Diabetes mellitus

Diabetes mellitus or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either
because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high
blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst),
and polyphagia (increased hunger).
There are three main types of diabetes mellitus (DM).

Type 1 DM ( Early Onset diabetes mellitus) results from the body's failure to produce insulin, and currently requires the
person to inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent diabetes mellitus"
(IDDM) or "juvenile diabetes".Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of
Langerhans in the pancreas, leading to insulin deficiency
Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with
an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or
"adult-onset diabetes".Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with relatively
reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor..
Type 2 diabetes is the most common type.
The third main form, gestational diabetes, occurs when pregnant women without a previous diagnosis of diabetes develop a
high blood glucose level. It may precede development of type 2 DM.

.
Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar
coma. Serious long-term complications include cardiovascular disease, chronic kidney failure, and diabetic
retinopathy (retinal damage). Adequate teatment of diabetes is thus important, as well as blood pressure control and lifestyle
factors such as stopping smoking and maintaining a healthy body weight.
All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with
medications. Insulin and some oral medications can cause hypoglycemia (low blood sugars), which can be dangerous if severe. Both
types 1 and 2 are chronic conditions that cannot be cured.
Gestational diabetes usually resolves after delivery.

Symptoms of diabetes mellitus:

Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting
in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis. A number of skin rashes that
can occur in diabetes are collectively known as diabetic dermadromes.

Complications of diabetes mellitus

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (1020), but may be the
first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to
damage to blood vessels. Diabetes doubles the risk of cardiovascular disease. The main "macrovascular" diseases (related
to atherosclerosis of larger arteries) are coronary artery disease (angina and myocardial infarction), stroke, and peripheral vascular
disease. About 75% of deaths in diabetics are due to coronary artery disease.
Diabetes also damages the capillaries (causes microangiopathy). Diabetic retinopathy, which affects blood vessel formation in
the retina of the eye, can lead to visual symptoms including reduced vision and potentially blindness. Diabetic nephropathy, the
impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of
protein in the urine, and eventually chronic kidney disease requiring dialysis.
Another risk is diabetic neuropathy, the impact of diabetes on the nervous system most commonly causing numbness, tingling,
and pain in the feet, and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs,
neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and
occasionally require amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.

Several studies suggest a link between cognitive deficit and diabetes. Compared to those without diabetes, the research
showed that those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function, and are at greater
risk
Causes of diabetes mellitus:

The cause of diabetes depends on the type.

Type 1
Type 1 diabetes is partly inherited, and then triggered by certain infections, Onset of type 1 diabetes is unrelated to lifestyle.

Type 2
Type 2 diabetes is due primarily to lifestyle factors and genetics. A number of lifestyle factors are known to be important to the

development of type 2 diabetes, including obesity (defined b a body mass index of greater than thirty), lack of physical
activity, poor diet, stress, and urbanization. Those who are not obese often have a high waisthip ratio.
Dietary factors also influence the risk of developing type 2 diabetes. Consumption of sugar-sweetened drinks in excess is
associated with an increased risk. The type of fats in the diet is also important, with saturated fats and trans fatty
acids increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk. Eating lots of white
rice appears to also play a role in increasing risk.
A lack of exercise is believed to cause 7% of cases.

Diagnosis of diabetes mellitus:

Diagnosis of diabetes mellitus is done by measuring blood glucose and glycated haemoglobin levels.

WHO diabetes diagnostic criteria

Condition

2 hour glucose

Fasting glucose

HbA1c

mmol/l(mg/dl)

mmol/l(mg/dl)

Normal

<7.8 (<140)

<6.1 (<110)

<6.0

Impaired fasting glycaemia

<7.8 (<140)

Impaired glucose tolerance

7.8 (140)

<7.0 (<126)

6.06.4

Diabetes mellitus

11.1 (200)

7.0 (126)

6.5

6.1(110) & <7.0(<126) 6.06.4

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

Fasting plasma glucose level 7.0 mmol/l (126 mg/dl)

Plasma glucose 11.1 mmol/l (200 mg/dL) two hours after a 75 g oral glucose load as in aglucose tolerance test
Symptoms of hyperglycemia and casual plasma glucose 11.1 mmol/l (200 mg/dl)

Glycated hemoglobin (Hb A1C) 6.

According to current definition, two fasting glucose measurements above 126 mg/dl (7.0 mmol/l) is considered diagnostic for
diabetes mellitus.

Glycated hemoglobin (Hb A1C)

Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin that is measured
primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a nonenzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of
glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a
predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement.
When blood glucose levels are high, glucose molecules attach to the hemoglobin in red blood cells. The longer hyperglycemia occurs
in blood, the more glucose binds to hemoglobin in the red blood cells and the higher the glycated hemoglobin.

Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell,
therefore, reflects the average level of glucose to which the cell has been exposed during its life-cycle. Measuring glycated
hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is
proportional to average blood glucose concentration over the previous four weeks to three months. Some researchers state
that the major proportion of its value is weighted toward the most recent 2 to 4 weeks. This is also supported by the data
from actual practice showing that HbA1c level improved significantly already after 20 days since glucose-lowering
treatment intensification.
. Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any

cause.

Management of diabetes mellitus:

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management

concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing hypoglycemia. This
can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes;
oral medications, as well as possibly insulin, in type 2 diabetes).
Patient education, understanding, and participation is vital, since the complications of diabetes are far less common and
less severe in people who have well-managed blood sugar levels. The goal of treatment is an HbA1C level of 6.5%, but should
not be lower than that, and may be set higher Attention is also paid to other health problems that may accelerate the
deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of

exercise. Specialised footwear is widely used to reduce the risk of ulceration, or re-ulceration, in incidences of diabetic feet.
Diabetic diet refers to the diet that is recommended for sufferers of diabetes mellitus. There is much controversy regarding what that
diet should consist of. The diet most often recommended is high in dietary fiber, especially soluble fiber, but low in fat
(especially saturated fat) and low in sugar and high in antioxidants. Fraction of total calories to be obtained from

carbohydrate are generally in the range of 40 to 65%, but recommendations can vary as widely as from 16 to 75% .
Lifestyle modifications
There are roles for patient education, dietetic support, and 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 .

Epidemiology:
Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. In 2011 it resulted
in 1.4 million deaths worldwide making it the 8th leading cause of death. This is an increase from 1 million deaths in 2000.
Its rate has increased, and by 2030, this number is estimated to almost double. Diabetes mellitus occurs throughout the world, but is
more common (especially type 2) in more developed countries. The greatest increase in rates is, however, expected to occur in Asia
and Africa, where most people with diabetes will probably be found by 2030.The increase in rates in developing countries follows
the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an
environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at present.