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Diabetes: by Dr Nizam, MBBS, MD, PhD

Posted in Uncategorized | February 23rd, 2011

Def: Diabetes is a chronic metabolic and Endocrine disorder due decreased insulin characterized by polyuria, polydypsia,polyphagia.

Types of Diabetes with Aetiology:

There are three main types of diabetes:
• Type 1 diabetes: results from the body’s failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
• Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)
• Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.
Others:
• Genetic defects of β-cell Function
o Maturity onset Diabetes mellitus(MODY)
o Mitochondrial DNA mutations
• Genetic defects in insulin processing or insulin action
o Defects in proinsulin conversion
o Insulin gene mutations
o Insulin receptor mutations
• Exocrine Pancreatic Defects
o Chronic pancreatitis
o Pancreatectomy
o Pancreatic neoplasia
o Cystic fibrosis
• Endocrinopathy
o Growth hormone excess (acromegaly)
o Cushing syndrome
o Hyperthyroidism
o Pheochromocytoma
o Glucagonoma
• Infections Cytomegalo virus, Coxa sachi

Signs and Symptoms
1. Frequent urination-sometimes almost hourly.
2. Unexplained weight loss.
3. Increased and excessive thirst.
4. Blurred vision.
5. Persistent fatigue.
6. In women, frequent yeast and bladder infections, sometimes missed menses.

What to do now
1. Take advice from a doctor specialized in Diabetes, if you know or suspect that you have diabetes.
2. Follow your doctor’s advice about diet, exercise, and monitoring your blood sugar levels.

When to call a doctor
1. If you feel weak and nauseous, excessively thirsty, are urinating very frequently, rapid breathing, and have abdominal pain.
2. If you experience extreme thirst, lethargy, weakness and mental confusion; you may have dangerously high blood sugar levels that could lead to coma.
3. If a person known to have diabetes loses consciousness.
4. If you have noticeable sweet smelling breath along with the symptoms listed above, you may have ketoacidosis-a life-threatening condition.

Call for an immediate appointment:
1. If you or your child develop symptoms of diabetes.
2. If you have diabetes and you get flu; flu and some other illness can make your blood sugar levels go out of control.

How to prevent it
1. There is no way prevent Type I diabetes.

To prevent Type II diabetes:
1. Keep your weight within the healthy range for your age, height and structure.
2. Exercise regularly. It is very crucial in preventing diabetes or managing it once it occurs.
3. If you are over 40, and overweight, or have a family history of diabetes, check up for diabetes every one to three years.

Management:
The treatment of diabetes is mainly by discipline, diet is second main step and finally the drugs. If any one maintain a discipline life diabetes can be cured. Diet habit should be changed according to diabetic association , Sugar should be avoided. Salt restricted. Regular morning walk and adequate exercise should be done.

Drugs added if above two step fails to control diabetes.
Oral hypoglycaemic agents: Sulphonylureas, Biguanides, usually used in NIDDM and Obese
Insulin is added in IDDM.

Combination of treatment should be done in complicated case.

Written by Dr Nizam, MBBS,MD(internal medicine),PhD (cardiology). I am consultant cardiology and medicine specialist cum Senior lecturer in Dhaka medical college since 2005.

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