Diabetes Mellitus

WHAT IS DIABETES?

It is a medical condition characterized by high blood gluccose, due to the lack of insulan or inadequate response of body cells towards the action of insulin. When blood gluccose is too high, gluccose is found in the urine. Diabetes mellitus in ancient Greek means 'a lot of sweet urine'.


WHAT IS INSULIN?

Insulin is a hormone secreted by the endocrine glands called Islets of Langerhans in the pancreas. Its function is to regulate the level of gluccose in the blood.


WHAT ARE THE SIGNS AND SYMPTONS OF DIABETES?

The classical symptons are:

• Frequent urination
• Excessive thirst
• Hunger
• Fatigue
• Weight loss

However, lack of sympton is very common and thus, many people only know of their condition during a routine medical check-up.


WHAT ARE THE TYPE OF DIABETES?

There are 2 main types:

1. Type 1 for Insulin Dependent Diabetes Mellitus(IDDM). This is an autoimmune disorder where the body immune system attacks the unsulin producing cells in the pancreas and destroys them. The pancreas then produces little or no insulin and diabetes develops, usually over a short period. It frequently affects younger persons and children and is sometimes called Juvenile Diabetes.
   
   
   
2. Type II or Non-Insulin Dependent Diabetes Mellitus (NIDDM). Tis accounts for 90-95% of all diabetes cases. It occurs when pancreas produces insulin, but the cells are unable to use it efficiently (insulin resistance). The symptons often develope gradually. Type II diabetes is associated with obesity, physical inactivity, family history of diabetes and age (>4o years).
   
   

HOW IS DIABETES DIAGNOSED ?

1. Diabetes is diagnosed when:
   (a) a fasting glucose level is above 140mg/dl or
   (b) a non fasting glucose level is above 200mg/dl with the presence of symptons of increased thirst and urination, fatique.
   
   If the person has no sympton, a second abnormal blood glucose is required to confirm the presence of diabetes.
   
   
2. A urine test for glucose is often used but it is frequently unreliable. Glucose usually appears in the urine when blood glucose is above 180mg/dl. Thus urine test will fail to detect many diabetic patients. From some people, glucose will appear in the urine even though their blood glucose levels are normal. They do not have diabetes but just a benign condition called Renal Glycosuria.
   
   
3. For persons who have no sympton and have normal fasting blood glucose levels, but are considered potential diabetics due to some clinical reasons, a glucose tolerance test can be done. By measuring the blood glucose reponse over 2 hours towards a standard load (75g) of glucose drink, a more accurate diagnoses of diabetes can be made.
   
   
   

WHAT ARE THE DANGER OF DIABETES ?

1. When blood glucose is persistently high, it results in damage to the body cells especially those of the blood vessels. The cells lining the fine capillaries in the kidneys are particularly vulnerable. Damage to those blood vessels will impair kidney function. Most cases of kidney failure requiring dialysis are caused by diabetes.
   
   
2. Blindness often occurs when blood vessels in the retina of the eyes are destroyed.
   
   
3. When blood vessels to the nerves are affected, the nerve damage may result in numbness and pain in the feet giddiness, diarrhoea and impotence in men.
   
   
4. Diabetes accelerates the narrowing of arteries with fatty plaque, a condition called atherosclerosis. It therefore increases the risk of coronary heart disease, stroke and foot gangrene. This is the most important complication as death from heart attack is twice as common in persons with diabetes.
   
   
   

WHAT SHOULD A DIABETIC DO?

Diabetes cannot be cured and needs lifelong treatment and monitoring. The aims of treatment are maintaining normal blood glucose level and preventing complications. This can be accomplished through regular physical exercise, a carefully controlled diet and medication. Blood glucose and HbA1c (glycosylated haemoglobin) need to be tested regularly, as well as monitoring of blood cholesterol, kidney function, blood pressure, heart disease and eyesight. Person with diabetes should pay regular visits to their physicians to monitor their conditions properly.


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