what is diabetes
Diabetes mellitus is a metabolic condition where the body is not able to utilize glucose which leads to elevated blood sugar.
It occurs due to pancreases not being able to produce enough insulin, or body cells having poor/reduced response to insulin.
Insulin promotes uptake of glucose by the body cells.
What are the types of diabetes melitus?
There are two major types of diabetes melitus.
Type 1 diabetes mellitus.
Type 1 diabetes mellitus occurs due destruction of the insulin producing β cells of the pancreases.
The destruction of β cells occur due to an auto-immune(body attacking its own cells) whereby the body produces antibodies that attack and destroy β cells of the pancreas.
when does Type 1 diabetes mellitus start?
The disease starts at an age below 30 years.
There is a genetically predisposition to getting diabetes mellitus type 1.
Currently there are no methods of determining when a person will develop the disease.
Diabetes mellitus Type 2
When Diabetes mellitus Type 2 start?
Diabetes mellitus Type 2 affects people above 40 years, though with increases cases of obesity the age has gone down.
Diabetes mellitus type 2 occurs due to body cells developing resistance or poor response to insulin.
There is also marked dysfunction of β-cell and therefore the body is not able to cope up with the increasing insulin resistance.
Type 2 diabetes also has a strong genetic predisposition.
About 85% of people with type 2 diabetes mellitus are obese.
How does insulin resistance occurs, how is abdominal fat involved?
There is a great correlation(connection) between abdominal fat and insulin resistance.
The abdominal fat is different from other subcutaneous fat(fat under the skin) in that it does not respond to normal body regulation.
When there is high blood sugar, Insulin is released by the pancreas.
The insulin stops breakdown of fat and stimulates intake of glucose by cells.
Abdominal fat is different, it continues to being broken down releasing excess fatty acids(body utilizes fat in form of fatty acid).
Excess fatty acids lead to insulin resistance by the liver and muscles
The excess fatty acids are converted to glucose by the liver.
Increased synthesis of glucose by the liver and reduced uptake by the cells lead to high blood sugars.
Excess fat may also directly cover muscles and other organs leading to insulin resistance(insulin may not penetrate the fat layer).
How do I know i have diabetes mellitus, what are the Signs and symptoms of diabetes?
- Both type present with the same symptoms
- Increased urine production especially at night.
- Increased thirst due to water loss through urination,
- Fatigue due to inability to utilize glucose
- Marked weight loss because the body switches to using proteins to survive.
- Blurred vision, the patient should not change lenses until after 3 months because eyesight improves with controlled blood glucose
- Higher infections especially of urinary tract due to increased glucose in urine(excess glucose is lost in urine).
Type 1 diabetes may present with the following on top of the above:
- Nausea and vomiting,
- Fruity smelling breath(due to ketoacidosis)
- Shortness of breath,
- In extreme cases coma may occur.
How to determine whether one has diabetes
- Presence of diabetes symptoms
- Blood sugar test(Random and fasting blood sugar)
Glucose tolerance test,
- the patient takes a normal diet for 3 days fasts for 12 hours
- Blood glucose is determined and then patient loaded with 75 grams of glucose in form of 394 mL of Lucozade® original.
- Blood glucose is then determined after 2 hours.
Symptoms of hypoglycaemia
What are the Causes of hypoglycaemiaor low blood sugar in diabetic patients
|Missed meals or delays in eating||reduced carbohydrate intake, therefore reduction in glucose levels|
|Not eating the usual amount of carbohydrates||reduced carbohydrate intake, therefore reduction in glucose levels|
|increased doses of insulin||increased uptake of glucose into cells and increased storage of glucose as glycogen|
|increased doses of oral drugs that enhance insulin secretion|| increased levels of insulin therefore increased uptake of glucose into cells and|
increased storage of glucose as glycogen
|introduction of other blood glucose-lowering agents to oral drugs that enhance insulin secretion||Enhanced hypoglycemic effects|
|increase in exercise||increased uptake of glucose into cells|
|Excessive alcohol consumption||impaired glucose synthesis|
|Liver disease||impaired gluconeogenesis and glycogen breakdown|
Hypoglycaemia (very low blood sugar)
This most of the time is caused by overdose of antiadiabetic medications and insulin.
It is managed by giving glucose to tje patient. If the patient cant take glucose due to risk of aspiration, then glucose infusion is given.
extreme hyperglycaemia(very high blood sugar)
This occurs when one has not taken their diabetes medication especially insulin.
This is treated using insulin and other medicines that the doctor will consider appropriate.
This is common with diabetes type 1.
Diagnosis requires demonstration of hyperglycaemia and metabolic acidosis with the presence of ketones.
What are the long-term diabetic complications?
Type 2 diabetes takes time before producing disturbing symptoms. This gives it enough time to have caused the complications.
- Diabetic complications affect the eyes especially the retina causing blurred vision,
- The nerves leading to reduced sensitivity. some patients have their Limbs burnt without feeling it.
- The kidneys are affected due reduced blood supply due to clogged micro vessels.
- Hypertension. Most patients with diabetes also have hypertension.
- Heart disease(coronary artery disease)
- Strokes(cerebrovascular disease)
- Diabetic foot ulcers. they do not heal easily due to poor blood supply
Prevention management and treatment of diabetes
Type 1 diabetes is treated using insulin and sometimes combined with other medications.
Type 2 diabetes can easily be managed through weight loss, exercise and diet.
If that doesn't work, then oral medications are used and sometimes with insulin.
Note, Lipid lowering drugs are used in combination with anti-diabetics.
Patients should be very compliant with medications to prevent complications.
Patient should never lie that they have been taking medication. This can easily be determined by assaying the levels of Glycated hemoglobin.