Diabetes mellitus, a bane of the advancing world

Diabetes mellitus, the cause, pathology, complications, management and prevention - A medical perspective. Chronic diseases are often difficult to treat and effective prevention and management is perhaps the best option. Read on to find the guide to knowing more about Diabetes with the medi-lingo simplified for all to understand and comprehend.

Diabetes mellitus, a bane of the advancing world

Often called as Diabetes, the term generally refers to Diabetes mellitus which is an error in glucose metabolism. Another similar but completely different term is Diabetes insipidus which refers to the failure of kidneys to conserve water leading to massive dehydration and excessive thirst. Now this article is about Diabetes mellitus also loosely called as ‘high blood sugar' which comes from the hyperglycaemic state in which the patients land up.

The paradox in Diabetes mellitus is that while the blood contains more than the required amount of glucose, the body tissues actually starve due to glucose deficiency. Thus the condition of hyperglycaemia refers to the glucose/sugar content of the blood.

Today we see the chronic diseases gradually taking over the place of infectious diseases as a burden to public health. With the ever growing world and all its technological advancements, the scene is set for the diseases of development too. Cancer, Diabetes mellitus, Cardiovascular illnesses are some of the rising health problems in the present scenario. Education and prevention is perhaps the best means to tackle these diseases, hence in public health we have the concept of Information, Education & Communication (IEC) which aims to spread awareness and bring about a change in the attitude and practices of the population towards a positive goal.

What is Diabetes type 1 and Diabetes type 2?

Type 1 Diabetes mellitus , also called as Juvenile diabetes mellitus and Insulin dependent diabetes mellitus results due to reduction of insulin levels in the body. Insulin is one of the metabolic hormones secreted from the Pancreas (beta islet cells) that facilitates the transport of glucose from the blood stream to the tissues.
At times due to immune system dysfunction, the body's immune system recognizes the beta islet cells as foreign particle and starts their destruction. Due to this, the levels of insulin fall in the body leading to a glucose excess in the blood stream. Insulin is thus prescribed for such patients mostly in injectable form.

Type 2 Diabetes Mellitus on the other hand is non insulin dependent Diabetes Mellitus and mostly has an adult onset. In this case, the scenario is of an insulin resistance where endogenous insulin is produced but not utilized. The defect lies in the insulin receptors present on the body tissues that respond to the presence of insulin and take part in the glucose uptake process.

Symptoms of Diabetes Mellitus?

The commonest symptoms of Diabetes Mellitus are:
  • Polyuria – Increased frequency as well as amount of micturition/urination. Generally compared with the subject's routine.

  • Polyphagia – Increased appetite.

  • Polydipsia – Increased thirst.

  • As can be noticed quite apparently that all of the above symptoms are subjective and may be purely physiological or normal in a person while may denote Diabetes Mellitus in another. Their importance lies in the unusual occurrence of these symptoms. For eg. after a long run or an exercise or staying out in the sun for hours, we automatically feel thirsty and hungry too. And our urinating frequency is increased during winters as a part of maintenance of the electrolyte balance by the body. But a sudden deviation from the normal routine is not expected in course of normal lifestyle. Hence, one needs to look out for the abnormal occurrence of these symptoms as warning signs of Diabetes Mellitus.

    Diagnosis of Diabetes Mellitus

    Diabetes Mellitus is commonly diagnosed by the following means in a health care setup:
  • Fasting Serum Glucose for eg. requires a fast of 8-10 hours before the blood sampling is done. A value of <110 mg/dL is normal, between 110-125 mg/dL indicates an impaired fasting glucose while values more than 126 mg/dL indicate Diabetes Mellitus.

  • Post-prandial Serum Glucose

  • Glycosylated Hemoglobin estimation

  • C-peptide analysis – to differentiate between type 1 and 2 Diabetes Mellitus

  • The values etc. of these tests are generally compared from a reference that may vary according to the sample taken (blood or serum) and the type of test applied. It is the physician who ultimately diagnoses a patient as having Diabetes Mellitus.

    Emergencies & Complications of Diabetes Mellitus

    Diabetes Mellitus, if not diagnosed and effectively managed can progress to cause a variety of emergencies and complications.
    Diabetic Ketoacidosis (DKA) is one of the commonest complications of Diabetes Mellitus in which there is an accumulation of ketone products in the body. It occurs commonly with type 1 DM but may be associated with type 2 DM as well. DKA occurs due to a deficiency of glucose (due to insulin deficit) which causes the body to utilize fatty acids as the source of energy and release ketone bodies. The ketone bodies disrupt the acid-base balance and cause metabolic acidosis. As a response to this, the body hyperventilates leading to Kussmaul's characteristic breathing. This pattern of breathing is slow and rapid in the beginning but progresses to deep and labored pattern as acidosis advances. This breathing pattern is accompanied by abdominal pain, nausea and vomiting. If not managed as an emergency, the condition is typically fatal. Prompt hospitalization is thus called for.

    As Diabetes Mellitus advances, organs are gradually involved leading to the following common entities:
  • Diabetic Retinopathy – Involvement of the retina of the eye leading to reversible and later irreversible changes and gradual loss of vision. Defective vision that is not corrected by spectacles/visual aids may indicate towards Diabetic retinopathy.

  • Diabetic Nephropathy – Involvement of the kidneys and their function of urine production and electrolye balance maintenance.

  • Diabetic Neuropathy – Due to the microvascular changes occurring in Diabetes Mellitus and affecting blood supply to the nerves leading to symptoms like numbness and loss of muscle power etc.

  • Along with these, virtually every organ is affected by diabetic changes unless the sugar levels are brought under control.

    What can be done for Diabetes Mellitus?

  • Diet – avoid eating fat rich and junk foods. Trans fats are to be avoided at all costs. Include more of vegetables and fruits in your diet to increase the fibre content.

  • Smoking – A strict no-no. Smoking is something that is associated with virtually every other ailment in medical sciences. Hypertension, Coronary Heart diseases, Lung cancer, Emphysema and what not. It is always a better choice to stay away from this deadly habit and to curtail it as effectively as possible if you are already in it. Appropriate counseling may be required.

  • Alcohol – Avoidance is necessary. Limitation if strictly adhered to should also help

  • Body weight and BMI – Obesity is one of the factors associated with DM and hence all efforts should be made to stay fit. BMI or Body Mass Index is measured by body mass in Kilogram divided by height in metres squared. Latest criteria for a normal BMI should be checked and followed.

  • Sedentary to active – Exercise, gymming, yoga and other means to an active lifestyle are always a welcome.

  • I have Diabetes mellitus, now what?

    Diabetes Mellitus is a disease that can be effectively managed though not cured completely. Its progression can be halted by early diagnosis and treatment regimes. One should strictly adhere to the treatment guidelines as they are responsible for maintaining the correct blood glucose levels in the body. Hypo- and hyper-glycaemia are both life threatening conditions that often result because of the patient ignoring routine medication.

    Lifestyle modifications as mentioned above should be followed in order to manage Diabetes Mellitus in a more effective manner. Avoidance of diet having high glucose/sugars should also be brought to practice.
    Monitoring of blood glucose levels at regular intervals is required to keep a check on the disease progression. Patients can either get their glucose levels checked at routine laboratories or can keep blood glucose kits, widely available in the market to monitor the sugar levels themselves.

    Last but not the least, it is important to get an ophthalmologic (eye) examination routinely and consult the physician for any abnormalities detected. Early diagnosis and continuing proper treatment is the best way to control Diabetes Mellitus.

    Lead a happy, healthy life …


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