DIABETES MELLITUS

INTRODUCTION:

Definition: Diabetes mellitus (DM), is a group of metabolic

diseases in which there are high blood sugar levels over a

prolonged period.

 Symptoms of high blood sugar include frequent urination,

increased thirst, and increased hunger.

 If left untreated, diabetes can cause many complications.

Acute complications can include diabetic ketoacidosis,

nonketotic hyperosmolar coma, or death. Serious long-term

complications include heart disease, stroke, chronic kidney

failure, foot ulcers, and damage to the eyes.

 Diabetes is due to either the pancreas not producing enough

insulin or the cells of the body not responding properly to

the insulin produced.

There are three main types of diabetes mellitus:

1. Type 1 DM

2. Type 2 DM

3. Gestational Diabetes

1. Type I DM: results from the pancreas's failure to

produce enough insulin. This form was previously

referred to as "insulin- dependent diabetes mellitus"

(IDDM) or "juvenile diabetes". The cause is unknown.

2. Type II DM: begins with insulin resistance, a condition

in which cells fail to respond to insulin properly. This

form was previously referred to as "non-insulin

dependent diabetes mellitus" (NIDDM) or "adult-onset

diabetes". The primary cause is excessive body weight

and not enough exercise.

in pregnant women without a previous history of

diabetes.

SIGNS AND SYMPTOMS

The classic symptoms of untreated diabetes are

 weight loss

 polyuria (increased urination)

 polydipsia (increased thirst)

 polyphagia (increased hunger).

 Symptoms may develop rapidly (weeks or months) in type

1 DM

 They usually develop much more slowly and may be subtle

or absent in type 2 DM.

Others include;

 Blurry vision

 Headache
 Fatigue

 Slow healing of cuts

 Itchy skin.

 Prolonged high blood glucose can cause glucose

absorption in the lens of the eye, which leads to changes

in its shape, resulting in vision changes.

 A number of skin rashes that can occur in diabetes are

collectively known as diabetic dermadromes.

COMPLICATIONS

 All forms of diabetes increase the risk of long-term

complications. These typically develop after many years

(10–20).

 The major long-term complications relate to damage to

blood vessels. Diabetes doubles the risk of

cardiovascular diseases, including stroke; collectively

known as "macrovascular" diseases.

artery disease.

 Peripheral vascular disease or “micro-vascular

diseases;

 The primary complications of diabetes due to damage in

small blood vessels include damage to the eyes, kidneys,

and nerves.

 Damage to the eyes, known as diabetic retinopathy, is

caused by damage to the blood vessels in the retina of the

eye, and can result in gradual vision loss and blindness.

 Damage to the kidneys, known as diabetic

nephropathy, can lead to tissue scarring, urine protein

loss, and eventually chronic kidney disease, sometimes

requiring dialysis or kidney transplant.

 Damage to the nerves of the body, known as diabetic

neuropathy, is the most common complication of

diabetes.
 The symptoms can include numbness, tingling, pain, and

altered pain sensation, which can lead to damage to the

skin.

 Diabetes-related foot problems (such as diabetic foot

ulcers) may occur, and can be difficult to treat,

occasionally requiring amputation.

 Additionally, proximal diabetic neuropathy causes

painful muscle wasting and weakness – Diabetic

Amyotrophy.

 Diabetic emergencies include;

 Diabetic coma

 Diabetic ketoacidosis.

PATHOPHYSIOLOGY

 Generally, insulin is the principal hormone that regulates

the uptake of glucose from the blood into cells of the

body, especially liver, adipose tissue and muscle, except

(Insulin-like growth factor - 1).

 Therefore, deficiency of insulin or the insensitivity of its

receptors plays a central role in all forms of diabetes

mellitus.

 The body obtains glucose from three main places;

 The intestinal absorption of food.

 The breakdown of glycogen, the storage form of glucose

found in the liver.

 Gluconeogenesis, the generation of glucose from non-

carbohydrate substrates in the body.

 Insulin plays a critical role in balancing glucose levels in

the body;

 It can inhibit the breakdown of glycogen or the process

of gluconeogenesis.

 It can stimulate the transport of glucose into fat and

muscle cells.
 It can stimulate the storage of glucose in the form of

glycogen.

 Insulin is released into the blood by beta cells (β-cells),

found in the islets of Langerhans in the pancreas, in

response to rising levels of blood glucose, typically after

eating.

 Lower glucose levels result in decreased insulin release

from the beta cells and results in the breakdown of

glycogen to glucose.

 This process is mainly controlled by the hormone

glucagon, which acts in the opposite manner to insulin.

 If the amount of insulin available is insufficient and cells

respond poorly to the effects of insulin.

 Or if the insulin itself is defective, then glucose will not

be absorbed properly by the body cells.

glucose, poor protein synthesis, and break down of fat

storage leading to Acidosis.

 When the glucose concentration in the blood remains

high over time, the kidneys will reach a threshold of

reabsorption, leading to glycosuria.

 This increases the osmotic pressure of the urine, leading

to polyuria (increased fluid loss).

 Lost blood volume will be replaced osmotically from

water held in body cells and other body compartments,

leading to dehydration and polydipsia.

DIAGNOSIS

DM can be diagnosed by demonstrating any one of the

following:

 Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)

mmol/l (200 mg/dl) two hours after a 75 g oral glucose

load.

 Symptoms of high blood sugar and casual plasma

glucose ≥ 11.1 mmol/l (200 mg/dl)

 Glycated haemoglobin (HbA1C) ≥ 48 mmol/mol (≥

6.5 DCCT %)

 Oral Glucose Tolerance Test (OGTT); measures the

body's ability to metabolise glucose. It is most

commonly done to check for gestational diabetes.

o The patient is asked to take a glucose drink and their

blood glucose level is measured before and at intervals

after the sugary drink is taken.

o For the standard glucose tolerance test, a drink

containing 75 grams or 100 grams is used.

a. Lifestyle changes, including alcohol & cigarette smoking

cessation.

b. Good nutrition- balanced diet with more fibre.

c. Regular exercise.

d. Diet control to maintain blood pressure. Medications;

insulin (short and long acting- 6 or 8 hourlies with

meals), oral hypoglycaemics e.g., metformin).

e. Surgery; pancreas transplant, kidney transplantation,

weight loss surgery.