Diabetes mellitus
Diabetes is a major burden on healthcare facilities in all countries. Globally, in 2015, diabetes caused 5 million deaths in those aged 20–79 years.
Diabetes Definition:
Diabetes mellitus is a clinical syndrome characterized by an increase in plasma blood glucose (hyperglycemia).
It has many causes .most commonly Type 1 diabetes or type 2 diabetes.
Symptoms of Diabetes
Thirst, dry mouth
Polyuria
Nocturia
Tiredness, fatigue, lethargy
Change in weight (usually weight loss)
Blurring of vision
Pruritus vulvae, balanitis (genital candidiasis)
Nausea
Headache
Polyuria
Nocturia
Tiredness, fatigue, lethargy
Change in weight (usually weight loss)
Blurring of vision
Pruritus vulvae, balanitis (genital candidiasis)
Nausea
Headache
Diabetes is diagnosed with
either plasma glucose in the random sample or 2 hrs after a 75 g glucose load ≥ 11.1 mmol/L (200 mg/dL) or
fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL) or
HbA1c ≥ 48 mmol/mol
fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL) or
HbA1c ≥ 48 mmol/mol
Read about hypoglycemia
Causes of diabetes mellitus
Type 1 diabetes
Type 2 diabetes
Genetic defects of β-cell function
Pancreatic disease:
Pancreatitis,
Pancreatectomy,
Neoplastic disease,
Cystic fibrosis,
Haemochromatosis,
Fibrocalculous pancreatopathy
Type 2 diabetes
Genetic defects of β-cell function
Pancreatic disease:
Pancreatitis,
Pancreatectomy,
Neoplastic disease,
Cystic fibrosis,
Haemochromatosis,
Fibrocalculous pancreatopathy
Excess endogenous production of hormonal antagonists of insulin, e.g.:
Growth hormone – acromegaly
Glucocorticoids – Cushing’s syndrome
Glucagon – glucagonoma
Catecholamines – phaeochromocytoma
Thyroid hormones – thyrotoxicosis
Glucocorticoids – Cushing’s syndrome
Glucagon – glucagonoma
Catecholamines – phaeochromocytoma
Thyroid hormones – thyrotoxicosis
Drug-induced :
Glucocorticoids,
Thiazide diuretics,
Phenytoin
Thiazide diuretics,
Phenytoin
Associated with genetic syndromes Down’s syndrome,
Klinefelter’s syndrome,
Turner’s syndrome,
DIDMOAD (Wolfram’s syndrome),
Friedreich’s ataxia,
Myotonic dystrophy)
Turner’s syndrome,
DIDMOAD (Wolfram’s syndrome),
Friedreich’s ataxia,
Myotonic dystrophy)
Management of Diabetes
Treatment of Diabetes
Dietary management of diabetes:
Dietary constituents and recommended % of energy intake
Carbohydrate: 50%: Sucrose: up to 10%
Fat (total): < 35%: n-6 Polyunsaturated: < 10% n-3 Polyunsaturated: eat 1 portion (140 g) oily fish once or twice weekly Monounsaturated: 10–20% Saturated: < 10%
Protein: 10–15% (do not exceed 1 g/kg body weight/day)
Fruit/vegetables: 5 portions daily
Sulphonylureas
Meglitinides
Metformin
Thiazolidinediones (glitazones)
DPP-4 inhibitors (gliptins)
GLP-1 receptor agonists
SGLT2 inhibitors
Impaired vision Nephropathy
Renal failure
Peripheral neuropathy
Sensory loss
Pain
Autonomic neuropathy
Gastrointestinal problems (gastroparesis; altered bowel habit)
Foot disease • Ulceration • Motor weakness • Postural hypotension • Arthropathy
Myocardial ischemia/infarction
Cerebral circulation
Transient ischemic attack, stroke
Peripheral circulation
Claudication
Ischemia
Dietary constituents and recommended % of energy intake
Carbohydrate: 50%: Sucrose: up to 10%
Fat (total): < 35%: n-6 Polyunsaturated: < 10% n-3 Polyunsaturated: eat 1 portion (140 g) oily fish once or twice weekly Monounsaturated: 10–20% Saturated: < 10%
Protein: 10–15% (do not exceed 1 g/kg body weight/day)
Fruit/vegetables: 5 portions daily
Drug management
InsulinSulphonylureas
Meglitinides
Metformin
Thiazolidinediones (glitazones)
DPP-4 inhibitors (gliptins)
GLP-1 receptor agonists
SGLT2 inhibitors
Complications of diabetes
Microvascular
Retinopathy, cataractImpaired vision Nephropathy
Renal failure
Peripheral neuropathy
Sensory loss
Pain
Autonomic neuropathy
Gastrointestinal problems (gastroparesis; altered bowel habit)
Foot disease • Ulceration • Motor weakness • Postural hypotension • Arthropathy
Macrovascular
Coronary circulationMyocardial ischemia/infarction
Cerebral circulation
Transient ischemic attack, stroke
Peripheral circulation
Claudication
Ischemia
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