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TREATMENTs at Navjivan - Diabetes mellitus

 

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.
Glucose in the blood gives you energy to perform daily activities, walk briskly, run for a bus, ride your bike, take an aerobic exercise class, and perform your day-to-day chores.

  • Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel.
  • People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
  • In diabetes, glucose in the blood cannot move into cells, so it stays in the blood. This not only harms the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.

Type 1 diabetes: The body stops producing insulin or produces too little insulin to regulate blood glucose level.

  • Type 1 diabetes comprises about 10% of total cases of diabetes in the United States.
  • Type 1 diabetes is typically recognized in childhood or adolescence. It used to be known as juvenile-onset diabetes or insulin-dependent diabetes mellitus.
  • Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin.
  • People with type 1 diabetes require daily insulin treatment to sustain life.

Type 2 diabetes: The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands.

  • At least 90% of patients with diabetes have type 2 diabetes.
  • Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.
  • Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. More than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.

Gestational diabetes is a form of diabetes that occurs during the second half of pregnancy.

  • Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life.
  • Women with gestational diabetes are more likely to have large babies

Complications of diabetes
Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycaemia. Over a long period of time, hyperglycaemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.

  • Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
  • Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.
  • Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations.
  • Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastro paresis), chronic diarrhoea, and an inability to control heart rate and blood pressure during postural changes.
  • Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).

Hypoglycaemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions

Diabetes Causes


Type 1 diabetes: Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin.
Type 2 diabetes: Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families. Several genes have been identified and more are under study which may relate to the causes of type 2 diabetes. Risk factors for developing type 2 diabetes include High blood pressure, High blood triglyceride (fat) levels , Gestational diabetes or giving birth to a baby weighing more than 9 pounds, High-fat diet , High alcohol intake Sedentary lifestyle , Obesity or being overweight
Diabetes Symptoms
Symptoms of type 1 diabetes are often dramatic and come on very suddenly.

  • Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus or urinary tract infection) or injury.
  • The extra stress can cause diabetic ketoacidosis.
  • Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium follow.
  • Without treatment, ketoacidosis can lead to coma and death.

Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.

  • A person may have type 2 diabetes for many years without knowing it.
  • People with type 2 diabetes can develop hyperglycaemic hyperosmolar nonketotic syndrome.
  • Type 2 diabetes can be precipitated by steroids and stress.
  • If not properly treated, type 2 diabetes can lead to complications like blindness, kidney failure, heart disease, and nerve damage

Common symptoms of both major types of diabetes are Blurry vision, Fatigue, Altered Mental Status, Unusual weight loss, Excessive eating (polyphagia), Poor wound healing, Excessive urination (polyuria), Excessive thirst (polydipsia), Infections.

A number of laboratory tests are available to confirm the diagnosis of diabetes.
Finger stick blood glucose: This is a rapid screening test that may be performed anywhere, including community-based screening programs.
Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL without eating anything, they probably have diabetes.
Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test at two hours after drinking a very sweet drink containing 75 grams of sugar.
Glycosylated haemoglobin or haemoglobin A1C: This test is a measurement of how high blood sugar levels have been over about the last 120 days


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