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Diabetes Melitus: causes and treatment

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia and abnormalities in carbohydrate, fat, and protein metabolism.

PATHOPHYSIOLOGY

• Type 1 DM (5%–10% of cases) usually develops in childhood or early adulthood and results from autoimmune-mediated destruction of pancreatic β-cells, resulting in absolute deficiency of insulin. The autoimmune process is mediated by macrophages and T lymphocytes with autoantibodies to β-cell antigens (eg, islet cell antibody, insulin antibodies).

gafacom image result for diabetes type 01


• Type 2 DM (90% of cases) is characterized by a combination of some degree of insulin resistance and relative insulin deficiency. Insulin resistance is manifested by increased lipolysis and free fatty acid production, increased hepatic glucose production, and decreased skeletal muscle uptake of glucose.

• Uncommon causes of diabetes (1%–2% of cases) include endocrine disorders (eg, acromegaly, Cushing syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (eg, pancreatitis), and medications (eg, glucocorticoids, pentamidine, niacin, α-interferon).

• Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include coronary heart disease, stroke, and peripheral vascular disease.

CLINICAL PRESENTATION OF TYPE 1 DIABETES MELLITUS

• The most common initial symptoms are polyuria, polydipsia, polyphagia, weight loss, and lethargy accompanied by hyperglycemia.

• Individuals are often thin and are prone to develop diabetic ketoacidosis if insulin is withheld or under conditions of severe stress.

• Between 20% and 40% of patients present with diabetic ketoacidosis after several days of polyuria, polydipsia, polyphagia, and weight loss.

TYPE 2 DIABETES MELLITUS

• Patients are often asymptomatic and may be diagnosed secondary to unrelated blood testing.

• Lethargy, polyuria, nocturia, and polydipsia can be present. Significant weight loss is less common; more often, patients are overweight or obese.

DIAGNOSIS

• Criteria for diagnosis of DM include any one of the following:
1. A1C of 6.5% or more
2. Fasting (no caloric intake for at least 8 hours) plasma glucose of 126 mg/dL (7.0 mmol/L) or more
3. Two-hour plasma glucose of 200 mg/dL (11.1 mmol/L) or more during an oral glucose tolerance test (OGTT) using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water
4. Random plasma glucose concentration of 200 mg/dL (11.1 mmol/L) or more with classic symptoms of hyperglycemia or hyperglycemic crisis In the absence of unequivocal hyperglycemia, criteria 1 through 3 should be confirmed by repeat testing.

• Normal fasting plasma glucose (FPG) is less than 100 mg/dL (5.6 mmol/L).

• Impaired fasting glucose (IFG) is FPG 100 to 125 mg/dL (5.6–6.9 mmol/L).

• Impaired glucose tolerance (IGT) is diagnosed when the 2-hour postload sample of OGTT is 140 to 199 mg per dL (7.8–11.0 mmol/L).

• Pregnant women should undergo risk assessment for GDM at first prenatal visit and have glucose testing if at high risk (eg, positive family history, personal history of GDM, marked obesity, or member of a high-risk ethnic group).

TREATMENT

• Goals of Treatment: Ameliorate symptoms, reduce risk of microvascular and macrovascular complications, reduce mortality, and improve quality of life. GENERAL APPROACH

• Early treatment with near-normal glycemia reduces risk of microvascular disease complications, but aggressive management of cardiovascular risk factors (ie, smoking cessation, treatment of dyslipidemia, intensive blood pressure [BP] control, and antiplatelet therapy) is needed to reduce macrovascular disease risk.

• Appropriate care requires goal setting for glycemia, BP, and lipid levels; regular monitoring for complications; dietary and exercise modifications; appropriate selfmonitoring of blood glucose (SMBG); and laboratory assessment.

NONPHARMACOLOGIC THERAPY

• Medical nutrition therapy is recommended for all patients. For type 1 DM, the focus is on physiologically regulating insulin administration with a balanced diet to achieve and maintain healthy body weight. The meal plan should be moderate in carbohydrates and low in saturated fat, with a focus on balanced meals. Patients with type 2 DM often require caloric restriction to promote weight loss.

• Aerobic exercise can improve insulin sensitivity and glycemic control and may reduce cardiovascular risk factors, contribute to weight loss or maintenance, and improve well-being.



Diabetes Melitus: causes and treatment Diabetes Melitus: causes and treatment Reviewed by gafacom on June 14, 2019 Rating: 5

4 comments:

  1. Diabetes is reversible. I am talking about the most common form of diabetes which is type 2.

    I have reversed it in so many cases myself and there are documented cases of thousands of people who have reversed diabetes with the help of experts.

    Glucose is the sugar which is used by every cell of the body to produce energy. This is carried by a hormone insulin to most of the cells. When sugar levels are high, the cells do not allow sugar inside and that is when we say Insulin has become ineffective. i.e. Insulin sensitivity has come down and the condition is known as Diabetes when excess sugar starts to circulate in the blood.

    Even the fat cells no longer store sugar. So any activity which burns energy will make your insulin sensitive and push glucose inside the cells reducing your sugar levels in the blood. When the intake of sugar is reduced, a similar result is observed.

    It takes a long time for the body to reverse diabetes and the body needs a lot of nutrients, as in a diabetic State the body is depleted of many nutrients.

    Diabetics are prone to infection and other chronic diseases like kidney failure, heart disease etc.

    Therefore it is important that you reverse the diabetes with a controlled and customized diet and not by yo yo dieting like reducing food intake. I definitely think that every parent needs to check out the site www.DiabetesReversalTactics.info if you’re serious about reversing your type 2 diabetes.

    Good luck!

    Nabila

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