DIABETES MELLITUS COMMON IN TODAY'S WORLD!

Hello friends!
Its me Anil mehta from Nepal,a medical students posting some information about Diabetes Mellitus "which is a clinical condition in which there is abnormal concentration of glucose in blood".Do read everyone and give your valuable advice and suggestion.

What is diabetes mellitus ?
It is a clinical syndrome characterised by high blood sugar level (hyperglycaemia) and glycosuria due to relative or absolute deficiency of insulin secretion and/or action, or insulin resistance that leads to disturbances in carbohydrate, protein, fat metabolism, and water and electrolyte homeoStasis.

The diagnostic criteria for diabetes mellitus :
• Symptoms of diabetes plus ‘random’ blood glucose concentration > 200 mg/dl, or
• ‘Fasting’ plasma glucose > 126 mg/dl, or
• ‘2h-postload’ plasma glucose > 200 mg/dl during an oral GTT.

The new diagnostic criteria for pre-diabetes and diabetes are :
In the new criteria, the categories of FPG are :
FPG <100 mg/dl = Normal fasting glucose - FPG >100 mg/dl and <126 mg/dl = Impaired fasting glucose (IFG)
FPG >126 mg/dl = Provisional diagnosis of diabetes (on more than one occasion)
The corresponding categories when the oral GTT is used, are as follows :
2 hPG <140 mg/dl = Normal glucose tolerance
2 hPG > 140 mg/dl and < 200 mg/dl = Impaired glucose tolerance (IGT)
2 hPG > 200 mg/dl = Provisional diagnosis of diabetes (must be confirmed on a subsequent day)

• FPG = Fasting plasma glucose; 2 hPG = 2-h postload glucose
  ** The prognostic significance and outcome (i.e., accuracy) are same whether it is the FPG > 126 mg/ dl or 2 HPG > 200 mg/dl (i.e., in diabetes). This is why, in clinical practice, the FPG test is now mostly preferred because of ease of administration, convenience, acceptibility to patients and its lower cost. *** 2-h postload glucose is done by taking 75 g of glucose dissolved in 300 ml water.
  **** Results are for venous plasma, the whole blood values are lower.
  ***** ‘Fasting’ is defined as no calorie intake (i.e., overnight) for at least 8 hours. ‘Random’ is defined as any time of the day without regard to time since the last meal.
  
  Who is a potential diabetic ?
  These patients usually have no symptoms, and show no abnormality on examination or by GTT but
  are susceptible to develop diabetes in any time of their life.

When one parent is diabetic and the other have a family history of diabetes. Diabetes present in both the parents.
Mother of a ‘Herculean baby’ (> 9 lbs).
Non-diabetic member of a monozygotic twin, where the other is diabetic.

• Patients with IGT(140-199 mg/dl)and / or IFG (100-125 mg/dl)are now regarded as ‘pre-diabetes’. Latent diabetic* are persons who show impaired GTT under stressful conditions like pregnancy,
  infections, physical and mental stress or when over-weight.
  Characteristics of Type 1 DM :

Age of onset is usually below 30 years.
Usually wasting is prominent (or lean patients).
Abrupt onset with rapid progress.
Pancreatic Islet cells (of Langerhans) are almost destroyed. Plasma insulin Is low to absent. Polyphagia, polyuria and polydipsia are classically present.
Always responsive to insulin.
Unresponsive to oral hypoglycaemic agents.
Diabetic ketoacidosis occurs very often.
Family H/O diabetes mellitus is usually absent.
Presence of other autoimmune diseases with autoantibodies.
HLA-DR3 or DR4 in > 90%.
Disappearance of C-peptide.
High mortality, if untreated.

Characteristics of type 2 DM :

1. Usually starts after the age of 30 years.
2. Obese persons (or overweight).
3. Insidious onset with gradual progress.
4. Pancreatic islet cells are not totally destroyed. Plasma insulin is normal to high.
5. Polyphagia, polyuria and polydipsia—Not so classically seen as in type 1 DM.
6. Responsive to oral hypoglycaemic agents.
7. Insulin therapy—Responsive to resistant.
8. Hyperosmolar hyperglycaemic non-ketotic coma occurs very often.
9. Family H/O diabetes mellitus is usually present.
10. Absence of other autoimmune diseases and autoantibodies.
11. No HLA links; 50% concordance in idential twins.
12. C-peptide persists.
13. Low mortality, if untreated.
    

Symptoms
Classical triad of symptoms (polyphagia, polyuria and polydipsia—the P., symptoms). Recurrent abscess, boils, carbuncles or fungal infections; recurrent urinary tract infections. Recurrent stye or chalazion.
Unexplained emaciation; undue tiredness or fatigue.
Delayed wound healing.
Frequent change of glasses due to error of refraction.
Cataract appearing at an early age.
Sudden, isolated Illrd cranial nerve palsy.
Resistant pulmonary tuberculosis.
Non-resolving pneumonia.
Silent myocardial infarction.
Generalised pruritus, balanitis or pruritus vulvae.

Effects of diabetes on pregnancy :
Hydramnios 2. Toxaemia of pregnancy 3. Maternal infections 4. Difficult labour 5. Recurrent

abortions 6. Postpartum haemorrhage 7. Puerperal sepsis.

Effects of diabetes on the foetus :

1. Prematurity 2. Stillbirth 3. Macrosomia (large baby) 4. Postpartum hypoglycaemia 5. Respiratory distress syndrome 6. Hyperbilirubinaemia 7. Congenital heart diseases, open neural tube defects.

Complications of DM :
The life-history of diabetes mellitus is full of complications. The patient presents to different special­ ists or superspecialists with different organs/systems involvement. The common cause of death in treated patients are cardiovascular ailments (70%), followed by renal failure (10%) and infections (6%).
(A) ACUTE (EARLY) :

1. Hypoglycaemia.
2. Diabetic ketoacidosis.
3. Hyperosmolar hyperglycaemic non-ketotic coma.
4. Lactic acidosis (rare).
5. Infections.
6. Acute circulatory failure.
   (B) LATE :

1.Circulatory abnormalities (macro- and microangiopathy).
2.Retinopathy (microangiopathy).
3.Neuropathy (peripheral and autonomic).

1. Nephropathy.
2. Gastrointestinal disorders.
3. Recurrent infections.
4. Diabetic foot.
5. Dermatological complications.
6. Miscellaneous — Malignant otitis externa, emphysematous cholecystitis, rhinocerebral mucor­
   mycosis, hypertriglyceridaemia, platelet aggregate abnormality etc.

Ocular complications of DM ;
(A) NON-RETINOPATHIC :

1. Recurrent stye and chalazion.

Signs of dyslipidaemia (corneal arcus and xanthelasma) may be present.
Anterior uveitis (hypopyon).
Rubeosis iridis (moth-eaten appearance of iris).
Pseudo Argyll Robertson pupil.
Frequent change of glasses due to error of refraction.
Snow flake cataract (specific of DM)—Rare.
Senile cataract—Accelerated senile cataract.
Glaucoma.
Illrd, IVth and VIth cranial nerve palsy.
(B) RETINOPATHY :
I. Simple, background or non-proliferative—

Increased capillary permeability.
Capillary closure and dilatation.
Microaneurysms (earliest change observed by ophthalmoscopy and is known as dots ).
Arteriovenous shunts.
Venous dilatation.
Haemorrhages (occur in deeper layer of retina and is known as blots’).
Hard exudate (due to leakage of protein and lipids from damaged capillaries, and is very characteristic of DM).
Cotton-wool spots (superficial exudates formed due to ‘microinfarction’ and is usually seen in diabetes with hypertension).

• c) and f) are collectively known as ‘dots and blots’. II. Proliferative —

Distal,
symmetrical,
mixed sensory-motor polyneuropathy (commonest).
Asymmetrical, proximal motor neuropathy (diabetic amyotrophy)—commonly affects qudriceps, adductor magnus muscles.
Distal, symmetrical, sensory polyneuropathy.
Asymmetric mononeuritis multiplex (painful).
Acute mononeuropathy (paralysis of Illrd, IVth or Vlth cranial nerves, or sudden foot drop and
wrist drop).
Radiculopathy (usually involves spinal nerves, over the chest wall or abdomen).

Neovascularisation (new vessel formation in response to retinal ischaemia). Pre-retinal haemorrhage (sub-hyaloid).
Retinitis proliferans.
Vitreal haemorrhage.
Retinal detachment.
** Other causes of microaneurysms are systemic hypertension, SLE, hyperviscosity syndrome and Coats disease (rare). Microaneurysms are the hallmark of diabetic retinopathy. Neovascularisation is also seen in sickle cell retinopathy, central retinal vein occlusion and Eales' disease.

#sources:
Different journal in health and medical books

So this all for today health steemians. Hope to see you on other health post.
Thanks,
With love
@anilmehta00