Diabetes Mellitus

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Definition

The medical term for diabetes is Diabetes Mellitus. It comprises of a group of diseases pertaining to metabolic disorders. The affected person develops high sugar in the blood for two reasons – either the body is sluggish in producing required quantities of insulin or because the cells fail to respond to the produced insulin. This high level of sugar in the blood leads to the typical symptoms of frequent urination or polyuria, increase of thirst or polydipsia and increase of hunger or polyphagia (Osterbrink & Münzinger, 2005).

Classification

Diabetes Mellitus Type I:

The typical characteristics of Diabetes Mellitus Type I is that the beta cells producing insulin from the pancreas, are lost. This leads to insufficient insulin. This kind of diabetes is also classified as idiopathic or immune-mediated. Most of Diabetes Type1 is of the latter type. Till now there is no preventive measure against this type of diabetes. It comprises of 10% of all the cases of diabetes in Europe and North America. Except for this most of the people suffering from it are in other respects healthy having a normal weight when the illness kicks off. In the early stages of the disease the affected are sensitive and responsive to insulin. Type1 Diabetes may happen both in children as well as adults. Conventionally it has been termed Juvenile Diabetes because it is the most common type among children affected with diabetes (Norris & Wolfsdorf, 2010).

The other names for Brittle Diabetes are unstable-diabetes or labile-diabetes. It refers to the kind of diabetes that is dependent on insulin. Those affected see sudden and repeated swings in levels of glucose; this often happens without any connected cause. This may result in irregular and unforeseen hyperglycemias often followed with ketosis and sometimes with grave hypoglycemias. Brittle diabetes happens in about 1% to 2% of diabetic sufferers and not more than that (Seino, 2010).

Diabetes Mellitus Type2:

The typical characteristics of Diabetes Mellitus Type2 are resistance to insulin that may be accompanied by relatively low secretion of insulin. The wrong responses of the tissues of the body to insulin are thought to be connected with insulin receptor. The specifics however are yet not known. Diabetes Mellitus that happens because of a known defect is categorized separately. Typ2 Diabetes is one of the most common types.

When Type2 Diabetes begins to set in, at the onset the dominating abnormality is reduction in insulin sensitivity. At this point hyperglycemia can be reversed by adopting a variety of measures and administering medications to boost up sensitivity to insulin or to bring down levels of glucose (Misso, 2010).

Gestational Diabetes:

GDM or Gestational Diabetes is in many ways similar to Type2 Diabetes – amalgam of relatively low insulin secretion and low responsiveness. It happens in 2% to 5% of all pregnancies. In general it improves or disappears, post delivery. Gestational diabetes can be totally cured under careful medical monitoring through pregnancy. Nearly 20% to 50% of the women affected develop Type 2 Diabetes in later life (Norris & Wolfsdorf, 2010).

Although it stays for a temporary period, if gestational diabetes is left untreated it can cause damage to the health of the mother and even the fetus. Risks to the fetus could be macrosomia or high weight at birth as well as anomalies leading to congenital heart problems or problems related to the central nervous system; it could also result in malformations of skeletal muscles. Increase in fetal insulin could cause respiratory-distress syndrome.

The destruction of red blood cells could result in hyperbilirubinemia. When it is severe it could lead to pre-natal death. This is quite common.  At the time of labour there will be reduced placental function. If the fetus shows marked distress in the fetus, or greater risk of injury connected with macrosomia like shoulder-dystocia, then the best option would be cesarean section operation (Matheson, 2010).

A study conducted in USA that was completed in 2008 showed an increase in number of women entering pregnancy who already suffer from diabetes. In the past six years the rate of pregnant women suffering from diabetes has increased. This is a serious problem as Diabetes increases the danger of complications during the period of pregnancy, while increasing the apprehension that children with diabetic mothers will develop the same problem in later life (Norris & Wolfsdorf, 2010).

Other Types:

There is another condition known as Pre-Diabetes. It happens when the blood glucose of a person is higher than the normal but not sufficiently high to be diagnosed as Type2 Diabetes.

Another type of Diabetes is latent autoimmune found it adult. It is the condition that later allows for the development of Type1 Diabetes. Those adults who have LADA are more often than not diagnosed wrongly to be suffering from Type2 Diabetes. The diagnosis is founded on age rather than on etiology.

Diabetes is sometimes caused by the tissue receptors of the body not responding properly to insulin, although the insulin levels are not abnormal; it is this that distinguishes it from Type2 Diabetes. This type of Diabetes is extremely rare (Norris & Wolfsdorf, 2010).

Mutations that are genetic (autosomal or mitochondrial) can often lead up to defects in the functioning of beta cell. Insulin action that is abnormal may also have been caused by genetic determinations. Any illness that causes severe injury to the pancreas may cause diabetes; for instance chronic pancreatitis and cystic fibrosis can be the cause to trigger off diabetes.

Diseases that are connected with too much secretion of insulin-antagonistic hormones could lead up to Diabetes. This is generally resolved when the excess of hormones is removed (Norris & Wolfsdorf, 2010). There are many drugs that cause damage to insulin secretion and there are some toxins that cause injury to pancreatic beta cells. 

Management

The chronic disease known as Diabetes Mellitus is incurable except in rare c cases. The management comprises of keeping the levels of blood sugar as close to normal as possible. This can be done by a combination of many factors – diet, physical exercises accompanied by intake of proper medicines.

Another important part of the treatment is making the patient educated and participating. This reduces the complications allowing the blood sugar levels to be within control. Other health problems should also be given due attention as these could expedite the negative effects of diabetes. Among these are problems related to smoking, high cholesterol levels, high blood pressure, obesity, and not taking regularl physical exercises (Matheson, 2010).

Lifestyle:

Life style is a very important factor in keeping levels of glucose within acceptable levels. Considering high risks involved of cardiovascular diseases, modification of lifestyle is very vital in controlling blood pressure (Seino, 2010).

Medications (Oral)

As a first line of approach in medicine metformin is usually recommended for Type2 Diabetes. There is sufficient proof that it has reduced number of deaths. Routine administration of aspirin though has not indicated improvements in cases uncomplicated diabetes.

Insulin:

Treatment of Type1 Diabetes generally comprises of the administration of combinations of regular as well as NPH insulin (or synthetic insulin-analogs). Initially a long-acting formula is added when insulin is used to treat Type2 Diabetes. Oral medication however is not discontinued. Insulin doses are afterwards increased for greater effectiveness (Osterbrink & Münzinger, 2005).

Support:

In countries like UK where the system of general practitioner is in vogue, care may be conducted primarily outside the hospitals. Use of specialists based in hospital may be used when complications arise and control of sugar becomes difficult or in instances of research requirements. In other cases, general practitioners and specialists join hands to form a team. Multidisciplinary expertise help may come from various streams of medicine – nursing specialists (DSN or diabetic-specialist-nurse), physiotherapists, dieticians, chiropodists, podiatrists, optometrists etc (Misso, 2010).

Assessment

According to WHO in 2000 about 171 million persons across the globe suffered from diabetes calculating to 2.8% of the population. Incidences are rapidly increasing and it is predicted that in 2030 the number will nearly double. Throughout the world Diabetes Mellitus is common but it is more so in the developed world. But the greatest pick up in speed of spreading of the disease will take place in Africa and Asia where the majority will be located. In the developing world Diabetes is spreading fast because of the fast miming of Western diet and habits (Matheson, 2010).

For a minimum of two decades rate of Diabetes in North America has been sharply increasing. 26 million were affected in 2010 only in USA; of these 7 million have not been diagnosed. Another 57 million are in the pre-diabetes stage (Seino, 2010).

Diabetes increase has been termed as an epidemic by The Centers for Disease Control. According to the National Diabetes Information Clearinghouse USA is burdened with $132 billion as expenses related to diabetes. In North America 5% to 10% are Type1 Diabetes while the rest belong to Type2. The proportion differs in other parts of the world. The reason for this difference is not known. The grim prediction by The American Diabetes Association is that after 2000 one out of three of those born in America will develop in their lifetime this disease (Osterbrink & Münzinger, 2005).

American Diabetes Association informs that nearly 18.3% calculating to 8.6 million Americans aged above sixty have diabetes. The prevalence of diabetes increases with advancing age. Since there is a growth in elderly citizens, diabetes too will grow (Norris & Wolfsdorf, 2010). According to NHANES III among those above 65 years nearly 18% to 20% are victims of diabetes; 40% either already have diabetes or are in the pre-diabetes stage indicating impairment in glucose tolerance (Misso, 2010). The indigenous people in the countries of the first world suffer more from diabetes than their non-indigenous counterparts.

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