Prepared By:
Mohammed Awad Al-Awfi
Contents
Definition
Symptoms
Treatment
Management
Prevention
References
Definition
Diabetes mellitus (DM) or simply diabetes is a group of metaolic diseases in which a
person has high lood sugar! This high lood sugar produces the symptoms of fre"uent
urination# increased thirst# and increased hunger! $ntreated# diaetes can cause many
complications! Acute complications include diaetic %etoacidosis and non%etotic
hyperosmolar coma! Serious long-term complications include heart disease# %idney
failure# and damage to the eyes!
Diaetes is due to either the pancreas not producing enough insulin# or ecause cells of
the ody do not respond properly to the insulin that is produced! There are three main
types of diaetes mellitus&
Type ' DM results from the ody(s failure to produce insulin! This form was
previously referred to as )insulin-dependent diaetes mellitus) (*DDM) or
)+uvenile diaetes)!
Type , DM results from insulin resistance# a condition in which cells fail to use
insulin properly# sometimes also with an asolute insulin deficiency! This form
was previously referred to as non insulin-dependent diaetes mellitus (-*DDM)
or )adult-onset diaetes)!
.estational diaetes# is the third main form and occurs when pregnant women
without a previous diagnosis of diaetes develop a high lood glucose level!
Symptoms
The classic symptoms of untreated diaetes are weight loss# polyuria (fre"uent urination)#
polydipsia (increased thirst)# and polyphagia (increased hunger)!Symptoms may develop
rapidly (wee%s or months) in type ' diaetes# while they usually develop much more
slowly and may e sutle or asent in type , diaetes!
Prolonged high lood glucose can cause glucose asorption in the lens of the eye# which
leads to changes in its shape# resulting in vision changes! /lurred vision is a common
complaint leading to a diaetes diagnosis! A numer of s%in rashes that can occur in
diaetes are collectively %nown as diaetic dermadromes!
Diabetic emergencies
People (usually with type ' diaetes) may also e0perience episodes of diaetic
%etoacidosis# a type of metaolic prolems characteri1ed y nausea# vomiting and
adominal pain# the smell of acetone on the reath# deep reathing %nown as 2ussmaul
reathing# and in severe cases a decreased level of consciousness!
3
A rare ut e"ually severe possiility is hyperosmolar non%etotic state# which is more
common in type , diaetes and is mainly the result of dehydration!
Complications
All forms of diaetes increase the ris% of long-term complications! These typically
develop after many years ('45,4)# ut may e the first symptom in those who have
otherwise not received a diagnosis efore that time!
The ma+or long-term complications relate to damage to lood vessels! Diaetes doules
the ris% of cardiovascular disease and aout 678 of deaths in diaetics are due to
coronary artery disease! 9ther )macrovascular) diseases are stro%e# and peripheral
vascular disease!
The primary microvascular complications of diaetes include damage to the eyes#
%idneys# and nerves! Damage to the eyes# %nown as diaetic retinopathy# is caused y
damage to the lood vessels in the retina of the eye# and can result in gradual vision loss
and potentially lindness! Damage to the %idneys# %nown as diaetic nephropathy# can
lead to tissue scarring# urine protein loss# and eventually chronic %idney disease#
sometimes re"uiring dialysis or %idney transplant! Damage to the nerves of the ody#
%nown as diaetic neuropathy# is the most common complication of diaetes!The
symptoms can include numness# tingling# pain# and altered pain sensation# which can
lead to damage to the s%in! Diaetes-related foot prolems (such as diaetic foot ulcers)
may occur# and can e difficult to treat# occasionally re"uiring amputation! Additionally#
pro0imal diaetic neuropathy causes painful muscle wasting and wea%ness!
Treatment
:ith type , diaetes# the disease may e reversed with lifestyle changes# especially
losing weight through e0ercising and eating healthier foods! Also# some cases of type ,
diaetes can e improved with weight-loss surgery!
There is no cure for type ' diaetes!
Treating oth type ' diaetes and type , diaetes involves medicines# diet# and e0ercise
to control lood sugar level!
.etting etter control over your lood sugar# cholesterol# and lood pressure levels helps
reduce the ris% of %idney disease# eye disease# nervous system disease# heart attac%# and
stro%e!
To prevent diaetes complications# visit your health care provider at least two to four
times a year! Tal% aout any prolems you are having! ;ollow your health care provider(s
instructions on managing your diaetes!
Management
Diaetes mellitus is a chronic disease# for which there is no %nown cure e0cept in very
specific situations! Management concentrates on %eeping lood sugar levels as close to
normal ()euglycemia)) as possile# without causing hypoglycemia! This can usually e
accomplished with diet# e0ercise# and use of appropriate medications (insulin in the case
of type ' diaetes< oral medications# as well as possily insulin# in type , diaetes)!
=earning aout the disease and actively participating in the treatment is vital for people
with diaetes# since the complications of diaetes are far less common and less severe in
people who have well-managed lood sugar levels! The goal of treatment is an >A'?
level of @!78# ut should not e lower than that# and may e set higher!
Attention is also
paid to other health prolems that may accelerate the deleterious effects of diaetes!
These include smo%ing# elevated cholesterol levels# oesity# high lood pressure# and lac%
of regular e0ercise! Specialised footwear is widely used to reduce the ris% of ulceration#
or re-ulceration# in at-ris% diaetic feet! Avidence for the efficacy of this remains
e"uivocal# however!
Prevention
There is no %nown preventive measure for type ' diaetes! Type , diaetes can often e
prevented y a person eing a normal ody weight# physical e0ercise# and following a
healthy diet!
Dietary changes %nown to e effective in helping to prevent diaetes include
a diet rich in whole grains and fier# and choosing good fats# such as polyunsaturated fats
found in nuts# vegetale oils# and fish! =imiting sugary everages and eating less red
meat and other sources of saturated fat can also help in the prevention of diaetes!
Active
smo%ing is also associated with an increased ris% of diaetes# so smo%ing cessation can
e an important preventive measure as well!
References
Alem1adeh R# Ali 9! Diaetes mellitus! *n& 2liegman RM# ed! Kliegman: Nelson
Textbook of Pediatrics ! 'Bth ed! Philadelphia# Pa!& Alsevier Saunders< ,4''&chap 7CD!
Amorosa =;# =ee AE# Swee DA! Diaetes mellitus! *n& Ra%el RA# Ra%el DP# eds!
Textbook of Family Medicine ! Cth ed! Philadelphia# Pa!& Alsevier Saunders< ,4''&chap
DF!
American Diaetes Association! Standards of medical care in diaetes -- ,4'D! Diabetes
Care ! ,4'D< Ean<DD Suppl '&S''-S@'!
Aisenarth .S# Polons%y 2S# /use E/! Type ' Diaetes Mellitus! *n& 2ronenerg >M#
Melmed S# Polons%y 2S# =arsen PR! Kronenberg: Williams Textbook of Endocrinology !
''th ed! Philadelphia# Pa& Saunders Alsevier< ,44C&chap D'!
