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Diabetes: Types, Clinical Features, Investigations and Management

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Definition  :

It is the clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin

  • FBS>126 mg/dl
  • RBS> 200 mg /dl

Diabetes mellitus is commonly known as diabetes, is a group of metabolic disorders characterized by high blood sugar over a prolonged period of time. diabetes is due  to either the pancreas not producing enough insulin or  the cell of the body not responding properties to the insulin produced

There are mainly three main types of diabetes mellitus :

  • Type I (IDDM)
  • Type II (not IDDM)
  • Gestational
  • others
    • Genetic defects of beta-cell function
    • Genetic  defects of  insulin action
    • Drug-induced like corticosteroid phenytoin thiazide

Pathophysiology

Type 1 :

Beta-cell destruction leads to an increase in insulin production

Type 2:

Beta-cell destruction and insulin resistance

 

Type-I vs Type-II

types of diabetes melitus

Clinical feature:

  • Polyuria
  • Polyphysia
  • Weight loss
  • Fatigue
  • Increased thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss
  • Irritability
  • Blurred vision

Investigation:

  • Blood sugar FBS/RBS/PP/OGTT
  • HBA1C: Glucose+ HB= Glucocylated HB
  • Urine from sugar
  • RFT
  • Lipid protein
  • Urine from acetone or ketone bodies

Management:

People with diabetes must take responsibility for their day to daycare this include monitoring blood glucose level dietary management marinating physical activities keeping weight and stress under control monitoring oral medication if required insulin use VIA injection or pump.

Diabetes can affect almost every part of our body, therefore, you will need to manage your blood glucose level also called blood sugar managing as your blood ensure and cholesterol can help prevent the health problem that can occur when we have diabetes.

  • Diet, lifestyle modification discipline
  • Oral hypoglycemia drug
  • Insulin

Diet and lifestyle:

  • Avoid sweet sugar
  • Carbohydrate 50- 55%
  • Fat 30-35 %
  • Protein 10- 18%
  • Salt < 6 gm / day

weight management

  • BMI :18- 25 ( below 18 lean 25-30 overweight , 30-35  obese )
  • BMI= Wt in kg /ht in meter
  • Exercise

Oral hypoglycemia drug :

  • Sulphonuria insulin production
  1.   Gliclazide, glipizide, glimepiride, tolbutamide
  • Biguanides: increase insulin sensitivity impairs glucose abortion
  1. metformin
  • Glycosidase incubator decrease glucose absorption
  1. Acarbose
  • DPP-4 inhibitors: seta gliptins

INSULIN:

Indication

  • type I
  • Type II if not controlled by oral medication
  • DKA

Route

  • Subcutaneous
  • IV
  • IM

Site

  • Buttock
  • Anterior thigh
  • Anterior abdominal wall
  • arm

Types of insulin :

According to preparation

  • Human
  • Animals

According to the duration of action

  • Ultra short-acting: lepra asport
  •  Short-acting: regular
  • Intermediate: lenti
  • long-acting: ultralente glargine

Flow chart treatment:

flow chart treatment

Complication:

Acute

  • Hypoglycemia
  • DKA
  • Non-ketotic hyperosmolar diabetes coma
  • Lactic acidosis

Long term

  1. Microvascular
  • Eye: diabetes control glaucoma
  • Neuropathy

2 .  Macrovascular

  • CVA, CAD, Diabetes foot, MI
  • Non-healing of wounds

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References: WHO

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