What is Diabetes Mellitus?

What is Diabetes Mellitus?

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia (elevated blood sugar) resulting from defects in insulin secretion, insulin action or both.

It is classified into:

Type 1 DM – insulin dependent, diagnosed at a young age

Type 2 DM – most common type, usually adult-onset

Gestational diabetes mellitus – elevated blood sugar with onset or first recognition during pregnancy that resolves after giving birth

 Other rare types of diabetes include genetic defects of beta cell function or insulin action, diseases or exocrine pancreas (e.g. pancreatitis, neoplasia, cystic fibrosis), endocrinopathies (e.g. acromegaly, Cushing’s syndrome, hyperthyroidism), drug or chemical-induced, and other uncommon forms of immune-mediated diabetes. The succeeding information will describe the most common type of diabetes, Type 2 DM.

 

How does one know if one has Diabetes Mellitus?

-          Frequent urination

-          Constant thirst

-          Extreme hunger

-          Weight loss

-          Tiredness or lack of energy

-          Blurred vision

-          Frequent urination

-          Slow/poor wound healing

-          Itchiness

-          Numbness or tingling of hands or feet

 

If you experience any of these signs and symptoms, you should see your doctor and be tested or diabetes.

 

What are the risk factors of Diabetes Mellitus?

-          Family history of diabetes

-          Age 45 years old and above

-          Hypertension (high blood pressure)

-          Elevated cholesterol/ triglycerides

-          Overweight / obesity

-          History of Gestational diabetes mellitus or have given birth to babies weighing > 8 lbs.

-          Asian, African-American, Native American, Hispanic

 

Diabetes in its early stage may be asymptomatic (no symptoms). Hence, if you have any of the above risk factors, see your doctor so you can be evaluated and managed properly.

 

What happens when you have Diabetes Mellitus?

Insulin is a hormone secreted by the beta cells of the pancreas responsible for regulating sugar and fat metabolism in our bodies. It acts as a key that unlocks the cells so that our body can use the glucose/ sugar from the diet and convert it to energy.

In type 1 DM, there is absolute or total lack of insulin because of destruction of pancreatic beta cells, hence type 1 diabetics are dependent on insulin injection to survive.

 In type 2 DM, there are two defects: insulin resistance where the body cannot use insulin properly and relative insulin deficiency where the pancreas does not produce enough insulin for the body’s needs.

The end result of the above defects is hyperglycemia and if not managed/ controlled properly is associated with long-term damage, dysfunction and failure of various organs including the eyes, kidneys, nerves, heart and blood vessels.

 

How is Diabetes Mellitus diagnosed? When/who do you consult?

There are three ways to diagnose DM namely:

1)      Fasting plasma glucose – (FBS) no caloric intake for at least 8 hours

Normal:

Impaired Fasting Glucose: 100-125 mg/dl

Diabetes Mellitus: 126 mg/dl and above

2)      Symptoms of DM plus casual plasma glucose – (RBS) defined as any time of day without regard to time of last meal

Diabetes Mellitus: 200 mg/dl and above

3)      Oral glucose tolerance test – (OGTT) using glucose load containing 75 mg anhydrous glucose

2 hour post-glucose load

Normal glucose tolerance:

Impaired glucose tolerance: 140-199 mg/dl

Diabetes Mellitus: 200mg/dl and above

 

Each of the above tests must be confirmed on a subsequent day by any of the three methods given. Consult your doctor when any of the results is above normal. Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) are considered pre-diabetic states and are risk factors for future diabetes and cardiovascular disease, hence should already be managed and treated.

 

What are the available treatment options?

As of date, there is still no cure for diabetes mellitus but there are a number of ways to control it to prevent complications. The most important management of DM and probably the hardest to comply with is a change of lifestyle. This includes a healthy diet with the right proportion of macronutrients (carbohydrate, protein, fat) suitable for the patient’s caloric requirement, a regular exercise or physical activity (e.g. brisk walking 30 minutes/day 3-5x/ week) will improve patient’s sensitivity to insulin and promote weight loss among overweight and obese diabetics. Diabetics are also advised to quit smoking, avoid alcohol and learn to manage stress.

 

Patients with type 1 DM are dependent on daily insulin injections to survive. Type 2 diabetics may be prescribed one or more oral anti-diabetic medications which may stimulate insulin secretion, decrease hepatic (liver) glucose output, improve the body’s utilization of glucose or delay the absorption of glucose in the intestines. Some type 2 diabetics may require insulin in combination with oral anti-diabetic medications or insulin alone in certain cases such as acute illnesses (heart attack and stroke), surgery, infection or when the kidney and liver functions are already impaired. Your doctor/ endocrinologist will be the best person to prescribe and adjust your medications depending on the different clinical situations.

 

Goals of Treatment

1)      Blood sugar control

Glycohemoglobin (HbA1c): 6% or lower (average blood sugar in the past 3 months)

2)      Blood pressure control: < 130/80

3)      Lipids: LDL: < 100 mg/dl

HDL: 40 mg/dl and above (males)

50 mg/dl and above (females)

Triglycerides: < 150 mg/dl   

 

Target Blood Sugar Level

(Using Glucose Meter)

 

Before meals:                          80- 100mg/dl

2 hours after a meal:              < 140mg/dl

 

What are the possible complications of diabetes?

Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS) are the two most serious acute metabolic complications of diabetes which may occur in both type 1 and type 2 diabetes. The above complications cause dehydration, hyperglycemia, electrolyte imbalance, low blood pressure and sometimes coma due to reduction of circulating insulin with elevation of counter-regulatory hormones. The most common precipitating factors in the development of DKA and HHS are infection but may also be due to stroke, heart attack, alcohol abuse, pancreatitis, trauma and drugs.

 

Long-term or chronic complications of diabetes lead to damage of blood vessels throughout the body. Damage to small blood vessels (microvascular complications) include retinopathy with potential loss of vision, nephropathy leading to kidney failure, peripheral neuropathy which involves nerves of extremities with risk of foot ulcers and amputations, autonomic neuropathy causing gastrointestinal, genitourinary and cardiovascular symptoms and sexual dysfunction. Damage to the big blood vessels (macrivascular complications) lead to stroke, heart attack and occlusion of the blood vessels of the extremities.

 

In The Medical City, what are the related services available?

 

Diagnostics:

-          Laboratory tests for the diagnosis of DM and monitoring of its complications

 

Management of DM:

-          Dietary counseling

-          Diabetes education (Diabetes nurse educator, insulin administration, self-monitoring of blood glucose, foot care, sick days, hypoglycemic precautions)

-          Exercise program/ Rehab

-          Endocrinologists (doctors who specialize in diabetes)

 

Prevention of DM:      

-          Center for Patient Partnership (Diabetes classes, Diabetes Lay Forum for diabetics and their families as well as people caring for diabetics)

 

Eating and Diabetes

You can take good care of yourself and your diabetes by learning

• What to eat
• How much to eat
• When to eat

 

Making wise food choices can help you

• Feel good every day
• Lose weight if you need to
• Lower your risk of heart disease, stroke, and other problems caused by diabetes

 

Healthful eating, along with physical activity and, if needed, diabetes medicines, helps keep your blood glucose in your target range. The diabetes target range is the level suggested by diabetes experts for good health. You can help prevent health problems by keeping your blood glucose levels on target.

 

Exercises for Diabetics: Tips to get you moving

 

Benefits:

• Improves insulin sensitivity.
• Assists in decreasing elevated blood glucose levels into normal range.
• Promotes weight loss and maintenance.
• Improves sense of well being and quality of life.
• Improves strength and endurance of conducting daily activities.

 

Perform details medical evaluation prior to initiation.

 

FREQUENCY

            3-5 days/ week

 

INTENSITY

            Low-impact to moderate impact

 

DURATION

            10-15 minutes / session up to 30 minutes

            Can be divided into 3 ten-minute sessions

 

MODE

            Walking – most convenient low-impact physical activity

 

PREVENTION OF RISK AND COMPLICATIONS

• Increase carbohydrate intake (15g)
• Drink fluids during and frequently to compensate for losses in sweat
• Assess for presence of MACRO / MICRO complications
• Assess appropriate time and site of insulin injection
• Monitor blood glucose level
• Proper footwear

 

MAINTENANCE FACTORS

• Warm up period (5-10 min)
• Exercise period (20-30 min)
• Cool down period (5-10 min)
• Set realistic measurable goals
• Set an exercise schedule
• Exercise Partner
• Self rewards

 

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

 

For more information, please call:

 

DIABETES CENTER

Tel. No. (632) 988-1000 / (632) 988-7000 ext. 6611

 

CENTER FOR PATIENT PARTNERSHIP

Tel. No. (632) 988-1000 / (632) 988-7000 ext. 6444