGM):
- Consider using a CGM device to provide real-time data on blood sugar trends.
Regular Healthcare Visits:
- Frequent follow-up appointments with an endocrinologist or diabetologist are essential.

Type 2 Diabetes:

Type 2 diabetes typically involves insulin resistance and can often be managed with lifestyle changes, oral medications, and, in some cases, insulin:

Lifestyle Modifications:
- Adopt a healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
- Lose weight if overweight or obese, as even modest weight loss can improve insulin sensitivity.
- Engage in regular physical activity.
Oral Medications:
- Depending on blood sugar levels and individual factors, medications like metformin, sulfonylureas, DPP-4 inhibitors, SGLT-2 inhibitors, and others may be prescribed.
Insulin Therapy:
- In some cases, Type 2 may require insulin therapy if blood sugar remains uncontrolled.
Blood Sugar Monitoring:
- Regularly monitor blood sugar levels, especially if taking medications.
Blood Pressure and Cholesterol Management:
- Manage blood pressure and cholesterol levels to prevent complications.
Regular Healthcare Visits:
- Schedule regular check-ups with healthcare providers for monitoring and adjustments.

Management of Gestational Diabetes:

It occurs during pregnancy and requires special management:

Blood Sugar Monitoring:
- Monitor blood sugar levels regularly to ensure they stay within the target range.
- Some women may require insulin or oral medications to control blood sugar.
Healthy Eating:
- Follow a well-balanced diet that supports both maternal and fetal health.
- Work with a registered dietitian for guidance.
Regular Physical Activity:
- Engage in safe and moderate physical activity as advised by healthcare providers.
Medical Supervision:
- Receive prenatal care and regular check-ups to monitor blood sugar and the baby’s growth.
- Consult with a maternal-fetal medicine specialist or endocrinologist as needed.
Postpartum Monitoring:
- After childbirth, continue monitoring blood sugar levels as advised.
- Many women with gestational hyperglycemia revert to normal blood sugar levels post-pregnancy, but they should still be monitored for Type 2 risk.

Precautions ;

Prediabetes
consult a diabetic educator .and get self diabetic education.
Nutrition
Physical activity
Smoking cessation
Psychosocial care
Immunizations
Glycemic treatment
Therapeutic targets
Appropriate self-monitoring of blood glucose (SMBG)
Regular monitoring for complications
Laboratory assessment
Monitoring blood pressure and cholesterol levels to prevent complications.
Being cautious about alcohol consumption

Remember,

Hyperglycemic management is personalized, and individuals should work closely with healthcare providers to tailor their approach based on their specific needs and medical history. Early detection, proper m

Diagnostic criteria by the American Diabetes Association (ADA) include the following^[1]:

A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or
A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or
A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis