Diabetes Mellitus

1. GLUCOSE

• Most of what we eat is broken down into a simple sugar called glucose.
• Food and liver are the main sources of Glucose in the body.
• Liver stores and makes Glucose .
• Glucose provides the energy your body needs for daily activities.
• The blood and blood vessels are the highways that transport glucose from where it is either taken to the cells where it is used or stored.
• Glucose cannot get into the body’s cells by itself. It needs a helper insulin
• Insulin helps to let the Glucose into the cells for use as energy. gless

2. INSULIN:

• Pancreas is an organ behind the stomach.
• The Beta cells of the pancreas produces insulin which is a hormone.
• The pancreas releases insulin into the blood which helps to lets glucose into the cells.
• These processes by which our bodies use digested food for energy and growth is referred to as metabolism.

3. DIABETES MELLITUS:

• Diabetes mellitus commonly referred to as diabetes, is a group of metabolic disorder.
• It is disease in which your blood glucose levels are too high over a prolonged period.
• It is either because the insulin production is inadequate, or because the body cells do not respond properly to insulin or both.

4. TYPES OF DIABETES

(A) Type 1 Diabetes

• Types 1 Diabetes results from the pancreas failure to produce enough insulin due to loss of Beta cells
• This form was previously referred to as “Insulin Dependent Diabetes Mellitus (IDDM) or “Juvenile Diabetes” or Early-onset Diabetes
• The cause is unknown.
• Type 1 diabetes cannot be prevented.
• The onset is sudden and if not treated it can be fatal.
• People usually develop type 1 diabetes before their 40th year
• 10% of all diabetes cases are type 1
• Patient with type 1 Diabetes will need to take insulin injections for the rest of their life.

(B) Type 2 Diabetes

• It begins with insulin resistance, a condition in which cells fail to respond to insulin properly.
• This form was previously referred to as “Non-Insulin Dependent Diabetes Mellitus (NIDDM)” or “Adult Onset-Diabetes “.
• The onset of type 2 diabetes is gradual and if not treated it can lead to complications.
• Type 2 diabetes develop after their 50th year
• The most common cause are excessive body weight, over-eating and insufficent exercise.
• Some people may be able to control their type 2 diabetes symptoms by losing weight and healthy diet.
• It may get worse and the patient may end up with insulin dependent
• 90% of all diabetes cases are type 2

(C) Gestational Diabetes:

• It occurs when pregnant women without a previous history of diabetes develop high Blood Sugar.
• Their body are unable to produce enough insulin
• Blood glucose level usually return to normal after childbirth.
• Women who have had gestational diabetes have an increased risk of developing type II diabetes later in life.
• Repeated pregnancy may increase the risk of developing type 2 diabetes.

(D) Other Specific Types

i. Pre-diabetes:

• It is indicated when a person blood glucose are higher than normal but glucose are higher than normal but not high enough for a diagnosis of type 2 diabetes mellitus spend many years in a state of pre-diabetes

ii. Endocrine conditions

• It can precipitate type II diabetes in susceptible individuals through antagonists to insulin.
• Thyford hormones- Thyrotoxicosis
• Glucocorticoids- Cushing’s syndrome
• Growth hormones- Acromegaly

iii. Diabetes associated with genetic syndrome.

• Down’s syndrome
• Klinefelters syndrome
• Turner’s syndrome

iv. Injury to the pancreas

• Trauma
• Infections
• Tumor- cancer
• Surgical removal of pancreases

v. Drug – induced

• Corticosteroids
• Thiazide diuretics

vi. Stressful condition

• Stressful conditions helps to precipitate type 1 diabetes

5. RISK FACTORS

a. Aging:

• Types II diabetes is principally a disease of the middle aged and elderly.

b. Genetic Factors:

• Genetic factors are responsible for some of type 1 and types 2 diabetes.

c. Family History of Diabetes

• Family histories are risk factors in both type 1 and type 2 diabetes but more common in type II diabetes.

d. Obesity / overweight

• Increase the risk of development type II diabetes

e. Sedentary lifestyle

• Increase the risk of development type II diabetes

f. Over-eating

• Increases the risk of development type II diabetes

g. Hypertension and hyperlipidemia

• Hypertension and hyperlipidemia makes insulin to be insensitive thereby increasing the risk of development type II diabetes

h. History of Gestational and Pre-diabetes

• Increase the risk of developing type II diabetes.

6. Symptoms and Signs:

a. Classical symptoms of type I diabetes:

• Frequent urination
• Excessive thirsty
• Extreme hunger
• Weight loss

b. Many of type II diabetes are asymptomatic or have non-specific symptoms such as:

• Tiredness
• Fatigue
• Malaise

c. Uncontrolled diabetes may present with:

• Frequent urination
• Excessive thirsty
• Extreme hunger
• Tiredness
• Fatigue
• Malaise
• Blurring vision
• Mood change
• Irritability
• Difficulty in concentrating
• Apathy
• Frequent genital candidasis in woman
• Recurrent skin infection like boils
• Delay wound healing

7. Complication of Diabetes

a. Brain damage

• Transient Ischemic Attack (TIA)
• Stroke

b. Eye damage

• Cataracts
• Blindness

c. Heart damage

• Myocardial Ischemic/ infraction (Heart attack) with its consequences such as;

Cardiac arrest

Irregular heart beat

Cardiogenic shock

Heart failure

e. Nerve damage

• Peripheral Neuropathy: numbness, pain or burning sensation of legs, fingers.

f. Foot damage

• Serious infection resulting in chroniculcer which may end with may end with amputation of foot or leg or toe.

8. Diagnosis

a Fasting Blood Sugar (FBS):

• fast for 8 to 10 hours before test
• Normal range: 70 to less than 110mg/dl
• Diabetes: 126mg/dl and above

b. Random Blood Sugar (RBS)

• Normal in average adults : 79 to less than 140mg/dl
• pre-diabetes: 140-199mg/dl.
• Diabetes : 200mg/dland above.

c. Glucose Tolerance Test (GTT)

• 8-10 HOURS FASTING
• Ask patient to take 75 grams of oral sugar.
• determine the level of sugar continually for 2 hours.

d. Other Specific Tests

• Blood Pressure check
• Cholesterol Profile
• Kidney Function Test
• Urine – Ketones

9. Prevention

i. Types 1 and Gestational diabetes they are no sure way to prevent it.

ii Types 2 diabetes:

Majority of type 2 can be prevented by embarking on healthy lifestyle such as:

a. Healthy weight

b. Healthy diet

• More of fish
• More of vegetables and fruits
• Less fat foods
• Eat less red meat and saturated fat

c. Physical activities

Avoid over-eating

Reasonable alcohol intake

Regular medical examinations

10. Management

Accept the condition and look for solution

Health education about diabetes

• types of diabetes
• how to measure and administer insulin injection

Learn from those suffering from diabetes how they have been managing their condition.

Learn how to measure blood pressure and blood glucose level.

Take a lot of water in order to protect your kidney

Take a lot of vegetables

Limit your alcohol consumption

Stop smoking

Protect yourself from injury

Live a healthy lifestyle

• Healthy weight
• Healthy diet
• Physical activities
• Low carbohydrate intake
• Don’t take free sugar

b. Medication and healthy lifestyles

• Type 1 diabetes the best treatment is insulin
• Type 2 diabetes and pre-diabetes

The first line of treatment is dietary modification.

If no improvement then oral medication.

c. Treatment of complications

11. Conclusions

• Gestational diabetes and Pre-diabetes if well managed will reduce the risk of developing type 2 diabetes.
• There is no sure way to prevent type l diabetes but healthy lifestyles will reduce the progress of the diseases.
• Majority of type ll diabetes can be prevented through healthy lifestyle.
• Regular medical examination is very important. It will help for early diagnosis and early treatment.
• If diabetes is well managed patient will live their normal life.