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Diabetes Mellitus





Diabetes Mellitus (DM) is known since ancient age, it was described by Charaka and Sushurata as ‘sweet urine’ or ‘honey urine’ in ancient writings.

The ‘diabetes’ is a Greek word and it means “passing though; or a large discharge of urine. And the Mellitus is Latin word which means pleasant tasting, like honey.

Diabetes Mellitus is commonly known as diabetes. The diabetes is a metabolic disease that causes high blood sugar. It is multi factorial clinical syndrome of glucose metabolism due to deficiency insulin secreted by beta cells of pancreas, resulting in impaired carbohydrate tolerance and persistent hyperglycemia with or without glycosuria, characterized by polyuria, polydipsia, polyphagia and weight loss.

Types of diabetes:

(1) Primary diabetes

(2) Secondary diabetes

(1) The primary Diabetes Mellitus syndromes are:

Type I - Insulin Dependent Diabetes Mellitus (IDDM)

Type II - Non-Insulin Dependent Diabetes Mellitus (NIDDM)

The main difference between IDDM and NIDDM clinical based:

If insulin therapy is needed to control the sugar level and prevent other diabetic related problems, the patient has IDDM.

If insulin therapy is not required to control the sugar level and prevent and other diabetic related problems then the patient has NIDDM.

Further if the patient has NIDDM but insulin is required to maintain acceptable sugar level, then the patient has insulin-treated NIDDM.

Juvenile onset – the exact cause in not known but the probability of its cause is autoimmune disorder.

Maturity onset diabetes of the young (MODY) is a rare primary diabetes mellitus syndrome.

(2) Secondary diabetes Mellitus Syndrome

Gestation Diabetes Mellitus (During pregnancy)

Endocrinal disorder

Chronic Pancreatitis

Haemochromatosis (it is a disorder that leads to our body stores excessive iron)

Here I am going to discuss in details about type I and type II diabetes mellitus syndromes:

The pancreas is about 6-inch long secretary gland situated in our abdomen near liver and small intestine. The pancreas plays dual role as an endocrine gland as well as exocrine gland.

As an endocrine system pancreas secretes hormones, which regulate blood sugar and they are insulin and glucagon.

Insulin is secreted by beta cells of pancreas which promotes glucose uptake, glycogenesis, lipogenesis, and protein synthesis of skeletal muscle and fat tissue through the tyrosine kinase receptor pathway.

Glucagon is secreted by the alpha cells of pancreas, it stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. When your sugar level is down the function of glucagon hormone is started.

Type I diabetes is an auto-immune disorder in which the immune system is activated itself and destroy the beta cells in the pancreas which produce insulin. The cause of the auto-immune is unknown. As of now there is no cure and it cannot be prevented. People with Type 1 diabetes must use insulin injections to control their blood glucose. Type 1 is the most common form of diabetes in people who are under age 30, but it can occur at any age. Ten percent of people with diabetes are diagnosed with Type 1.

Type 2 diabetes originates from a combination of genetics, inactivity and lifestyle factors. Overweight or obesity increases risk. Carrying extra kilos, especially around your waist/belly, makes your cells more resistant to the effects of insulin on your blood sugar. This condition runs in families. Family members share genes that make them more likely to get type 2 diabetes and to be overweight.

Symptoms of diabetes:

Frequent urination

Increased thirst.

Extreme fatigue

Increased hunger

Dry mouth.

Weight loss

Blurred vision.

Numbness or tingling in the hands or feet.

Slow-healing of wound and cuts.

Dry and itchy skin.

Frequent yeast infections or urinary tract infections.

Diagnosis and Tests

Diabetes is diagnosed by testing of blood glucose level, if your reports show any of following result you may diagnosed with diabetes mellitus.

Your fasting blood sugar level is equal to or greater than 120 mg/dl

Your two random blood sugar tests result is over 200 mg/dl

Your PP or oral glucose tolerance test with results over 200 mg/dl

Your Hemoglobin A1c (HbA1c) test is greater than 6.5 percent on two of separate days reports.

Type of tests commonly used in India:

Type of test Normal Pre-diabetes Diabetes

Fasting glucose test Less than 100 100-125 126 or higher

Random glucose test Less than 140 140-199 200 or higher

HbA1c test Less than 5.7% 5.7 - 6.4% 6.5% or higher

Diabetes Mellitus - Management and Treatment

As of now there is no cure for diabetes, but it can be treated and controlled. The goals of managing diabetes should be to:

Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.

Maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as possible.

Maintain your blood pressure around 130/80 it should not go over 140/90.

Decrease or possibly prevent the development of diabetes-related health problems.

Do the following things routinely:

Maintain balance diet

Exercising regularly

Adhere to medication prescribed by your physician, and closely following the guidelines on how and when to take it.

Monitor your blood glucose and blood pressure levels at home

Click here to know the group of medicines used in diabetes mellitus

Complications arise due diabetes mellitus if left untreated:

Many long-term complications gradually arise, some of those are listed below:

MACROVASCULAR DISEASES:

Cardiovascular diseases (Heart disease) - diabetes increases the risk of various heart diseases, like coronary artery disease, heart attack, chest pain (angina), stroke and narrowing of arteries (atherosclerosis).

MICROVASCULAR DISEASES:

Neuropathy (Nerve damage) Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Retinopathy (Eye damage) - Clinical impact is mainly on peripheral nervous system. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), and leads to blindness. It also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

Nephropathy (Kidney damage) - The kidneys contain millions of tiny blood vessel clusters known as glomerulus that filter waste from our blood. If diabetes left untreated it can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

OTHERS

Foot damage - nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications, like ulceration, wounds, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

Skin disease - diabetes may lead you more susceptible to skin problems, including bacterial and fungal infections.

Hearing impairment. Hearing problems are more common in people with diabetes.

Alzheimer's disease - type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease the higher your blood sugar level, the greater the risk appears to be.

Depression - depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.


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#nephropathy #neuropathy nephropathy #sugar #madhumeh #cardiovascular #diseases #pharmacology #alzheimer #depression #nerve

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