DIABETES MELLITUS (HYPERGLYCEMIA)

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DIABETES MELLITUS (DM)

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Refers to a group of common metabolic disorders in which there are marked increase of blood sugar level (hyperglycemia). There are several types of Diabetes mellitus caused by complex interaction of genetic and environmental factors. Depend on the case of origin of Diabetes mellitus, factors that contribute to high blood sugar includes:
  • Reduced Insulin secretion,
  • Decreased glucose utilisation and,
  • Increased glucose production.
Defect in body energy regulation that is energy production and utilization lead to multiple organs complication and early mortality. This metabolic defect associated with Diabetes mellitus cause secondary patho-physiogic damage in several organs systems. Diabetes can lead to End Stage Renal diseases (ESRD), non-traumatic lower extremity amputations, Adult blindness and even predisposing to cardiovascular diseases.


CLASSIFICATION OF DIABETES MELLITUS

There are two broad categories of Diabetes mellitus, Classification based on pathogenic process that leads to high blood sugar (hyperglycemia) and both types are preceded by a phase of abnormal glucose homeostasis as the pathogenic process progress: 
  1. Type 1 Diabetes mellitus
  2. Type 2 Diabetes mellitus
Other types of Diabetes mellitus are:

Type 1 Diabetes Mellitus

Results from autoimmune beta cells destruction which usually lead to insulin deficiency, that is complete or near total in insulin deficiency.

Type 2 Diabetes Mellitus

A heterogeneous group of disorders characterized by various degrees of insulin resistance, impaired insulin secretion and increased glucose production as well as a tendency of develop Ketosis. 

SYMPTOMS AND SIGNS OF DIABETES MELLITUS

Manifestations of Diabetes mellitus depend on the severity of disease and it's effects to other organs of the body. 
  • Production of abnormal large amount of urine (Polyuria)
  • Excessive thirst (Polydipsia) 
  • Excessive eating or appetite (Polyphagia)
  • Excessive amount of sugar in urine (Glycosuria)
  • Blurred vision 
  • Persisted infections
  • Slow healing of skin lesion and trauma
  • Weight loss
  • Fatigue and weakness
  • Coma (unconsciousness)
  • High blood sugar (Hyperglycemia)
  • Presence of ketone bodies in the body tissue (Ketosis) and 
  • Large amount of acid into body fluids (Acidosis)
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COMPLICATIONS OF DIABETES MELLITUS

  1. Acute complications
      2. Chronic complications

Chronic complication is grouped into Vascular and Non vascular complications
  • Vascular coplications
Divided into two (Micro-vascular and Macro-vascular) complications:

      a) Micro-vascular complications are as follows:

             -Diabetic Retinopathy
             -Diabetic Neuropathy
             -Diabetic Nephropathy

       b) Macro-vascular complications are as follows:

             -Colonary Artery Disease
             -Peripheral Vascular Disease
             -Cerebrovascular Disease
  • Non vascular complications
             -Gastroparesis
             -Sexual Dysfunction
             -Skin Change

TREATMENT OF DIABETES.

The main goals of treatment for both type 1 and type 2 diabetic mellitus are to:
  • Eliminate/reduce symptoms and signs related to high blood sugar
  • Eliminate/reduce the long term diabetic complications ( micro-vascular and macro-vascular)
  • Help the client/patient to resume to normal life
Health care provider should apply non-pharmacological and pharmacological strategies to monitor diabetic complications, treatments of hyperglycemia involves many specialists (neurologists, nephrologists, surgeons, cardiologists, ophthalmologists and podiatrists) with experience in diabetes related complications are essential.

Non-pharmacological treatment approaches: 
  • Nutrition
  • Education about diabetes
  • Physical exercise
Pharmacological treatment approaches:
  • Intensive insulin therapy
  • Intensive glycemic control
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control glycemic with regular blood glucose test

Both treatment approaches will be posted later on this site. 

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