Diabetes Mellitus -Things you must know;
By: Haya Hassan
(Doctor of Pharmacy)
Diabetes Mellitus is a chronic metabolic disorder caused by
deficiency of insulin or its action, manifested by abnormal metabolism of
Carbohydrates, Proteins and Fats. This disease is also called hypoglycemia. The
disease is so common that it is the 7th leading cause of death in the world
with 69,071 death certificates listing it as the underlying cause of death in
United States, and a total of 234,051 death certificates listing diabetes as an
underlying or contributing cause of death.
Some History: Clinical features similar to
diabetes mellitus were described 3000 years ago by the ancient Egyptians. The
term "diabetes" was first coined by Araetus of Cappodocia (81-133AD)
who named it diabainein meaning “to pass
through” (referring to the excessive urine passage) Later, the word mellitus
(honey sweet) was added by Thomas Willis (Britain) in 1675 after rediscovering
the sweetness of urine and blood of patients. The concept that diabetes is due
to excess glucose production by Claude Bernard (France) in 1857. The role of
the pancreas in pathogenesis of diabetes was discovered by Mering and Minkowski
(Austria) 1889. Later, this discovery constituted the basis of insulin
isolation and clinical use by Banting and Best (Canada) in 1921. Tolbutamide
and Carbutamide were first marketed in 1955 as the oral sugar level reducing
agents.
The pancreas is the organ which produces insulin, one of the
main hormones that helps to regulate blood glucose levels. Two of the hormones
produced by the pancreas are insulin and glucagon. Insulin tones down the blood
glucose level. Pancreas secretes 40-50 units of insulin daily.
Maintenance of Blood
Glucose Levels:-
Type 1 Diabetes Mellitus: Diabetes mellitus type 1 (also known as type 1 diabetes) is a
form of diabetes mellitus that results from the autoimmune destruction of the
insulin-producing beta cells in the pancreas.[2] The subsequent lack of insulin
leads to increased glucose in blood and urine. The causes of this type of
Diabetes is unknown but the possible ones are thought to be genetic, viral or
chemical induced.
Signs and Symptoms: The classical symptoms are frequent
urination, increased thirst, increased hunger, and weight loss.
Management: Patients with type 1 diabetes
mellitus (DM) require lifelong insulin therapy. Most require 2 or more
injections of insulin daily, with doses adjusted on the basis of
self-monitoring of blood glucose levels.
Who Gets Type 1
Diabetes?
Only about 5% of people with diabetes have type 1.It’s more
common in whites than in African-Americans and It affects men and women
equally.Although the disease usually starts in people under 20, it can happen
at any age.
Type 2 Diabetes Mellitus: Formerly called as non-insulin dependent diabetes mellitus is
a disorder that characterized by high blood glucose in the context of insulin
resistance and relative insulin deficiency.The bodies of people with type 2
diabetes make insulin. But either their pancreas does not make enough insulin or
the body cannot use the insulin well enough.Type 2 diabetes makes up about 90%
of cases of diabetes. Signs and symptoms are same as that of Type 1 Diabetes.
Who gets type 2 DM?
The people are at high risk of Type 2 DM who:
·
Have age over 45
·
Are obese or overweight
·
Have had gestational diabetes
·
Have family members who have type 2 diabetes
·
Have pre diabetes
·
Don't exercise
·
Have low HDL cholesterol or high triglycerides
·
Have high blood pressure
Comparison
Of Type 1 &Type 2 Diabetes:-
Gestational Diabetes:-
Gestational diabetes is a condition in which women without
previously diagnosed diabetes exhibit high blood glucose levels during
pregnancy (especially during their third trimester). This type ofdiabetes
affects 3-10% of pregnancies, depending on the population studied.
Causes:
Gestational diabetes is caused when insulin receptors do not
function properly. It may also be due to pregnancy-related factors such as the
presence of human placental lactogen that interferes with susceptible insulin
receptors.This type of Diabetes increases the risk of Type 2 Diabetes for the
mother later in life; therefore the mothers are advised to see the doctor early
for diabetes test.Complications may occur later in life. These include Low
blood sugar, Jaundice, seizures or stillbirth and Offspring are prone to
developing childhood obesity.
Other possible types of
diabetes are: MODY
(Maturity Onset Diabetes of the Young), Prediabetes, Imapired fasting glucose (IFG):
It refers to a condition in which the fasting blood glucose is elevated above
what is considered normal levels but is not high enough to be classified as
diabetes mellitus. Impaired Glucose Tolerance (IGT): It is a pre-diabetic state
of dysglycemia that is associated with insulin resistance and increased risk of
cardiovascular pathology. IGT may precede type 2 diabetes mellitus by many
years. IGT is also a risk factor for mortality.
Diagnostic Tests for
Diabetes:
Glycated Hemoglobin (HbA1c): This blood test indicates your
average blood sugar level for the past two to three months
Random blood sugar test: A blood sample will be taken at a
random time. Regardless of when you last ate, a random blood sugar level of 200
milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or
higher suggests diabetes.
Fasting blood sugar test:
A blood sample will be taken after an overnight fast. The results are
interpreted as follows:
Oral glucose tolerance test: The oral glucose tolerance test
(OGTT) measures the body's ability to use a type of sugar, called glucose,
which is the body's main source of energy. An OGTT can be used to diagnose
prediabetes and diabetes. An OGTT is most commonly done to check for diabetes
that occurs with pregnancy (gestational diabetes).
Management of Diabetes:
Some Facts about
Diabetes:
·
About 347 million people worldwide have diabetes
·
Diabetes is predicted to become 7th leading cause of
death in the world by the year 2030
·
Cardiovascular disease is responsible for between
50-80% of deaths in people with Diabetes
·
80% of diabetes deaths occur in low and middle income
countries
·
In Pakistan about 10% of people suffering from this
disease
·
Diabetes is the leading cause of blindness ,
amputation and kidney failure
·
In USA during the year 2002 annual cost of diabetic
treatment was estimated to be 132 billion dollar that means one out of ten
dollars is spent on diabetes.
Some famous celebrities
with Diabetes:-
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