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Diabetes Mellitus is a long-term condition caused by having too much glucose (sugar) in the blood.
What is the underlying condition causing high blood sugar?
Normally, the amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, the insulin helps the body turn glucose into energy. However, in people with diabetes, the body can’t do this. That’s either because there’s not enough insulin being produced, or because the insulin doesn’t work properly.
Important fact about Diabetes Mellitus
Currently,there is no known cure for Diabetes Mellitus, you will have to live with it for the rest of your life,but disease can be controlled enabling you to lead a healthy and reproductive life.
Types of Diabetes Mellitus
Type 1 Diabetes Mellitus or Insulin Dependent Diabetes Mellitus
Type 2 Diabetes Mellitus or non-insulin dependent Diabetes Mellitus
What is type 1 diabetes?
This is also known as juvenile, early-onset, or insulin-dependent diabetes. It usually first develops in children or young adults. With type 1 diabetes the illness usually develops quite quickly, over days or weeks, as the pancreas stops making insulin. It is treated with insulin injections and a healthy diet (see below in treatment session).
Why does the pancreas stop making insulin?
In most cases, type 1 diabetes is thought to be an autoimmune disease. The immune system normally makes antibodies to attack germs called bacteria and viruses, and also other germs. In autoimmune diseases the immune system makes antibodies against part or parts of the body. If you have type 1 diabetes you make antibodies that attach to the beta cells in the pancreas. These are thought to destroy the cells that make insulin. It is thought that something triggers the immune system to make these antibodies. The trigger is not known but a popular theory is that a virus triggers the immune system to make these antibodies. Rarely, type 1 diabetes is due to other causes. For example, severe inflammation of the pancreas, or surgical removal of the pancreas for various reasons.
What is type 2 diabetes?
This is also known as maturity-onset, late-onset, or non-insulin-dependent diabetes. Type 2 diabetes usually develops after the age of 40 (but sometimes occurs in younger people). It is more common in people who are overweight or obese. With type 2 diabetes, the illness and symptoms tend to develop gradually (over weeks or months). This is because in type 2 diabetes you still make insulin (unlike type 1 diabetes). However, you either do not make enough for your body's needs, and/or the cells in your body are not able to use insulin properly. This is called insulin resistance.
Are you at risk of Diabetes Mellitus?
You are at risk of developing this condition if
- You are overweight ( Body Mass Index >23 kg/m2 or waist circumference >80 cm for women and >90 cm for men)
- You have history of heart diseas ( Ischaemic heart disease)
- You have history of hypertension
- Your first or second degree relatives have Diabetes
- You are having inactive lifestyle
- You have medical conditions such as Cushing’s syndrome, women with Polycystic Ovarian Syndrom.
- You have history of stoke
- You have condition called Gestational Diabetes, which is high blood sugar during in pregnancy period
How do you know you have Diabetes Mellitus?
Common symptoms of Diabetes Mellitus
Forty eight percent of people above the age of 30 years old are not aware that they have diabetes as it is asymptomatic in majority. But there are some common symptoms that may suggest high blood sugar :
- You feel thirsty all the time
- You are passing more urine
- Tiredness and weight loss
- Itchiness at genitalia ( pruritus vulvae, balanitis)
Confirmation by blood test
Diagnosis is made by measuring blood sugar level
Fasting Blood Sugar : > 7 mmol / L
2 Hrs after eating meal or Random blood sugar : >11
Hb A1C (a substance that is formed when blood sugar attaches Haemoglobin) : >6.5 %
Complications of Diabetes Mellitus
Very high blood sugar (glucose) level
If you are not treated, or use too little insulin, a very high blood glucose level can develop quite quickly - over several days. If left untreated this causes lack of fluid in the body (dehydration), drowsiness, and serious illness which can be life-threatening. A very high blood glucose level sometimes develops if you have other illnesses such as any infections. In these situations you need to seek urgent medical attention.
Diabetes complications are medical problems that occur more often in people with diabetes than in people without diabetes. Changes in the blood vessels or the nerves are often the causes of diabetes complications.
- Vascular disease
Some people with diabetes may be at greater risk for changes in large blood vessels. This is called vascular disease. It starts when the linings of the blood vessels get thicker. Then, blood has a hard time flowing through the narrowed vessel. As a result, the blood cannot carry nutrients to your body's many organs. Heart disease or stroke can result.
The main warning signs of heart disease are chest pain, shortness of breath, swollen ankles, and/or irregular heart beat. When blood flow is blocked in the legs, you may experience weakness, pain, and/or cramping in the calves when walking. Your health-care practitioner can check for these symptoms (and others) of vascular disease during your regular office visits.
- Small blood vessel disease
Damage to small blood vessels can occur in the eyes and kidneys of people with diabetes. At first, there may be no outward symptoms but damage to blood vessels can lead to blindness and kidney disease.
Your health-care practitioner can check for symptoms of these complications during your regular office visits.
- Nerve damage, or neuropathy
Most often, nerve damage affects the feet and legs.
Symptoms of nerve damage include loss of feeling, tingling, burning, or pain in the feet and legs, and sometimes the hands. Nerve damage can also cause impotence (when a man cannot have an erection).
Serious problems can occur in people who have nerve and blood vessel damage in the legs or feet. They may not feel a blister or a small cut on the foot. The blister or cut may become infected, which may sometimes lead to amputation.
- Who gets diabetes complications?
No one can tell who will have diabetes complications. But experts think that keeping blood-sugar levels close to normal helps to prevent or delay trouble. High levels of sugar in the blood over time (poorly controlled diabetes) may speed the onset of complications.
Good control of blood sugar may help delay some complications
Some people try hard to control their blood sugars. But they still may have a complication. Experts aren't sure why this happens. But even if you do have complications, there is hope. So be sure to see your health-care practitioner regularly.
- What can you do now to avoid diabetes complications?
First, get regular checkups. You may not know that you have a complication. But your health-care practitioner can spot trouble long before symptoms appear. Finding problems early is the best way to keep complications from getting serious.
Keep your appointments with your health-care practitioner -- even if you are feeling fine. This includes your eye doctor and any other specialists you may need to see.
Also be aware of the warning signs of trouble:
1.Vision problems (blurriness, spots).
2.Tiredness or pale skin colour.
3.Obesity (more than 20 pounds overweight).
4.Numbness or tingling feelings in hands or feet.
5.Repeated infections or slow healing of wounds.
8.Constant headaches (This may be a symptom of high blood pressure.)
If you have one or more of these symptoms, tell your health-care practitioner!
How will your health care provider manage your Diabetes Mellitus?
Most diabetes will be treated by your GP or your practice nurse. If your diabetes is difficult to control, you may be referred to specialist diabetes services in the community for treatment, either in the community or at hospital.
For people with Type 1 Diabetes Mellitus
This condition is when the body produces no insulin at all. You will need to take insulin for life, and the only treatment that works is injections. You must also make sure that your blood glucose levels stay within normal range by eating a healthy diet and having regular blood tests. So it’s important you follow this programme:
- Step 1: Diagnosis – your health team will identify whether you have type 1 or type 2 diabetes.
- Step 2: You will be referred to dietitian and diabetic educator as well as pharmacist who will give training how to inject insulin.
- Step 3: Treatment. Type 1 can only be controlled by insulin injections. Don’t worry, you will be given advice and training from your health team. It’s not a daunting as it seems.
- Step 4: Check ups – you will have regular check ups with your specialist team at the hospital and/or from your GP/Practice nurse. During each visit, your body weight, blood pressure, blood sugar, blood cholesterol levels , kidney functions will be checked at timely intervals .You will have an annual appointment which will include a yearly retinal eye examination. Simple eye tests are NOT enough – this needs to be a special examination to make sure diabetes does not damage your vision.
For people with Type 2 Diabetes Mellitus
- Step 1: Diagnosis – your team will have identified you as having type 2 through a blood-test.
- Step 2: You will be referred to dietitian who will help you with healthy way of eating. You will be referred to diabetic educator who will explain you about the condition and complications and how to manage accordingly
- Step 3: You will be started on treatment, usually h.ealthy diet and exercise initially. Later tablets called oral hypoglycaemic agents and possibly insulin will be added if your blood sugar is not well controlled.
- Step 4: Check ups – you will have regular check ups with your specialist team at the hospital and/or from your GP/Practice nurse. During each visit, your body weight, blood pressure, blood sugar, blood cholesterol levels , kidney functions will be checked at timely intervals. You will also have an annual appointment which will include a yearly retinal eye examination. Simple eye tests are NOT enough – this needs to be a special examination to make sure diabetes does not damage your vision.
What are the aims of treatment?
Although diabetes cannot be cured, it can be treated successfully. If a high blood sugar (glucose) level is brought down to a normal or near-normal level, your symptoms will ease and you are likely to feel well again. However, you still have some risk of complications in the long term if your blood glucose level remains even mildly high - even if you have no symptoms in the short term. Studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared with those people who have poorer control of their glucose level.
Therefore, the main aims of treatment are:
- To keep your blood glucose level as near to normal as possible.
- To reduce any other risk factors which may increase your risk of developing complications. In particular, to reduce your blood pressure if it is high, and to lead a healthy lifestyle.
- To detect any complications as early as possible. Treatment can prevent or delay some complications from getting worse.
Treatment aim 1 - keeping your blood glucose level near normal
How is the blood sugar (glucose) level monitored?
It is likely you will need to monitor your glucose levels by using a monitor at home. If you check your blood glucose level, ideally you should aim to keep the level between 4 and 7 mmol/L before meals, and less than 9 mmol/L two hours after meals. It may be best to measure your blood glucose level at the following times:
- At different times in the day
- After a meal
- During and after vigorous sport or exercise
- If you think you are having an episode of low blood glucose (hypoglycaemia)
- If you are unwell with another illness (for example, a cold or infection)
Another blood test is called HbA1c. This test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your blood glucose control over the previous 1-3 months. This test is usually done regularly by your doctor or nurse. Ideally, the aim is to maintain your HbA1c to less than 48 mmol/mol (6.5%). However, this may not always be possible to achieve and your target level of HbA1c should be agreed between you and your doctor.
Doctors and patients can use Decision Aids together to help choose the best course of action to take.
Insulin comes in several different preparations and each work slightly differently. For example, some are long-acting (lasting up to a whole day), some are short-acting (lasting up to eight hours), and some are rapid-acting (they work quickly but do not last very long). Your treatment may include a combination of these different insulin
Most people take 2-4 injections of insulin each day. The type and amount of insulin you need may also vary each day, depending on what you eat and the amount of exercise you do.
Alternatives to injecting insulin
There has been plenty of research done in recent years to develop ways to administer insulin other than by injection. These have included insulin nasal and oral sprays, patches, tablets and inhalers. After many years of work, some of the methods being researched are showing a degree of success. However, it will be some time before any of these devices will be available to people with diabetes in the UK.
You should eat a healthy diet. This diet is the same that is recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Diabetic foods still raise blood glucose levels, contain just as much fat and calories and are usually more expensive than non-diabetic foods. Basically, you should aim to eat a diet low in fat, salt and sugar and high in fibre and with plenty of fruit and vegetables. However, you will need to know how to balance the right amount of insulin for the amount of food that you eat. Therefore, you will normally be referred to a dietician for detailed advice.
Balancing insulin and diet, and monitoring blood glucose levels
Monitoring your blood glucose level will help you to adjust the amount of insulin and food according to the level and your daily routine.
Treatment aim 2 - to reduce other risk factors
You are less likely to develop complications of diabetes if you reduce any other risk factors. Everyone should aim to cut out preventable risk factors, but people with diabetes have even more of a reason to do so.
Keep your blood pressure down
It is very important to have your blood pressure checked regularly. The combination of high blood pressure and diabetes is a particularly high risk factor for complications. Even mildly raised blood pressure should be treated if you have diabetes. Medication, often with two or even three different drugs, may be needed to keep your blood pressure down.
Changing your lifestyle can help manage and control your condition.
Giving up smoking: If you smoke - now is the time to stop
Smoking is a high risk factor for complications. You should see your practice nurse or attend a smoking cessation clinic if you have difficulty stopping smoking. If necessary, medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.
Healthy Weight, Healthy Life
Maintaining a healthy weight can have a major impact on your health. Being overweight can increase your risk of raised blood pressure, diabetes and heart disease while being significantly underweight can impact on your immune system. Getting to a perfect weight is often unrealistic.
Your healthcare team will refer you to the dietitian can help you make informed choices about the food you eat. You can access general healthy eating advice and condition specific advice from the dietitian as well as from websites.
Regular physical activity can help and also reduces the risk of other serious conditions, such as heart disease and stroke. Do some physical activity regularly.
If you are able, a minimum of 30 minutes' brisk walking at least five times a week is advised. Anything more vigorous is even better - for example, swimming, cycling, jogging, dancing. Ideally you should do an activity that gets you at least mildly out of breath and mildly sweaty. You can spread the activity over the day (for example, two fifteen-minute spells per day of brisk walking, cycling, dancing, etc).
Depending on your age and how long you have had diabetes, you may be advised to take a medicine to lower your cholesterol level. This will help to lower the risk of developing some complications such as heart disease and stroke.
Some of these lifestyle issues may not seem to be relevant at first to young children who are diagnosed as having diabetes. However, as children grow, a healthy lifestyle should be greatly encouraged for the long-term benefits.
Adherance to medications
Around half of patients with a long-term condition do not take their medicines as prescribed. However, to take real control of the condition, you will need need fast and convenient access to medicines, involvement in decisions about those medicines, advice about how to take them and information on any side effects which they may suffer. Your diabetic nurse as well as pharmacist will help you with the medications.
Treatment aim 3 - to detect and treat any complications
Most GP surgeries and hospitals have special diabetes clinics. Doctors, nurses, dieticians, specialists in foot care (chiropodists), specialists in eye health (optometrists), and other healthcare workers all play a role in giving advice and checking on progress. Regular checks may include:
- Checking levels of blood glucose, HbA1c, cholesterol and blood pressure.
- Ongoing advice on diet and lifestyle.
- Checking for early signs of complications; for example:
Eye checks - to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse. Increased pressure in the eye (glaucoma) is also more common in people with diabetes, and can usually be treated.
Urine tests - these include testing for protein in the urine, which may indicate early kidney problems.
Foot checks - to help to prevent foot ulcers.
Blood tests - these include checks on kidney function, and other general tests. They also include checks for some autoimmune diseases which are more common in people with diabetes. For example, coeliac disease and thyroid disorders are more common than average in people with type 1 diabetes.
It is important to have regular checks, as some complications, particularly if detected early, can be treated or prevented from getting worse.
You should be immunised against flu (each autumn) and against infection from pneumococcal germs (bacteria) (just given once). These infections can be particularly unpleasant if you have diabetes.