DIABETES MELLITUS

DIABETES MELLITUS
Is a group of metabolic disease characterized by increased level of glucose in the blood results from defects in insulin secretion, insulin action or both.
CLASSIFICATION OF DIABETES MELLITUS
Diabetes mellitus is categorized into four types.
1) Type 1 Diabetes
2) Type 2 Diabetes
3. Diabetes mellitus associated with other conditions or syndromes.
4. Gestational Diabetes mellitus(GDM)
1) Type 1 Diabetes
The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 30th year, often in early adulthood or teenage years.
Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 5%- 10% of all diabetes cases are type 1. It is characterized by destruction of the pancreatic beta cells. Combined genetic, immunologic and environment (viral) are thought to contribute on destruction of beta cell. This genetic tendency has been found with people certain human leukocyte antigen (HLA) types. The destruction of beta cells results in decreased insulin production, unchecked glucose production by the liver and fasting hyperglycemia. When the concentration of glucose in the blood exceed the threshold level (180200mg/dl)/ (9.9-11.1mmol/L) the kidney cannot reabsorb all of filtrated glucose, hence glucose appears in urine(glycosuria). In this type 1 diabetes fat breakdown occurs contributing to Diabetic ketoacidosis (DKA)
2) Type 2 Diabetes
The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Approximately 90%-95 of all cases of diabetes worldwide is of this type. It occur most in people who are older than 30 years old of age and obese. The vast majority of patients with type 2 diabetes initially had prediabetes. The two main problems resulted to type 2 diabetes are insulin resistance (decreased tissue sensitivity to insulin) and impaired insulin secretion. These problems contribute to increased amount of blood glucose. Although there is impaired insulin secretion that is characteristic of type 2 diabetes, there is enough insulin present to prevent the breakdown of fat forming ketones, therefore Diabetic ketoacidosis(DKA) does not occur in type 2 diabetes.
3. Diabetes mellitus associated with other conditions or syndromes
This is accompanied by conditions known to cause a disease: pancreatic diseases, hormonal abnormalities, medications ie corticosteroids and estrogen containing preparations.
4. Gestational Diabetes mellitus (GDM)
This is any degree of glucose intolerance with its onset during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. This is due to insulin resistance caused by placental hormone secreted during pregnancy. Women who are at high risk for GDM are those with marked obesity, a personal history of GDM, glycosuria or a strong family history. High risk ethnic group include Hispanic, Americans, African Americans and Pacific Islenders. Initial management includes dietary modification and blood glucose monitoring. If hyperglycemia persists insulin is prescribed. After delivery blood glucose return to normal but many of them develop to type 2 diabetes later in their life.
CAUSES OF DIABETES MELLITUS
The causes of diabetes mellitus are unclear, however, they seem to be both hereditary (genetic factors passed on in families), and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers.
In Type 1 diabetes (Type I diabetes),
– The immune system, the body’s defense system against infection, is believed to be triggered by a virus or another microorganism to destroy the cells in the pancreas that produce insulin.
In Type 2 diabetes, age, obesity, and family history of diabetes contributes to development of this type of diabetes.
Gestational diabetes is caused by secretion of placenta hormone that impair the action of insulin.
PATHOPHYSIOLOGY
Insulin is secreted by beta cells, which are one of four types of cells in the islet of langerhans in the pancreas. Insulin is an anabolic or storage hormone. Once a person eats a meal, insulin secretion increases and moves glucose from the blood into the muscle, liver and fat cells. In those cells, insulin;
• Transport and metabolizes glucose for energy,
• Stimulates storage of glucose in the liver and muscle in form of glycogen
• Signals the liver to stop the release of glucose,
• Enhances storage of dietary fat in adipose tissue,
• Accelerates transport of amino acids into cells
Breakdown of stored glucose, protein and fats is inhibited by insulin. The small amount of insulin is released during fasting periods (between meal and overnight). Glucagon from alpha cells of islets of langerhans is released when glucose levels decrese and stimulates the liver to release stored glucose. The insulin and glucagon maintain a constant level of glucose in the blood by stimulating the release of glucose in the liver. Inadequate insulin or failure of insulin to act results in increased amount of blood sugar, hence diabetes mellitus.
SIGNS AND SYMPTOMS
The signs and symptoms of all types of diabetes include the 3P’S namely
1. Polyuria (Frequent urination)
2. Polydipsia (Disproportionate thirst)
3. Polyphagia (Intense hunger)
Others include;
• Increased fatigue and weakness
• Sudden vision changes.
• Cuts and bruises don’t heal properly or quickly
• Recurrent infections.
• Tingling / numbness in hands/feet.
The onset of type 1 diabetes results into Diabetic ketoacidosis (DKA) associated with;
• Sudden weight loss
• Nausea and vomiting
• Abdominal pain
Diagnosis of diabetes mellitus
Diabetes can often be detected by carrying out;
• Urine test for presence of glucose and ketone bodies
• Blood test, which measures blood glucose levels and can confirm if the cause of symptoms is diabetes.
 Normal blood sugar level ranges from
60-110mg/dL or 3.3-6.05mmol/L during fasting and;
65-140mg/dL or 3.58-7.7mmol/L during postprandial (2hours)
In diagnosis of diabetes Fasting plasma glucose (FPG), random plasma glucose and glucose level 2 hours after receiving glucose should be done.
MEDICAL MANAGEMENT
Frequent blood glucose monitoring and weekly contacts with diabetes educators. Diabetes management has five components; Nutrition therapy, Exercise, Monitoring, Pharmacologic therapy and Education.
Nutrition therapy
• The most important objectives in nutrition therapy are control caloric intake to attain a normal weight, control of blood glucose level and normalization of lipids and blood presure to prevent heart disease.
• Increasing food rich fibers like legumes, fruits, whole grains, cereals and vegetables all increase satiety that is important in weight loss.
• Food rich in sugar should be consumed in little amount.
Pharmacologic therapy
• In inadequate insulin, pharmacologic therapy is required;
1. Insulin therapy.
• Type 1 diabetes treatment is a daily task. Lack of insulin production by the pancreas makes Type 1 diabetes is particularly difficult to control.
• Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, multiple daily insulin injections and home blood glucose testing a number of times per day.
• Type 1 and some type 2 or gestational diabetes melitus should be prescribed with long acting insulin like glargine (Lantus) or Detemir(Levemir).
2. Oral ant diabetic agents.
This is prescribed for type 2 diebetes that cannot be treated with medical nutritional therapy and exercise alone.

These include
First generation sulphonylureas ie chropropamide, Tolbutamide.
Second generation sulphonylureas ie glimepiride, glipizide. Biguanide ie Metformin.
Alpha-Glucosidase Inhibitors. Ie Acarbose, Miglitol
 Non-sulphonylurea Insulin Secretagogues ie Nateglinide.
 Thiazolidinediones ie Pioglitazone
NURSING MANAGEMENT
• Providing patient education on self administering of insulin.
• Administering prescribed antidiebetic.
• Assisting patient to meet the required diet.
• Caring of wound by proper dressing.
• Administering fluid for fluid balance.
 COMPLICATIONS
• Diabetic ketoacidosis in type 1 diebetes.
• Hyperglycemia hyperosmolar state
• Diabetic coma
• Retinopathy
• Nephropathy
• Neuropathy
PREVENTION
The following are diabetes prevention tips from the American Diabetes Association.
• Tip 1: Get more physical activity
• Tip 2: Get plenty of fiber
• Tip 3: Go for whole grains
• Tip 4: Lose extra weight
For consultation about Diabetes mellitus and herbal treatments
Email ndatalapaul@gmail.com
Whatsapp/imo +255652759322
Facebook Paul Ndatala

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