Diabetes Mellitus

Source

Diabetes mellitus is a common endocrine disorder in Bangladesh. In 2015 one in 11 adults has diabetes. Diabetes is the fastest growing endocrine disease in our country.

Defination :

Diabetes mellitus is a metabolic disorder characterized by hyperglycaemia with or without glycosuria due to absolute or relative deficiency of insulin.

Classifications of DM :

1. Type-I or Insulin dependent diabetes mellitus (IDDM).
2. Type-II or non insulin dependent diabetes mellitus (NIDDM).
3. Gestational diabetes mellitus : Diabetes during pregnancy.

Causes of DM :

1. Genetic defect of beta cell of pancreas because insulin is secreted from beta cell of pancreas & alpha cell secret glucagon.
2. Genetic defect of insulin action.
3. Infection of pancreas is called pancreatitis.
4. Any neoplastic disease in pancreas.
5. Acromegaly.
6. Cushing's syndrome.
7. Thyrotoxicosis.

Source

Type-I DM :

1. Age of onset - Usually less than 40 years.
2. Duration of symptoms - Weeks.
3. Body weight - Normal or low.
4. Rapid death without treatment with insulin.
5. Auto antibodies - Present.
6. Family history of DM - Uncommon.
7. Acute complications - Diabetic ketoacidosis.

Type-II DM :

1. Age of onset - Usually more than 50 years.
2. Duration of symptoms - Months to year.
3. Body weight - Obese.
4. No Rapid death without treatment with insulin.
5. Auto antibodies - Absent.
6. Family history of DM - Common.
7. Acute complications - Hyperosmolar non-ketotic coma.

Symptoms of DM :

1. Polyuria.
2. Polydipsia.
3. Polyphagia.
4. Weight loss.
5. Fatigue.

Diagnostic criteria of DM (The American Association criteria) :

HbA1c ≥ 6.5% in DCCT standard. Or
Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl) or
2hrs after 75 gm glucose ≥ 11.1 mmol/L (200 mg/dl) or
Classical symptoms with Random plasma glucose ≥ 11.1 mmol/L (200 mg/dl).

Investigations :

A. In Blood -
1. HbA1c.
2. FBS, RBS or 2 hrs after breakfast or 2 hrs after 75 gm glucose.
B. In Urine -
1. Ketonuria (Rotharas test).
2. Glycosuria (Benedict's test)
C. Others -
1. CBC.
2. CXR.
3. ECG.

source

Complications :

A. Acute complications :
1. Hypoglycaemia coma.
2. Diabetic ketoacidosis.
3. Non ketotic hyperosmolar diabetic coma.
4. Lactic acidosis.
5. Acute circulatory failure.

B. Chronic complications :

(a). Microvascular-
1. Retinopathy.
2. Neuropathy.
3. Nephropathy.

(b). Macrovascular-
1. MI.
2. Stroke.
3. TIA.
4. Ischemia.