Archive for March 2016

DIABETES MELLITUS

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Diabetes Mellitus is clinical syndrome characterized by an increase in plasma blood glucose – hyperglycemia. Mainly there are two types i.e Type 1 and Type 2. Mainly to understand, Type 1 is presented in early stage of life. Type 2 is has late onset around 40-50 years.

When you eat food, your body changes most of the food into glucose (a form of sugar). A hormone called insulin allows this glucose to enter all the cells of your body and utilize it to get energy. Insulin is produced by the pancreas. In Type1, there is total destruction of β cells of pancreas so insulin is not produced whereas in type 2 diabetes, the pancreas doesn’t make enough insulin or the body’s cells can’t use insulin properly (insulin resistance). This increases the glucose in your blood. Too much glucose in the blood can lead to serious health problems that may damage the blood vessels, nerves, heart, eyes and kidneys.

Risk Factors for Type 1
  • Family History
  • Viral Infections – Mumps, Coxsackie B4, Retrovirus, Rubella, Cytomegalovirus and Ebstein-Barr Virus

 Risk Factors for Type 2
  • Age above 45 years
  • Family History – Parents and Siblings with Diabetes
  • Ethnic Group - Native American, Hispanic American, African American and Pacific Islander
  • Sedentary Lifestyle
  • Diet high in Fat, Calories and Cholesterol
  • Obesity with BMI >30 kg/m2
  • Hypertension >140/90 mm of Hg
  • Gestational Diabetes – Diabetes during the pregnancy
  • Triglyceride level above 250 mg/dl or HDL below 35 mg/dl
  • Diagnosed as Pre-Diabetes
  • Woman with PCOS - Polycystic Ovary Syndrome

 Symptoms of DM
Symptoms Of Diabetes
  1. Polyuria – frequent urination
  2. Polydypsia – drinking too much of water
  3. Polyphagia – eating too much
  4. Thirst and dry mouth
  5. Nocturia – urinating frequently at night
  6. Tiredness
  7. Fatigue
  8. Lethargy
  9. Weight loss
  10. Blurring of vision
  11. Headache
  12. Nausea
  13. Slow-healing wounds, sores or bruises
  14. Dry, itchy skin
  15. Tingling or numbness in the hands or feet
  16. Frequent or recurring skin, gum, bladder or vaginal yeast infections

 Investigation

 Urine Test
  • Glucose
  • Ketones
  • Protein
Blood Test
  • Glucose
  • Ketone
  • Glycated Hemoglobin (Hb A1C)
 Other
  • Triglyceride and HDL

Criteria For Diabetes

Diabetes Diagnosis: American Diabetes Association (ADA) 2015 (ANY ONE)
Glycated Hemoglobin (Hb A1C) ≥6.5%
Fasting Blood Glucose (FBG - no calorie intake ≥8 hrs) ≥126 mg/dL ( 7mmol/L)
Post-Prandial Glucose (PPG - after 2-hr of having 75g of anhydrous glucose dissolved in water) ≥200 mg/ (11 mmol/L)
Random Blood Glucose (RBG – In patient with symptoms) ≥200 mg/dL (11 mmol/L)

Criteria for Pre-Diabetes (ANY ONE)
Impaired Fasting Glucose (IFG):- FBG 100 -125 mg/dL (5.6 - 6.9 mmol/L)
Impaired Glucose Tolerance (IGT):- PPG 140 -199 mg/dL (7.8 - 11.0 mmol/L)
HbA1C:- 5.7 - 6.4%

Complications Of Diabetes
Diabetic Foot Ulcer
  1. Retinopathy  - Impaired vision, cataract
  2. Nephropathy - Renal failure
  3. Neuropathy - sensory loss, pain and motor weakness
  4. Foot ulceration
  5. Myocardial Infraction
  6. Stroke
  7. Peripheral Claudication

 Treatment For Diabetes
Management Of Diabetes
  • Diet 
    • Should be balanced, nutritious and low in fat and cholesterol. 
    • Aim is to achieve glycemic control, weight maintenance, reduce the complication and adequate nutritional intake
    • Carbohydrate: 45-60%
    • Fat: <35%
    • Protein 10-15%
    • Fruits/Vegetables: 5 portions daily
    • Limit salt intake not more than 6 g daily
  • Weight Reduce– maintain the BMI within normal range (18.5 to 24.9 kg/m2)
  • Exercise – For at least 30 min of exercise. Physical exercise lowers the blood sugar, cholesterol and weight.
  • Regular monitoring of glucose – Whether you are on insulin or not, it is a must.
  • Insulin or antidiabetic medication
    • Insulin is must in Type 1
    • Oral Antidiabetic medications are glipizide, glicazide, Rosiglitazone, Pioglitazone, sitagliptin, saxagliptin, repaglinide, etc. Most commonly used is the Metformin
  • Educating the patient
  • Foot Care
    • Inspect feet every day
    • Wash feet every day
    • Moisturize skin if dry
    • Change socks every day
    • Cut the toenail regularly
    • Avoid walking barefoot
    • Check footwear for foreign bodies
    • Wear suitable and well-fitting shoes
    • Cover minor cuts with sterile dressing
    • Specially manufactured and fitted orthotic footwear is required to prevent recurrent ulceration 

 Hypoglycemia

 Patient may have hypoglycemic state those under the medication. Their blood sugar immediately falls down below 63 mg/dl

Symptoms
  1. Sweating
  2. Trembling
  3. Hunger
  4. Anxiety
  5. Confusion
  6. Drowsiness
  7. Incoordination
  8. Inability to concentrate
  9. Irritability
  10. Headache
  11. Nausea
Causes
  1. Missed, delayed or inadequate meal
  2. More exercise
  3. Alcohol intake
  4. Improper dose/schedule/administration of insulin and oral anti-diabetic agents
  5. Lipohypertrophy at the injection site
 Treatment
Glucometer
  1. Always carry chocolates and glucose drinks with you. Immediately take it when you feel the symptoms.
  2. Follow with the carbohydrate snacks
  3. If patient is severe then immediately rush the patient to the hospital for glucose drink or parenteral dextrose (if unconscious)
  4. To prevent this, perform frequent blood glucose test

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