Overview of diabetes mellitus

Diabetes mellitus (DM) is a metabolic disorder in which blood glucose levels become too high, as the body produces little or no insulin (a hormone produced by the pancreas that aids in the utilization of glucose for energy), or cannot use insulin properly. The disorder has been growing at an alarming pace not only in the developed countries but also in the developing countries where noncommunicable diseases are rapidly surpassing communicable diseases as the commonest cause of death. The World Health Organization (WHO) has suggested that over the next two decades, DM in the developing countries will be seen more in the lesser age group ranging from 20 to 45 years.1 India, with a population over 1 billion has the largest number of diabetic patients in the world, (estimated over 32 million in the year 2000) and this figure is predicted to increase to nearly 80 million by the year 2030. 1,2 Characterized by chronic hyperglycemia (high blood glucose), long-term DM is associated with damage to various organs such as the nerves (neuropathy), eyes (retinopathy), kidneys (nephropathy) and the heart (cardiovascular diseases). The cornerstone of therapy revolves around disease prevention, motivation toward healthy lifestyle choices and complication surveillance. Education of partner or caretakers is important in maintaining positive lifestyle changes in diabetic patients. Oral hypoglycemic agents (OHAs) are the primary treatment of type 2 DM. Intensive treatment with insulin has been shown to have significant benefits in both type 1 and type 2 diabetic patients.3

Types of diabetes
Type 1 Diabetes mellitus Type 2 Diabetes mellitus Gestational Diabetes mellitus Other specific types Types and pathogenesis of diabetes

Symptoms of diabetes
Symptoms of diabetes

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Risk factors for diabetes

Certain groups of people are ata higher risk for type 2 diabetes mellitus, therefore, asymptomatic individuals with the following criteria should be screened fordiabetes:1

Age more than 45 years History of gestational diabetes mellitus Impaired glucose tolerance Excess body weight Sedentary lifestyle Family history of diabetes History of delivery of big baby weighing more than 3.5 kg Dyslipidemia Hypertension (blood pressure 140/90 mmHg) Clinical cardiovascular diseases (myocardial infarction, angina and stroke) or peripheral vascular diseases.

Diagnosis of diabetes
The diagnosis of diabetes can be made in one of the following three methods but each must be confirmed on a subsequent day: Presence of symptoms of diabetes and a random blood glucose value of 200 mg/dL Fasting plasma glucose 126 mg/dL Two-hour plasma glucose 200 mg/dL during an oral glucose tolerance test (OGTT)

The OGTT is carried out after an overnight fast of 810 h following 3 days of adequate carbohydrate intake (>150 g/day). After taking an initial fasting blood sample, a 75g load of oral glucose dissolved in 250 mL of water is given and the blood sample is collected again 2 h after the drink. In addition, the glycosylated hemoglobin (HbA1c) may be used to diagnose diabetes although it is not specifically recommended as a diagnostic test for diabetes mellitus. A HbA1c level of 1% above the upper range of normal reference value is suggestive of diabetes and has a specificity of 98%.1 Blood sugar test HbA1c test

Management of diabetes
Treatment for Diabetes Self monitoring of blood glucose Role of insulin in managing blood sugar

Best ways to beat high blood sugar

Living with diabetes

Living with diabetes Life style modifications for diabetes

Prevention of diabetes
Recommendations for diabetes treatment and prevention are the following Maintain a healthy body weight (body mass index of 2025 kg/m). Be physically active. Eat a healthy and balanced diethigh fiber, whole meal products, more fruits and vegetables (at least 5 portions a day). Reduce intake of fatty and sugar-containing foods. Consume low-fat dairy foods such as skimmed or semi-skimmed milk. Avoid smoking and alcohol intake.

Diet for diabetic patients Ways to prevent diabetes

Micro and macro vascular complications of diabetes

Diabetes significantly increases an individuals risk of developing multiple microvascular and cardiovascular complications. Microvascular complication: The long-term microvascular complications of diabetes include Retinopathy Nephropathy and Neuropathy

Retinopathy: Retinopathy can result in loss of vision, therefore early diagnosis of retinopathy is essential as early use of laser photocoagulation may delay and prevent visual loss. This early detection can only be achieved by a program of routine screening. Read more details about Diabetic retinopathy Nephropathy: Nephropathy may lead to end-stage renal disease. The rate of decline in renal function is accelerated by the presence of hypertension. Peripheral neuropathy which is complicating diabetes most commonly affects the sensory and motor nerves of the lower limbs. Read more details about Diabetic nephropathy Neuropathy: Neuropathy poses the risk of foot ulcers, limb amputation, neuropathic joint damage, sexual dysfunction and dysfunction of other internal organs such as the stomach, bowel and bladder. Read more details about Diabetic neuropathy Macrovascular complication: The macrovascular complications of diabetes include atherosclerotic cardiovascular, peripheral vascular and cerebrovascular diseases. Diabetes is a major risk factor for the development of atherosclerosis of the major vessels especially coronary and aorto-iliofemoral systems. These in turn are the major cause of premature death in people with T2DM. Prevention of the cardiovascular complications is a major goal of current therapeutic policy. Although reduction in macrovascular complications depends on tight glycemic control, modification of other risk factors such as smoking, hypertension and dyslipidemia is also equally important. Diabetes complications can be avoided and even if they occur, their progress can be prevented through early surveillance and treated. The appropriate approach to treat the diabetic complications is first ensure appropriate implementation of the therapies that can avoid the complications and also to detect the complications at the earliest possible time so that treatment can be initiated.

Diabetic ketoacidosis Diabetic ketoacidosis (DKA) is a complication of diabetes. It is a state during which the insulin levels in the blood becomes inadequate. Pre diabetes Pre diabetes is a metabolic condition in which blood sugar levels becomes higher than the required level, but not high enough for considering them as type 2 diabetes. Type 1 diabetes Type 1 diabetes is said to be a genetic condition. The exact cause of the condition is still unknown. Type 2 diabetes The exact cause of type 2 diabetes is unknown. It tends to develop when the pancreas fails to produce enough insulin. Insulin resistance Insulin is a hormone that helps in the absorption of glucose into the cells of the body as a source of energy. Questions to ask your doctor about diabetes

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