Diabetes mellitus
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| DIABETES |
Definition and epidemiology
As per the W.H.O. diabetes mellitus is defined as a heterogeneous metabolic disorder characterized by common feature of chronic hyperglycemia with disturbance of carbohydrate fat, protein,fat metabolism, at this point it is also important to understand another related terms metabolic syndrome also called syndrome "x" or insulin resistance syndrome consisting of a combination of metabolic abnormalities which increase the risk to develop Diabetes mellitus and cardiovascular disease.
Major feature of metabolic syndrome are Central obesity. Hypertriglyceridaemia ,low LDL cholesterol ,hyperglycemia and hypertension.
Top 5 countries with highest prevalence of Diabetes mellitus are India, China, US, Indonesia and Japan.
The rise in prevalence is more for type 2 diabetes then for type 1. It is anticipated that by the year 2030 the number of Diabetics globally will double from the present figure of 250 million.
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| SYMPTOMS OF DIABETES MELLITUS |
Classification and etiology(causes of diabetes)
Type 1 Diabetes mellitus hit constituents about 10% cases of DM it was previously determined as Juvenile onset diabetes due to its occurrence in younger age and was called insulin dependent Diabetes mellitus. Because it was known that these patient have absolute requirement for insulin replacement as treatment.
Based on underline etiology and causes of diabetes Type 1 Diabetes mellitus is further divided into two types-
Subtype 1A immune-mediated Diabetes mellitus characterized by autoimmune destruction of Beta-cell which usually leads to insulin deficiency.
Subtype 1B idiopathic Diabetes mellitus characterized by insulin deficiency with the tendency to develop ketosis but these patients are negative for autoimmune markers.
Type 1 Diabetes mellitus occurs only in patient under 30 year of age, autoimmune destruction of Beta-cells can occur at any age .In fact 5 to 10% patient who developed DM above 30 year of age are of Type 1 diabetes mellitus.
Type 2 Diabetes mellitus this type comprises about 80% cases of DM it was previously called maturity onset diabetes or non insulin dependent Diabetes mellitus of obese and non obese type. Although type 2 Diabetes mellitus predominantly effects older individual, it is now known that it also occur in obese adults and children and the term MOD for it is inappropriate, moreover many type 2 Diabetes mellitus patient also require insulin therapy to control hyperglycemia or to prevent ketosis and thus are not truly non-insulin-dependent contrary to its older nomenclature.
Other specific types of diabetes
Genetic defect of Beta cell function
Genetic defect in insulin action
Disease of exocrine pancreas
Endocrinopathies
Drug or chemically induced
Infections
Uncommon forms of immune mediated DM
Other genetic syndromes gestational Diabetes mellitus.
Gestational Diabetes mellitus
about 4% pregnant women develop DM due to metabolic changes during pregnancy, although they revert back to normal glycemic level after delivery ,these women are prone to develop DM later in their life.
Pathogenesis of Diabetes mellitus
Depending upon at etiology of DM, hyperglycemia may result from the following-
1.Reduced insulin secretion
2.Decreased glucose used by body
3.Increased glucose production
clinical features(sign and symptoms of Diabetes mellitus)
Type 1 Diabetes mellitus sign and symptoms
1.Patient of Type 1 Diabetes mellitus usually manifest at early age, generally below the age of 35. the onset of symptoms is often abrupt at presentation these patients have polyurea,polydipsia and polyphagia.
2.The patient are not obese but have generally progressive loss of weight, these patients are prone to develop metabolic complications such as ketoacidosis and Hypoglycemia episodes.
Type 2 diabetes sign and symptoms
This form of diabetes generally manifest in a middle age or beyond usually above the age of 40.The onset of symptoms in type 2 Diabetes mellitus it slow and insidious, generally the patient is asymptomatic. when the diagnosis is made on the basis of glycosuria for hyperglycemia, during physical examination or may present with polyurea and polydipsia.
The patient are generally obese and have unexplained weakness and loss of weight .
Metabolic complications such as ketoacidosis are infrequent.
Complication of diabetes
Acute metabolic complications
Diabetic ketoacidosis
Hyperosmolar hyperglycemic nonketotic coma
Hypoglycemia
Late systemic complications
Atherosclerosis
Diabetic microangiopathy
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Infections
Diagnosis of diabetes
1.urine testing
Glycosuria
Ketonuria
2.Single blood sugar estimation
3.Screening by fasting glucose test
4.Oral glucose tolerance test
Other tests-
Glycosylated hemoglobin
Glycated albumin
Extended GTT
Intravenous GTT
Cortisone primed GTT
Insulin assay
Proinsulin assay
Peptide assay
Islet autoantibodies
screening for diabetes-associated complications
Treatment of diabetes
Enhance insulin secretion
Sulphonyl, tolbutamide , glyburide, glipizide, gliclazide glimperide
Meglitinide /D-phenylalanine analogues
repaglinide,nateglinide
Glucagon-like peptide-1 receptor antagonist
Meglitinide this meglitinide analogue oral hypoglycemic is designed to normalise mil time glucose excursion not a sulfonyl ureas it acts in an analogue manner.
It differs markedly from sulphonyl urea causes little or no hypoglycemia in non diabetics and even in Diabetics episodes of glycemia are there it does not stimulate pancreatic Beta cells, metformin is reported to improve Lipid profile as well in type 2 diabetics..
