Educative Information On Diabetes Mellitus

Overview Of Diabetes Mellitus, Complications, Diagnosis, Management And Treatment 

Do you all know that, after Cancer and Heart Disease, Diabetes Mellitus is the 3rd of leading cause of death in the world?

Yes, diabetes is very deadly and its starts frm our infantile stage.

Now, the question we should ask ourselves is, "WHAT IS DIABETES MELLITUS".

The answer that will pop up to the mind of many of us is, "diabetes is excess "sugar" in the body".

What do sugar in this scenario stands for?
Majority of us refer to sugar as;

• substance added to tea to sweeten it
• Sweetners and sweetened items. 

Well, the above answer above is substantially correct and at the same time is 70% wrong. 

It may interest you to know that sugars are not only restricted to the aforementioned above. 

The appropriate definition of sugar ranges from food reach in monosaccharide to polysaccharides carbohydrates.

Do we know that the RICE we consume is rich in sugar? 

Yea. Its contains starch which is composed mainly of glucose as its backbone (monosaccharide). Thes e glucose are linked by alpha 

Diabetes 

Types Of Diabetes. 

It should be beared in mind that there are two main types or classifications of diabetes. They include;

1) Diabetes Insipidus. 

2) Diabetes Mellitus 

Diabetes Insipidus. 

This is neurological disorder that is characterised by increased and persistent excretion of water as a result of malfunctioning of Aldosterone. 

Diabetes insipidus doesn't tend to impend much clinical complications as compared to diabetes Mellitus (which will be discussed in full below). 

My Granny will always say, "WITHOUT THE NECK, WHERE WILL THE HEAD BE PLACED and vice versa". So also, before proceeding to discussing diabetes Mellitus in full, its important to talk about some of crucial terms that might be encountered as the class goes on. 

What are some of these terms? Here they are below;

Hormones Produced By The Pancreas

1) Glucagon which is secreted by the alpha cells of the islet of Langerhans. 
2) Insulin which is secreted by the beta cells of the islet of Langerhans. 
3) Somatostatin which is secreted by the delta cells of the islet of Langerhans.

Glucagon is secreted when there is decreased production of GLUCOSE by the body.

The body cells (most especially the brain cells) depends mainly only on Glucose for survival.

Glucagon production triggers metabolic pathways such as "GLUCONEOGENESIS (ie synthesis of glucose frm non-carbohydrate moieties such as lipids and proteins) , GLYCOGENOLYSIS( ie breakdown of stored glycogen to release glucose) , LIPOLYSIS (ie lipid breakdown which could lead to ketoacidosis) etc.

Insulin is secreted when there is elevated level of glucose in the blood. This insulin secreted is anabolic in nature in the sense that, it promotes glycogen formation and allow uptake of glucose by the cells brain, RBCs, Cornea and Skeletal Muscle.

Insulin is also a hormone responsible for growth. (this will not be discussed)

Somatostatin also will not be discussed as it has no relevance to today's discussion.

Insulin 

Now, insulin was mentioned above while defining diabetes.  

1. What is this insulin?
2. Where is it produced? 
3. What are its effects?

Insulin is a hormone that is produce in the pancreas by the islet of Langerhans.

Anatomy & Detailed physiology of the pancreas won't be discussed.

The site(gland) of production, specific mainly for insulin is the pancreas. This is the gland which is responsible for regulation of elevation and decreasing of glucose level in the system by secreting several hormones.

These hormones are responsible for "blood glucose homeostasis".

Now, which the little written above, the three questions asked above could now be answered without stress.

1) What is insulin? 
Is a hormone produced by the beta cells of islet of Langerhans. 
2) Where is insulin Produced? 
In the beta cells of islet of Langerhans of the pancreas. 
3) What are its effect? 
Allow glucose uptake by the cell. Decrease blood glucose level. Serves as a hormone for growth. 

All the above been known. Insulin will now be discussed in details. 

Diabetes Mellitus.

What is diabetes Mellitus?

Diabetes Mellitus is a metabolic clinical disorder characterised by inefficient or insufficient level of INSULIN to regulate blood glucose level thereby allowing glucose to spill into urine..

Hormones That Affect Blood Glucose Level

Aside insulin, all other hormones listed below increase blood glucose level during starvation. 

•  Glucagon 
•  Adrenocorticotropic Hormone (ACTH) 
•  Epinephrine 
•  Thyroxine 
•  Glucocorticoid 
•  Growth Hormone 

When there is decreased glucose level in the blood, the body secrete the above hormone to increase its level to maintain life. 

A discussion and class on diabetes wont be complete if two terms are not briefly explained. 

These terms are as follows:

1) Hypoglycemia. 

2) Hyperglycemia. 

HYPOGLYCEMIA

HYPOGLYCEMIA literally means low blood sugar (hypo = low, gly = sugar, emia = blood). 

When blood glucose concentration falls to less than 45 mg/dl(approx 4.44mmol/L), the symptoms of hypoglycemia appear. 

Manifestations of Hypoglycemia

The manifestations include; 

1.  headache, 
2.  anxiety, 
3.  confusion, 
4.  sweating, 
5.  slurred speech , 
6.  seizures and coma, 
7.  death (if not corrected early in time). 

All these symptoms are directly and indirectly related to the deprivation of glucose supply to the central nervous system (particularly the brain) due to a fall in blood glucose level. 

The mammalian body has developed a well regulated system for an efficient maintenance of blood glucose concentration (details already described above.).

Hypoglycemia, therefore, is not commonly observed. But when a case of patient is been reported to be hypoglycemic, accurate measures, treatments and managements should be ensured. 

Types Of Hypoglycemia 

The following three types of hypoglycemia are encountered by physicians.

1 . Post-prandial hypoglycemia: This is also called reactive hypoglycemia and is observed in subjects with an elevated insulin secretion following a meal. This causes transient hypoglycemia and is associated with mild symptoms. The patient is advised to eat frequently rather than the 3 usual meals.

2. Fasting hypoglycemia: Low blood glucose concentration in fasting is not very common. However, fasting hypoglycemia is observed inpatients with pancreatic B-cell tumor and hepatocellular  damage.

3. Hypoglycemia due to alcohol intake: Insome individuals who are starved or engaged inprolonged exercise, alcohol consumption may cause hypoglycemia. This is due to the accumulation of NADH (during the course of alcohol metabolism by alcohol dehydrogenase)which diverts the pyruvate and oxaloacetate(substrates of gluconeogenesis) to form, respectively, lactate & malate. 

4. Hypoglycemia due to insulin overdose. 

HYPERGLYCEMIA

HYPERGLYCEMIA also literally means high blood sugar (hyper = increased/elevated/high, gly = sugar, emia = blood). 

When blood glucose concentration rises to above 100 - 120 mg/dl (approx 8.88 - 10.00mmol/L), the symptoms of hyperglycemia is said to manifest. 

When the blood glucose level exceed this limit, the kidney tries to reabsorb and regulate glucose from spilling into the urine. When glucose spill into urine, its known to be that the RENAL THRESHOLD of the kidney has been exceeded (blood glucose above 180mg/dl. Greater than 10.00mmol/L). 

Manifestations of Hyperglycemia

The manifestations include; 

1.  Polyuria, 
2.  anxiety, 
3.  confusion, 
4.  sweating, 
5.  slurred speech , 
6.  seizures and coma, 
7.  death (if not corrected early in time). 

Classifications Of Diabetes Mellitus. 

Basically, there are three classifications of diabetes Mellitus. Among which first  two impose very severe clinical complications. 

•  Insulin dependent diabetes Mellitus. 
•  Non insulin diabetes Mellitus. 
•  Gestational diabetes Mellitus. 

Insulin Dependent Diabetes Mellitus 

IDDM, also referred to as Type I diabetes or (more & less frequently) Juvenile Onset Diabetes. This mainly occurs during childhood (particularly between the age range of 2 - 15years). IDDM is known to  accounts for about 10% to 20% of the known diabetics. 

Causes Of IDDM

IDDM is characterized by;

1) Almost total deficiency of insulin due to destruction of B-cells of pancreas. 

The beta-cell destruction may be caused by drugs, viruses or autoimmunity. 

2) Due to genetic variations. 

Due to certain genetic variations, the Beta-cells are recognized as non-self and they are destroyed by immune mediated injury.

Irrespective of what might have brought about the cause of IDDM, usually, the symptoms of diabetes appear when 80-90% of the Beta-cells have been destroyed. This leads to inability of the pancreas ultimately secrete insulin in response to glucose ingestion. 

Management of IDDM

The patients of IDDM require insulin therapy.

Non Insulin Dependent Diabetes Mellitus. 

NIDDM, also referred to as  type II diabetes or (less frequently also) adult-onset diabetes, is the popular and most common reported case of Diabetes Mellitus. 

It accounts for about 80% to 90% of the diabetic population. NIDDM occurs in adults(usually above 35 years) but is less severe than Insulin Dependent Diabetes Mellitus (IDDM) because there is no gland destruction. Therefore insulin is produced but its functionality is inefficient to regulate the body blood glucose level. 

Causes Of NIDDM

NIDDM could be caused as a result of the  following viz;

1) Genetic Inheritance or Induction  and 

2) Environmental factor. 

It should be noted that NIDDM is occurs mostly in Obesed individuals. Obesity could be as a result of Over-eating coupled with underactivity leading to associated development of NIDDM. 

Obesity acts as a diabetogenic factor in genetically predisposed individuals by increasing the resistance to the action of insulin. This is due to a decrease in insulin receptors on the insulin responsive (target) cells. The patients of NIDDM may have either normal or even increased insulin levels. lt is suggested that over-eating causes increased insulin or reduction but decreased synthesis of insulin receptors.

Correction Of NIDDM. 

This is based on the fact that weight reduction by diet control alone is often sufficient to correct NIDDM. Also, sufficient exercise should be carried out by the individual. 

Complications of Diabetes Mellitus. 

The complications of diabetes Mellitus can be divided and discussed under two headings namely;

1) Acute complications of Diabetes Mellitus - which include;

•  hypoglycemia 
•  diabetic ketoacidosis (DKA) 
•  diabetic foot

2) Chronic complications of diabetes mellitus - which include;

•  retinopathy 
•  atherosclerosis 
•  cataract
•  neuropathy 
•  nephropathy

Laboratory Relationships Of Diabetes Mellitus.

By And Large, lots have been discussed in full about diabetes, insulin, hypoglycemia and hyperglycemia etc.

Laboratory Diagnosis. 

Sample, Type Of Test and Lab recommendations is included while discussing the laboratory diagnosis of DM. 

Sample Required For Diabetes Mellitus diagnosis. 

The two main types of samples required in the diagnosis of D.M are;

1) Urine. 

2) Blood. 

These two samples are test specific depending on the type of investigation to be carried out. 

Urine Sample. 

The urine sample is used mainly for qualitative analysis in the detection for presence or absence of glucose in urine. 

Urine Test Strip

The kit used for this analysis is called a URINE TEST STRIP pad. 

This method of using URINE TEST STRIP for the qualitative determination of URINE CONSTITUENTS is called URINALYSIS. 

Principle Of The Test (Urinalysis Principle). 

The strip is impregnated with various chromogens and immobilised enzymes such that when the particular analytes to be detected comes in contact with the CHROMOGEN, series of reactions tend to occur immediately which then leads to change in colours on the test pad. 

This strip is designated in different forms known to as COMBI. These COMBIs range from COMBI-9 to COMBI-12.

Analytes To Detected Using Various Urine Test Strip COMBIs. 

The number of analytes a test strip can estimate depends on the suffix number affixed to the COMBI. 

If "11" is attached as suffix to the COMBI, (ie COMBI-11), it means the strip can detect the presence and absence of 11-different analytes. 

Analytes detected by strips include;

1) blood

2) citrate

3) ketone (or ketone bodies namely beta-hydroxybutyrate, acetoacetate and acetone). 

4) Glucose

5) Proteins

6) Urobilonogens

7) Bilirubin 

8) 

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