Diabetes Mellitus refers to an elevated blood sugar level along with metabolic disturbances. Our body produces insulin, the pancreatic hormone which is responsible for the utilization of glucose by the cells. It helps in glucose uptake by the cells and thus reduces blood glucose levels.
Diabetes mellitus is classified as
Type 1 is also known as Insulin-dependent or Juvenile Onset Diabetes Mellitus. It is characterized by the destruction of pancreatic cells by the body’s own white blood cells (autoimmune destruction). There is an absolute deficiency of insulin, leading to hyperglycemia. It thus requires treatment with insulin administration.
Type 2, is referred to as Insulin independent or Adult Onset Diabetes Mellitus. It is characterized by loss of tissue receptor sensitivity to insulin. Despite adequate insulin being produced by the pancreatic cells, the body’s cells do not respond to insulin.
Thus, despite an adequate amount of circulating insulin, due to the non-responsiveness of tissue receptors, hyperglycemia develops. It is treated with various oral anti-diabetic medications.
Tests and Diagnosis
- The normal blood sugar level is in the range of 70-110 mg/ dL. A fasting blood glucose level of more than 140 mg/dL or a post-prandial (1 hour after a meal) level of more than 200mg/dL is diagnostic of diabetes.
- Another good indicator is HbA1c also known as glycated hemoglobin. It is a marker of glycaemic control over the past 3 months. The normal range is 4-6 gm% (excellent control). Pre-Diabetes is 6-8 gm% (good control) and Diabetes is defined as above 8 gm% (poor glycaemic control).
- An oral glucose tolerance test may also be performed. A sugary solution is provided after 8 hours of fasting. Periodic blood glucose levels are checked at every half an hour for 3 hours)
(Pre-Diabetes refers to a blood glucose level between 120-140 mg/dL and Gestational Diabetes refers to hyperglycemia during pregnancy as a result of anti-insulin hormones from the placenta. The blood glucose level returns to normal after delivery.)
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Diabetes Mellitus Symptoms
The general symptoms include:
- Increased hunger
- Increased thirst
- Increased frequency of urination
- Fatigue
- Non-healing sores
- In men, there may be associated loss of sexual drive, erectile dysfunction, and poor endurance.
- In women, there may be frequent urinary tract infections, candida infections, and dry skin.
Diabetes Mellitus Causes and Risk Factors
Diabetes is caused by multiple factors that interact with each other. They are broadly divided into non-modifiable risk factors and modifiable risk factors.
For Type-1 disease, having a parent/sibling with diabetes and younger age are the major risk factors.
For Type-2 disease, the factors include:
- Increasing age: Age more than 45 years
- Race: Indian Americans, African Americans, Latino-Americans are at a greater risk
- Obesity: Characterized by an increased BMI (above 23 in the South Asian population and above 25 in the Pacific-West)
- Hypertension
- Hyperlipidemia
- Smoking and Alcoholism
- Physical inactivity
- Family History
- Gestational Diabetes Mellitus and Pre-Diabetes
Diabetes Mellitus Complications
Complications include wounds that do not heal, gangrene of the lower foot or extremities, nephropathy, neuropathy, and vasculopathy.
It may lead to optic nerve damage, heart disease, and dementia as well.
Diabetes Mellitus Treatment
Type 1 diabetes
Insulin therapy is the main treatment for type 1 diabetes.
There are four types of insulin that are used based on the onset and duration of action.
- Rapid-acting insulin starts to work within 15 minutes and its effects last for 3 to 4 hours.
- Short-acting insulin starts to work within 30 minutes and lasts 6 to 8 hours.
- Intermediate-acting insulin starts to work within 1 to 2 hours and lasts 12 to 18 hours.
- Long-acting insulin starts to work a few hours after injection and lasts 24 hours or longer.
Type 2 diabetes:
It involves treatment with oral antidiabetic drugs if exercise and dietary control fail to maintain blood glucose. Fruits, vegetables, whole grains, polyunsaturated fatty acids, lean meat (fish, poultry), are to be promoted. Saturated fatty acids, refined carbohydrates are to be avoided.