Diabetes Mellitus

Introduction :

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, nonketotic hyperosmolar coma, or death. Serious long-term complications include heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:

Type 1 DM 

Results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.

Type 2 DM 

Begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is excessive body weight and not enough exercise.

Gestational diabetes

Is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood-sugar levels.

Manifestations of diabetes :

  • polyuria, polyphasia, polydipsia, blurring of vision , fatigue. 

investigations :

  • fasting sugar >= 126 mg/dl
    random blood sugar >= 200 mg/dl
    postprandial >= 200 mg/dl

  • HbA1c :

  • normal  -  below 0.6%

  • pre diabetes  - 6% to 6.4%

  • diabetes 6.5% and over

Complications :

  • Dawn phenomena : is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood suger  (glucose) 

  • Somogi effect: it is a rebounding high blood sugar that is a response to low blood suger. When managing the blood glucose level with insulin injections, this effect is counter-intuitive to insulin users who experience high blood sugar in the morning as a result of an overabundance of insulin at night.
    Diabetic ketoacidosis 

  • Hyperosmolar coma 

  • Retinopathy ( treated by control DM , BP , laser photocoagulation )

  • Nephropathy : micro albuminuria  ( treated by control DM , BP , ACEI )

  • Neuropathy : peripheral neuropathy – pain – ulcer of foot – infection  - delayed gastric emptying – esophageal dysmotility ( treated by foot care , antibiotics , analgesics )  

  • Cardiac complications , stroke , peripheral vascular disease 

  • By Dr. Mostafa Aljubbawy

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