Patients Care

DIABETES

Diabetes mellitus often simply referred to as diabetes—is a condition in which a person has a high blood sugar (glucose) level as a result of the body either not producing enough insulin, or because body cells do not properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose, to turn into energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia), leading to various potential medical complications.

There are many types of diabetes, the most common of which are:

• Type 1 diabetes: results from the body's failure to produce insulin and requires the person to inject insulin.

• Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.

• Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy.

Causes

Causes and Risk Factors of Diabetes

The cause of Type 1 diabetes is genetically based, coupled with an abnormal immune response.

The cause of Type 2 diabetes is unknown. Medical experts believe that Type 2 diabetes has a genetic component, but other factors also put people at risk for the disease. These factors include:

  • Sedentary lifestyle.
  • Obesity (weighing 20 percent above a healthy body weight).
  • Advanced age
  • Unhealthy diet
  • Family history of diabetes.
  • Improper functioning of the pancreas.
  • Medication (cortisone and some high blood pressure drugs).
  • Women having given birth to a baby weighing more than 9 lbs.
  • Previously diagnosed gestational diabetes.
  • Previously diagnosed impaired glucose tolerance.

Type 2 diabetes is determined primarily by lifestyle factors and genes. These are:

  • Diet is a major factor responsible for causing diabetes. Eating too many carbohydrates, fats and proteins are harmful for the body. Our body generally needs a balanced diet to perform vital functions. Too much food hampers the pancreas to perform its function of insulin secretion. The blood sugar level raises leading to diabetes. Normally people are in habit of eating food rich in refined carbohydrate like biscuits cake ice-cream etc so the risk of diabetes increases.
  • Obesity is also the major factor causing diabetes. Excessive body weight as compared to height of an individual serves as a predisposing factor for diabetes. Due to extra amount of fat the insulin does not function properly in the body. Due to increased fat in the body the muscle and tissues become resistant to insulin.
  • Virus infections can also lead to diabetes. Viruses like coxsackie b virus may infect the pancreas impairing the release of insulin and causing increased blood sugar level.
  • Nowadays life style of people has changed drastically. They no longer believe in physical work and exercise and prefer a comfortable life sitting for long hours in a chair. It has been noted that the lesser active a person is, the greater is the risk of developing diabetes.
  • The age is the commonest predisposing factor of diabetes. It has been noted that as a person grows older particularly above the age of 45, the chances of developing diabetes are increased.
  • Emotional stress also leads to diabetes. Nowadays, people have a highly stressed life, busy all the time, exertive work, pancreatic insufficiency due to irregular and chaotic lifestyle deeply influences the metabolism of the body. Even grief, worry, death of a close person can alter blood sugar levels of the body.
  • People who smoke frequently are highly susceptible to develop diabetes. They are much prone to developing retinopathy and joint immobility. If a diabetic patient does not stop smoking then there are chances of premature mortality.

Sign and symptoms

Usually, the symptoms of Type I diabetes are obvious. That is not true for Type 2. Many people with Type II do not discover they have diabetes until they are treated for a complication such as heart disease, blood vessel disease (atherosclerosis), stroke, blindness, skin ulcers, kidney problems, nerve trouble or impotence.

Many of the signs of Type 1 and Type 2 diabetes are similar. In both, there is too much glucose in the blood and not enough in the cells of your body. High glucose levels in Type 1 are due to a lack of insulin because the insulin producing cells have been destroyed.

Type 2 diabetes occurs when the body's cells become resistant to insulin that is being produced. Either way, your cells aren’t getting the glucose that they need, or your body lets you know by giving you these signs and symptoms.

The warning signs and symptoms are:

Type 1:

  • Frequent urination
  • Increased thirst
  • Extreme hunger
  • Unexplained weight loss
  • Extreme fatigue
  • Blurred vision
  • Irritability
  • Nausea
  • Vomiting

Type 2:

Any Type I symptom, plus:
  • Unexplained weight gain
  • Pain
  • Cramping
  • Tingling or numbness in your feet
  • Unusual drowsiness
  • Frequent vaginal or skin infections
  • Dry, itchy skin
  • Slow healing sores
Note: If a person is experiencing these symptoms, they should see a doctor immediately.

Management

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia and is diagnosed by demonstrating any one of the following:

  • Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).
  • Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
  • Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L (200 mg/dL).
  • Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion was recommended by the American Diabetes Association in 2010.
  • Diabetes mellitus is a chronic disease which is difficult to cure. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible without presenting undue patient danger. This can usually be achieved with close dietary management, exercise and use of appropriate medications (insulin only in the case of type 1 diabetes mellitus. Oral medications may be used in the case of type 2 diabetes, as well as insulin).
  • Modifying the diet to limit and control glucose (or glucose equivalent, e.g., starch) intake and in consequence, blood glucose levels, is known to assist type 2 patients, especially early in the course of the condition's progression. Additionally, weight loss is recommended and is often helpful in persons suffering from type 2 diabetes.
  • Several dietary modifications using dietary supplements are sometimes recommended to those with type 2 diabetes.
  • There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds.
    In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure in patients with hypertension, cholesterol in those with dyslipidmia. Exercising more, smoking less or ideally not at all and consuming a recommended diet.
  • Patients with foot problems are also recommended to wear diabetic socks and possibly diabetic shoes.

Treatment options

  • Lifestyle modifications
  • Oral Antidiabetic Drugs
  • Insulin