Diabetes Mellitus Prof. Dr. Berrin Çarmıklı Demirbaş Created: 2016-03-15 14:10:21
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Diabetes Mellitus

Diabetes mellitus is a syndrome of disordered metabolism with inappropriate hyperglycemia due either to an absolute deficiency of insulin secretion or a reduction in the biologic effectiveness of insulin or both. It may lead to serious complications. In conclusion, one may not use the glucose, which is derived from foods and transported into the blood circulation, and blood glucose level increases.

Diabetes Mellitus

Fasting (for 10 hours) and postprandial (two hours after meal) blood glucose levels of a healthy subjects do not exceed 100 mg/dL and 140 mg/dL, respectively.
Diagnosis of diabetes is based on Fasting Blood Glucose (FBG) , post-prandial glucose determination or Oral Glucose Tolerance Test (OGTT). A FBG value of 100-125 mg/dL is the warning signal of pre-diabetes. Diabetes is considered if FBG is ≥126 mg/dL. and post-prandial glucose is ≥ 200 mg/dl. In addition, diabetes is diagnosed if FBG is ≥126 mg/dL and post-prandial glucose is ≥ 200 mg/dl on two sequential measurements.

HbA1c is of value in the follow-up of diabetic patients and it gives an idea about three months blood glucose level. For diabetic patients, optimum level of HbA1c is below 6.5 percent.

What is insulin?

  • For healthy subjects, the ingested foods, particularly carbohydrates, are metabolized into glucose in the body for generating energy. Pancreas is located at posterior side of stomach and the gland produces a hormone, namely “insulin”, which enables uptake of glucose by muscles and other tissues from blood circulation in order to generate energy. Glucose is transported from foods into blood circulation and insulin ensures intra-cellular transportation of glucose. Cells use glucose as fuel. If amount of glucose is above fuel need of the body, it is stored in liver (storage form is glycogen) and fat tissue.
  • Insulin is required to transport glucose into cells in order to generate energy.
  • Insulin is the "key", which opens the door of the cell to glucose.
  • It is also important for regulating blood glucose levels within physiological ranges.
  • Insulin insufficiency or deficiency leads to hyperglycemia (elevated serum glucose levels).

What is insulin resistance?

It implies failure of tissue to response to normal stimuli of insulin. In other words, tissues, such as liver, muscle and fat tissue, does not obey commands of insulin. Transportation of serum glucose into muscle, fat tissue and liver cells impairs in patients with insulin resistance. Therefore, glucose starts to accumulate in blood. In this case, pancreas starts working harder and producing more insulin in order to transport glucose into cells. Ultimately, pancreas will be exhausted and it will fail to release sufficient insulin to blood circulation, resulting with diabetes.

Overweight, policystic ovary syndrome, treatments with cortisone, increased waist circumference (>80 cm for female subjects and >94 cm for male subjects), aging and sedentary life style are predisposing factors of insulin resistance.
Morning tiredness, waking up at night and eating sweets, tiredness after lunch and fatigue can be symptoms of insulin resistance.

What are types of diabetes?

  • Type 1 diabetes mellitus (it is rare; it is more common in young population): Blood glucose level rapidly increase due to lack of insulin hormone. Patient starts using fats to generate energy, instead of glucose, and weight loss is very remarkable.
  • Type 2 diabetes mellitus (it is frequent; it is more common in elder population): Type 2 diabetes is associated with 2 primary problems.
    • Insulin resistance
    • Insulin deficiency

If type 2 diabetes mellitus is diagnosed at early stage, it is preventable disease, should life style changes are made (diet and exercise) and drugs are regularly used, if required.

  • Gestational diabetes
  • Other specific types of diabetes

Who are under risk for type 2 diabetes?

Subjects with BMI >25 kg/m2 and female subjects with waist circumference > 80 cm and male subjects with waist circumference >94 cm

Patients with familial history of diabetes in first degree relatives (mother, father, sibling)

Subjects with high total cholesterol, LDL-cholesterol and triglyceride and low HDL-cholesterol levels

Patients with cardiovascular disease

Patients with polycystic ovary disease

Subjects with high blood pressure

Subjects with diagnosis of gestational diabetes and who delivered infants with birth weight of 4 kg

Subjects with known diagnosis of diabetes are considered as subjects with high risk.

What are symptoms of diabetes?

The condition can be asymptomatic, although common symptoms involve polydypsia (excessive thirst), polyuria (excessive or abnormal production or passage of urine), fatigue and unexplainable weight loss. If you have one or more than one of above written symptoms, you should immediately consult to a healthcare facility.

Onset of type 1 diabetes is usually sudden and dramatic. You may experience symptoms such as excessive thirst, polyuria, tiredness, unexplainable weight loss and recurrent infections.

Symptoms of Type 1 diabetes is can be seen in patients with Type 2 diabetes, although frequency is lower. Onset of Type 2 diabetes is somewhat slow and therefore, diagnosis is more challenging. No early symptom can be experienced by some patients with Type 2 diabetes and diagnosis can be made several years later after complications of diabetes occur. If you have any concerns about diabetes, you should consult to a healthcare facility to make or rule out the diagnosis.

Why is diabetes a serious disease?

  • It is the most causes of new blindness cases,
  • Risk of ophthalmic problems is 25 times higher
  • Risk of heart crisis is 2-4 times higher
  • Risk of stroke is 6 times higher
  • Risk of diseases, which may lead to amputation of leg, is 20 times higher
  • Risk of renal disease is 5 times higher

All above specified complications can be avoided with treatment, which should be started in a timely manner, and good glycemic control.

What is incidence of diabetes?

  • Number of diabetic subjects is gradually increasing worldwide.
  • Number of diabetic subjects is almost 5 million in Turkey.
  • It is expected that number of diabetic patients will increase from 171 million in 2000 to 366 million in 2030 worldwide.

Why is incidence of diabetes increasing?

  • More common sedentary life
  • Increasing incidence of obesity (overweight)
  • Non-healthy dietary habits

Who are possible candidates of diabetes?

Type 1 diabetes occur more commonly in children and adolescents; however, it can be seen in adults. It is among common chronic diseases of children. Risk factors of type 1 diabetes are not well defined. However, it is shown that genetic and environmental factors induce the disease in first-degree relatives of Type 1 diabetics.

Although type 2 diabetes is more common in adults, it is rapidly becoming a health problem at adolescence worldwide. Risk factors of Type 2 diabetes include aging, obesity, familial history of diabetes, macrosomia (big baby syndrome), gestational diabetes, poor physical exercise, impaired glucose tolerance and race/ethnical origin.

Treatment of Diabetes:

Treatment should be customized according to individual patient and type of diabetes.

Diabetes can be under control, if following measures are taken.

  • Training/Education
  • Healthy nutritional plan
  • Regular physical exercise
  • Appropriate medical treatment
  • Regular check-up and control visits

Simple nutritional clues

  • Small portions, regular meal times and healthy snacks
  • Fat-free milk and vegetable oil
  • Modification of cooking methods - boiling, grill and steaming
  • You should avoid following foods
    • Excessive saturated fat and margarine, butter and fried foods
    • Fat meat
    • Excessive consumption of refined sugar, such as tea sugar, honey, jam and chocolate

Physical exercise has many advantages:

  • It facilitates losing weight.
  • It promotes healthy blood circulation.
  • Self-confidence is promoted.
  • Muscle strength is enhanced.
  • Your heart is strengthened.
  • Sleep quality is improved.
  • Stress is alleviated.
  • Appetite is controlled.
  • Survival is prolonged.
  • It makes you feel better and energetic.

Drugs in diabetes:

  • They play no role in Type 1 diabetes.The only option is insulin.
  • Usually, a patient with Type 2 diabetes is started on tablets.Insulin can be considered at advanced stages.

What are possible outcomes if blood glucose level cannot be controlled?

Serious complications of diabetes may occur.

  • Ophthalmic problems - loss of vision (blindness)
  • Renal problems (renal failure; requires dialysis/renal transplantation).
  • Sensorial/nervous problems (loss of pain sensation, sensorial loss and occurrence of wounds)
  • Cardiovascular problems - heart crisis
  • Stroke
  • Foot problems (gangrene - loss of extremity)

What are protective measures?

  • Blood glucose monitoring
  • Blood pressure monitoring
  • , Body measurements
  • Foot examination
  • Urine protein analyses
  • Cholesterol test
  • Ophthalmic examination
  • Dental control visits
  • ECG (electrocardiography) should be regularly carried out.

This post has been written by Prof. Dr. Berrin Çarmıklı Demirbaş and viewed 11289 times.



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