Details Descriptions About :: Diabetes Mellitus

 Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from lack of insulin, lack of insulin effect, or both. Three general classifications are recognized: type 1—absolute insulin insufficiency type 2—insulin resistance with varying degrees of insulin secretory defects gestational diabetes—manifested during pregnancy. Age Alert Although possible at any age, type 1 usually manifests before age 30. It requires exogenous insulin and dietary management. Type 2 usually occurs in obese adults after age 40. It’s treated with diet and exercise combined with various antidiabetic drugs; treatment may include insulin therapy.

Causes for Diabetes Mellitus

Causes Heredity Environment (infection, toxins) Stress, diet, lack of exercise in genetically susceptible persons Pregnancy

Pathophysiology Diabetes Mellitus

Pathophysiology Type 1 and type 2 diabetes mellitus are two separate and distinct pathophysiological entities. In persons genetically susceptible to type 1 diabetes, a triggering event, possibly a viral infection, causes production of autoantibodies which kill the beta cells of the pancreas. This leads to a decline in and an ultimate lack of insulin secretion. Insulin deficiency, when more than 90% of the beta cells have been destroyed, leads to hyperglycemia, enhanced lipolysis, and protein catabolism. Type 2 diabetes mellitus is a chronic disease caused by one or more of the following factors: impaired insulin production, inappropriate hepatic glucose production, or peripheral insulin receptor insensitivity. Gestational diabetes mellitus is glucose intolerance during pregnancy in a woman not previously diagnosed with diabetes. This may occur if placental hormones counteract insulin, causing insulin resistance.

Signs and symptoms Diabetes Mellitus

Signs and symptoms Polyuria and polydipsia Nausea; anorexia (common) or polyphagia (occasional) Weight loss (usually 10% to 30%; persons with type 1 diabetes often have almost no body fat at diagnosis) Headaches, fatigue, lethargy, reduced energy levels, impaired school or work performance Muscle cramps, irritability, emotional lability Vision changes such as blurring Numbness and tingling Abdominal discomfort and pain; diarrhea or constipation Recurrent vaginal candidiasis

Diagnostic Lab Test results

Diagnostic test results In men and nonpregnant women Two of the following criteria obtained more than 24 hours apart, using the same test twice or any combination are indicators of the disease: fasting plasma glucose level of 126 mg/dl or more on at least two occasions typical symptoms of uncontrolled diabetes and random blood glucose level of 200 mg/dl or more blood glucose level of 200 mg/dl or more 2 hours after ingesting 75 g of oral dextrose. Other criteria include: diabetic retinopathy on ophthalmologic examination other diagnostic and monitoring tests, including urinalysis for acetone and glycosylated hemoglobin (reflects glycemic control over the past 2 to 3 months). In pregnant women Positive glucose tolerance test reveals high peak blood sugar levels after ingestion of glucose (1 g/kg body weight) and delayed return to fasting levels.

Treatment for Diabetes Mellitus

Treatment Type 1 diabetes mellitus Insulin replacement, meal planning, and exercise (current forms of insulin replacement include mixed-dose, split mixed-dose, and multiple daily injection regimens and continuous subcutaneous insulin infusions) Pancreas transplantation (currently requires chronic immunosuppression) Type 2 diabetes mellitus Oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates (drug combinations may be used) Exogenous insulin, alone or with oral antidiabetic drugs, to optimize glycemic control Type 1 and type 2 diabetes mellitus Individualized meal plan designed to meet nutritional needs, control blood glucose and lipid levels, and reach and maintain appropriate body weight Weight reduction (obese patient with type 2 diabetes mellitus) or high calorie allotment, depending on growth stage and activity level (type 1 diabetes mellitus) Gestational diabetes Medical nutrition therapy and exercise Alpha glucosidase inhibitors, injected insulin, or both (if euglycemia not achieved) Counseling on the high risk for gestational diabetes in subsequent pregnancies and type 2 diabetes later in life Exercise and weight control to help avert type 2 diabetes Clinical Tip Although patients with type 2 diabetes are able to suppress development of ketones under basal conditions, they may develop diabetic ketoacidosis in the presence of precipitating factors such as sepsis.

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