Diabetes Mellitus

DM is a group of metabolic diseases in which there is high blood sugar levels over a prolong period of time.

Its symptoms are frequent urination, Increase Thirst, Increase hunger

If left untreated, diabetes can cause complications.

Acute complication include diabetes Ketoacidosis, hyperglycaemia  hyper-osmolar coma. Serious long term complication include: Cardiovascular disease, Stroke, kidney failure, foot ulcers, blindness.

There 4 main types of diabetes mellitus.

Type 1 DM (Formerly called Juvenile onset or Insulin dependent diabetes). The cause is unknown.

Type 2 DM (Formerly called Adult onset or non-insulin dependent. It is associated with insulin resistance and insufficient insulin production.  One of the associated cause is excessive body weight with genetic determinant that reflect diet.

Gestational DM: It occurs in pregnant women without a previous history of diabetes who develop high sugar level during pregnancy.

Symptoms and Signs 

The most common symptoms of DM are those of hyperglycaemia an osmotic diuresis cause by glycosuria leading to urinary frequency, polyuria and polydipsia that may progress to orthostatic hypotension and dehydration. Severe dehydration causes weakness fatigue and mental status changes.

Patient with type 1 DM present with symptomatic hyperglycaemia and sometimes with diabetic ketoacidosis DKA

Patient with type 2 may present with symptomatic hyperglyceamia but are often asymptomatic.

In some patients initial symptoms are those of diabetes complications. In some type 2 DM, hyperosmotic coma occurs initially especially after a period of stress or when glucose metabolism is further impaired by drugs such as corticosteroids.

Complications

Years of poorly controlled hyperglyceamia can lead to multiple primarily vascular complication. Microvascular disease underlies the 3 most common and devastating manifestation of DM.

Diabetic Retinopathy: this is one of the commonest causes of adult blindness,

Diabetic Nephropathy: A leading cause of chronic renal failure which might end with the person either dying or needing a transplant.

Diabetic Neuropathy: There are multiple types including symmetric polyneuropathy and autonomic neuropathy. Symmetric polyneuropathy is most common and affect the distal feet and hands (Stockings and glove distribution).

It manifest as parasthesia, dysethesias or a painless loss of sense of touch, vibration, propioception or temperature. It can lead to foot ulceration, infections with amputations, fractures, dislocation or destruction of normal foot architecture (Charcot’s joint).

Additional Complications

Diabetics have an increase risk of rhematological diseases including muscle infarction, carpal tunnel syndrome dupuytren’s contracture. Also opthalmological diseases unrelated to diabetic retinopathy like (cataracts, glaucoma, etc.

Depression and dementia are also common.

Diagnosis

First by the present of symptoms with clinical evaluations:

·        Fasting plasma glucose > or equal to 7.0 mmol/ litre (126mg/dl)

·        Plasma glucose > or equal to11.1mmol/ litre (200mg/ dl) 2 hours after 75g oral glucose load as in glucose tolerance test.

·        Glycated haemoglobin (HBA1c) > or equal to 48mmol/mol or > or equal to 6.5 %.

Prevention

There is no known measure for prevention of type 1 DM. Type 2 Diabetes can be prevented by a person being of normal weight, physical exercise and following a healthy diet. For diet whole grains and fibre are preferable as they have a low glycaemic index. Good fats such as poly unsaturated fats found in nuts vegetable oil and fish.

Cutting down on sugary beverages and eating less red meat and other sources of saturated fats can help in the prevention. Cessation of smoking is an important prevention measure as well.

Management

The preventive measure highlighted above is important. The goal is to keep blood sugar levels as close to normal “euglycemia” without causing hypoglycemia. This can be achieved with diet, exercise and use of appropriate medications. Insulin in type 1 DM and oral medication- oral hypoglycaemics as well as possibly insulin in type 2. Learning about the disease and actively participating in the treatment is vital. The goal of treatment is an HB A1C level less than 7.0%.

Specialized foot wear is widely used to reduce the risk of ulceration or reulceration in at risk diabetic feet.