Nowadays, Diabetes is a common disorder in the world. But many people may never realize, how did they get diabetes and what will happen to them and what will they go through. Diabetes is a metabolic disorder that is identified by high blood sugar levels. Increased blood sugar levels damage the vital organs of the human body causing other potential health ailments.
It is the most common endocrine disorder. It is characterised by hyperglycemia resulting from defects in insulin secretion, insulin action or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Several pathogenic processes are involved in the development of diabetes.
The basis of abnormalities in carbohydrates, fat and protein metabolism in diabetes is the deficient action of insulin on the target tissues. Deficient insulin action results from inadequate insulin secretion and/or diminished tissue response to insulin at one or more points in the complex pathways of hormone action.
1) Primary – a) type 1
b) type 2
2) Secondary – due to other pathology-
1) Gestational diabetes
2) Generic syndrome associated with Diabetes
3) Uncommon immune mediated
4) Genetic defects of insulin secretion
6) Drug induced
7) Toxin induced
8) Genetic effects of beta- cells
9) Secondary to infection
Type 1 diabetes, the cause is an absolute deficiency of insulin secretion.
Type 2 diabetes, the cause is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response.
Testing for Diabetes in presumably healthy individuals
Type 1 diabetes is usually an autoimmune disease, characterized by the presence of a variety of autoantibodies to protein episodes on the surface of or within the beta cells of the pancreas. The presence of such markers before the development of the overt disease can identify patients at risk.
It is epidemiological evidence that retinopathy begins to develop at least 7 years before the clinical diagnosis of type 2 diabetes. Because hyperglycemia in type 2 diabetes causes microvascular disease and may cause contribute to macrovascular disease, the undiagnosed disease is a serious condition.
Screening for Diabetes
Urine examination – urine testing for glucose 2 hours after a meal is used in medical practice for detecting cases of diabetes.
Blood sugar testing – Blood sugar testing remains the cornerstone of the diagnosis of diabetes. Mass screening programs have used glucose measurement for fasting, postprandial or random samples. The most reliable is the combination of fasting and 2 hours post radial blood glucose testing.
Target population – screening of high-risk groups seems more appropriate. These groups are-
a) age 40 and above
b) family history of diabetes
c) person with obesity
d) women who have had a baby of more than 4.5 kg
e) women showing excessive weight gain during pregnancy
f) patients with premature atherosclerosis
1) extreme thirst
2) excessive urination
3) weight loss
4) stomach problem
5) foot problem
6) high blood pressure
7) low concentrations
8) sweat smell breath
9) cracked skin
10) loss of consciousness
a) population strategy – the development of prevention programs for Diabetes based on the elimination of environmental risk factors is possible. The measures comprise normal body weight through the adoption of healthy nutritional habits and regular physical exercise. The nutritional habits include an adequate protein intake, a high intake of dietary fibre and avoidance of sweet foods.
b) High-risk strategy – Nutritional education, nutritional rehabilitation and management of obesity are the hallmarks of reducing the incidence and prevalence of diabetes.
Secondary prevention –
The aim of the treatment is-a) to maintain the blood glucose levels as close to normal limits as possible
b) to maintain body weight in the ideal range for the desirable BMI level
The treatment is based on
a) diet modification alone
b) dist change along with oral hypoglycemic drugs
c) diet change and insulin
Good control of diabetes prevents complications that would otherwise have taken place
Routine checks are a must for –
Blood Pressure, blood sugar, urine for protein and ketones, visual acuity and weight, defective circulation in the feet, loss of sensation of the skin, estimation of Glycated Haemoglobin levels yearly etc.
Tertiary prevention –
Diabetes is a major cause of deformity and disability through its communication like blindness, kidney failure, coronary thrombosis, and gangrene of the feet.
Long term complications
1) peripheral atherosclerosis – it may cause intermittent claudication, gangrene, coronary artery disease and stroke.
2) cardiomyopathy – it can cause heart failure.
3) Diabetic retinopathy
4) Renal disease – it is a major cause of death and disability.
5) peripheral sensory neuropathy causes numbness, paraesthesia, severe hypothesis, and pain that may be deep-seated and severe and it often works at night.