Diabetes Mellitus | Symptoms | Treatment | Dr A Chakraborty

Diabetes Mellitus

What is Diabetes Mellitus [Definition]?
Diabetes Mellitus is a clinical disorder described by hyperglycemia because of inadequacy or lessened adequacy of insulin.


The classification of Diabetes Mellitus
Clinical classes
Diabetes Mellitus
Insulin Dependent Diabetes Mellitus[IDDM]
Non- Insulin Dependent Diabetes Mellitus[NIDDM]
Malnutrition Related Diabetes Mellitus[MRDM]
Fibrocalculous Panceatic Diabetes[FCPD]
Protein Deficiency Diabetes Mellitus[PDDM]

Secondary Diabetes: Other types, associated with certain conditions and syndromes, pancreatic disease, disease of hormonal etiology. Medication or synthetic initiated conditions, irregularities of insulin or its receptors certain hereditary disorders and random.

Impaired Glucose Tolerance: Obese and non-obsese or associated with certain conditions and syndromes.

Gestational Diabetes Mellitus : Gestational mellitus (GDM) is characterized as any level of glucose intolerance from the start or first identification during pregnancy.  The definition applies whether insulin or dietary alteration is just utilized for treatment, and whether the condition perseveres after pregnancy. Not to mention that it is possible that an unknown glucose intolerance may have started or started with pregnancy.

About 7% of all pregnancies are complicated by GDM, leading to more than 200,000 cases a year. The recurrence might go from 1 to 15% of all pregnancies, contingent upon the quantity of individuals tried and the demonstrative tests utilized...

Statistical Risk Classes
  • Previous abnormality of glucose tolerance.
  • Potential abnormality of glucose tolerance.

The new classification use type 1 and type 2 diabetes:
a] Type-1 diabetes mellitus: It is immune mediated in 90% and idiopathic in less than 10%. In is also called juvenile onset diabetes mellitus as it affects 10-14 years old children. The insulin production is hampered, so they require exogenous insulin.

b] Type-2 diabetes mellitus: The tissues where insulin acts become insensitive [tissue resistance].


Symptoms / Signs
IDDM
Patient, usually less than 40 years of normal or less than normal weight.

NIDDM
Patient is generally an obese, over weight, middle-aged or elderly.
Polydipsia.
Polyuria, nocturia.
Loss of weight.
Pruritus vulvae / balanitis.
Impotence.
Some patients may present as a fulminant ketoacidosis.
Some patients may be discovered to be having glycosuria in the course of some routine examination.


Pathophysiology of Diabetes Mellitus
Diabetes mellitus is a different chronic disease with complex pathogenesis. It is characterized by elevated blood sugar levels or hyperglycemia, which are caused by insufficiency in insulin production or insulin secretion or both. Hyperglycemia is manifested in a variety of ways with different presentation and causes malnutrition of carbohydrates, fats, and proteins. Chronic hyperglycemia often leads to various complications of microvascular and macro vascular diabetes, which is a major cause of diabetes-related illness and death. Hyperglycemia acts as a major biomarker for the diagnosis of diabetes.


Investigations
Hyperglycemia: A fasting blood sugar value of more than 100 mg/dl and a postprandial blood sugar exceeding 120 mg/dl or a random blood sugar greater than 250 mg/dl.

Glycosuria

Glycosylated hemoglobin: Glycosylated hemoglobin [HbA1c], is now well established as a parameter to judge long-term control of diabetes. As glycosylation of hemoglobin is directly proportionate to the glucose concentration and as the process is largely irreversible, a single estimation provides a time averaged, integrated blood glucose concentration of the past three months.

Ketonuria: May be found in normal people who have been fasting for long periods or after severe repeated vomiting. But if ketonuria is present with glycosuria, the diagnosis of diabetes is certain.

Glucose tolerance test [GTT]: Patient who should have been on an unrestricted carbohydrate in take of at least 150gm for 3 days or more, fast overnight. A fasting blood sample is taken. The patient is then given 52-100 gm glucose dissolved in 250-300 ml water by mouth. Thereafter, blood samples are collected at half-hourly intervals for at least 2 hours and their glucose content is estimated.

Serum Fructosamine analysis

Lipid Profile
LDL increased
High triglyceride level
Low HDL - Cholesterol.


Complications / Risk factors
Diabetic keto acidosis: Any form of stress particularly an acute infection can precipitate severe ketoacidosis in even the mildest diabetic.

The clues of ketoacidosis: Vomiting of blood or coffee ground material in acute gastric dilation or erosive gastritis.
Dehydration - probably most obvious feature
Drowsiness
Breath smells of acetone
Oberbreathing
Gastric splash
Hyperthermia
Hypotension in severe cases

Diabetic nephropathy: There may be proteinuria due to diabetic glomerulosclerosis.

Vascular disorders: Include atherosclerosis, making these patients more prone to myocardial infarction and hypertension. The patients usually show ischemic changes in feet, and gangrene usually set in after a minor injury.

Diabetic retinopathy: Is a common long-term complication. Venous abnormalities, hemorrhages, microaneurysms, exudates, new-vessel formation occur in varying combinations in different patients.

Infections: Poor control of diabetes is associated with a lowered resistance to infections such as pulmonary tuberculosis, UTI, candidiasis etc.

Diabetic neuropathy


Treatment
Monitoring control of diabetes
Urine sugar
Blood sugar Fructosamine

What is good control?
  • Freedom from symptoms of hypo/hyperglycemia and ketoacidosis.
  • Normal premeal urine and blood sugar and postparandial less than 180gm%.
  • 24 hours sugar excretion less than 20gm.
  • Normal serum lipids.
  • Glycosylated Hb, not more than 6.
  • Absence of complications of diabetes.
  • The main aim of treatment for diabetes is to allow the patient to lead a completely normal life.
  • A very important step to achieve this aim is education of the patient:
  • Measuring glucose concentration in urine by dip stick method.
  • If he is to take insulin, then, to measure the dose and inject himself.
  • Recognize symptoms and consult doctor before taking any drugs themselves.
  • Care of feet by regular chiropody.
  • Carrying a card on his person stating that he is a diabetic and specify the treatment that he is taking for the same.
  • Co-operating with his physician in the attainment and maintenance of appropriate body weight.

Types if treatment
Diet alone: Calories/day, percentage of calories derived from various food constituents has to be decided.
Diet and oral drugs.
Insulin and diet.
Exercises.


Common cause of Diabetes Mellitus
Liver disease
Pancreatic disease
Genetic
Sedentary habit
Obesity


Homeopathic medicines [Expert Homeopathy]
Phosphoric acid: Diabetes of nervous origin, urine milky and contains much sugar, cases due to grief, worry and anxiety, of those who are indifferent and apathetic, poor in mental and physical force, curative in early stages with great debility and bruised feeling in the muscles, loss of appetite, unquenchable thirst occasionally there may be boils on the body, deposit of phosphates in urine, or larger quantities of pale colorless urine.

Uranium nitrate 3x: Diabetes which begins from dyspepsia or acid reflux, polyuria, dryness of mouth and skin, it diminishes sugar and the amount of pee, blemished processing and digestion, much sugar in pee, colossal craving and thirst, but then he loses tissue.

Helonias: Urine contains phosphates and sugar, diabetes with melancholia, emaciation, thirst and restlessness.

Syzygium: A palliative remedy and should be used in tincture doses. It diminishes the amount of sugar. Diabetes with ulceration.

Insulin (3X or 30X): The use of this drug in potentized form has given better results. It should not, however, be overdoses.

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