DIABETES MELLITUS

                                                                                  Introduction

Diabetes Mellitus: A disease which occurs when there is raised levels of glucose in the blood (hyperglycemia) because the body cannot produce any or enough of the hormone Insulin or cannot use insulin effectively.

Glucose is a major energy source for the human body carried through the bloodstream to the body’s cells

Major source: Carbohydrates in our food after digestion and absorption are reduced to their simplest form, glucose. The liver also produces, stores and releases glucose.

Insulin: A hormone that is made in the pancreas. Insulin opens the door of the cells of our body allowing glucose to go from the bloodstream into the cells where it’s then used for energy. Insulin and glucose have to work together, for the body to utilize and maintain normal levels of glucose, there must be adequate levels of insulin.

Results from a deficiency/shortage of insulin

Critical mass of the beta islet cells are destroyed and the pancreas produces very little or no insulin.

The body cells become insensitive to insulin produced (insulin resistance) and the body is unable to produce enough insulin to compensate. As a result, people with diabetes cannot effectively utilize glucose in the blood stream which leads to the amount of glucose in the blood being excessively high (Hyperglycaemia). Persistently elevated levels of glucose in the blood is known as Diabetes mellitus

TYPES OF DIABETES MELLITUS

1. Type 1 diabetes
2. Type 2 diabetes
3. Gestational diabetes

TYPE 1 DIABETES

• Body immune (defense) system malfunctions and destroys the insulin producing cells of the pancreas.
• The pancreas is unable to make enough insulin because its insulin producing cells have been destroyed.
• More common in children and young adults, but can occur at any age.

TYPE 2 DIABETES

• It is the most common form of diabetes worldwide, it accounts for 90% of persons with diabetes.
• It is more common in the middle aged and elderly but can occur earlier, even in children.
• It is often associated with overweight or obesity.
• In Type 2 diabetes, the pancreas still makes insulin but the insulin doesn’t work very well (it is like having the wrong key for the door). Body cells cannot effectively use the insulin produced by the pancreas (insulin resistance). Though the pancreas can still produce some insulin, it is unable to produce all the insulin that is required by the body as a consequence of the decreased effectiveness.

GESTATIONAL DIABETES

Diabetes diagnosed for the first time in pregnancy. In this form of diabetes, the blood glucose often returns to normal after the baby is born but there is an increased risk of developing type 2 diabetes mellitus later in life.

WHY SHOULD WE CARE ABOUT DIABETES?

• Diabetes is a huge and growing problem and the cost to society are high and escalating.
• Many with Type 2 diabetes mellitus also have over weight/obesity, and elevated blood cholesterol levels.
• Increase risk for complications above and beyond risk of hyperglycemia.
• Diabetes is a life long medical condition if untreated or poorly treated. Diabetes can result in serious health problems and premature death.

WHAT ARE THE RISK FACTORS FOR DEVELOPING DIABETES?

Risk factors for Type 1 Diabetes Mellitus 

1. Genetic predisposition, if someone in the family has Type 1 diabetes, chances of developing the disease are increased.
2. Research suggests environmental factors trigger the immune system

Risk factors for Type 2 diabetes

1. Unhealthy diet; high fat, inadequate intake of fruits, vegetables, fiber and excessive intake/overeating.
2. People with essential hypertension are at a high risk.
3. Impaired glucose tolerance and impaired fasting glucose, levels of blood glucose which higher than normal but not yet in the diabetic range.
4. Women who have had gestational diabetes are at a greater risk of developing Type 2 diabetes later.
5. People with a history of babies greater than or equal to 4kg.
6. People with high cholesterol levels.

Body Mass Index (BMI)

An indicator to determine an average person’s weight status.

To calculate your BMI: Weight (kg)/height(m²) e.g. 80kg/1.6mx1.6m or 80/1.6m²)

• 5 – 24.9 Normal
• 25 – 29.9 Overweight
• 30 – 39.9 Obesity
• 40 and above Morbid obesity.

Waist Circumference

• Abdominal Obesity
• Adult male greater than or equal to 94cm
• Adult female greater than or equal to 80cm
• Increasing abdominal fat associated with increased risk of Type 2 diabetes and cardiovascular disease.

DIAGNOSIS OF DIABETES MELLITUS

In both Type 1 and Type 2 diabetes, there is too much glucose in the blood with little or none getting into the body’s cells. As a result of the high blood glucose, people with diabetes might experience the following:

1. Pass urine frequently
2. Be extremely thirsty
3. Feel very tired
4. Have blurry vision
5. However, some people with Type 2 diabetes may not have any symptoms. Diagnosing diabetes requires measurement of the blood glucose to establish the diagnosis.
6. Sometimes, the doctor might ask you to repeat blood glucose test done on another day to be certain about the diagnosis.

MANAGEMENT OF DIABETES MELLITUS

• Diabetes mellitus requires long term medical care, it is a life long condition but it can be effectively controlled.
• Early diagnosis and proper management is crucial in order to achieve more optimal outcomes.
• People with diabetes can live an active, healthy life and prevent/significantly reduce the risk of developing complications.
• Health education and good self-care
• Adopting a healthy lifestyle which includes:
• Healthy eating
• Regular exercise as appropriate
• Encouraging weight loss, in the overweight/obese
• People with Diabetes mellitus also need to assume active role in their care. Good self care is essential for good diabetes outcomes.
• Vital that persons with diabetes be empowered and motivated to take responsibility for their care.
• Effective self management skills through diabetes education.
• In both types of diabetes daily blood glucose checks using a glucose meter helps to know whether the treatment plan is working or needs adjusting.
• Regular monitoring of blood glucose, BP, weight, BMI and blood lipids as well. Know your numbers.
• Regular follow-up visits to health care providers and investigation as at when due.
• Diabetes requires a team approach to keep the person with diabetes healthy, the team includes his/her family working together with their healthcare team.

Outcome of Diabetes mellitus

Diabetes is a serious condition, but doesn’t have to stop a child or adult from living long, living healthy and being active.

Prevention of diabetes

Right now, Physicians are not quite certain on how to prevent Type 1 diabetes, but many scientists are trying to discover how it can be prevented. 

Preventing Type 2 Diabetes

• Exercise regularly
• Healthy life
• Eat healthy
• Reduce stress
• Drink plenty of water.

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