What is it?

Condition of permanently disordered carbohydrate metabolism with a relative or absolute deficiency of insulin.

Symptoms:

* Thirst
* Polyuria
* Loss of weight.

Cause:

No single cause,
* Probably multifactorial genetic-predisposition HLA, DRB, DRA, B8, B15.
* Immunological-insulin antibodies
* Sometimes environmental,
* Viral infection.

Two clinical types:

Type 1- Insulin-dependent-(IDDM)
Type II- Non insulin -dependent (NIDDM) Mild-Mature onset

Classification:

A.)Primary (Idiopathic) diabetes:

I. Type-I (Insulin- dependent diabetes mellitus)- IDDM
II. Type -II (Non-Insulin dependent diabetes mellitus )- NIDDM

B)Secondary to other pathology

I. Pancreatic :Pancreatic carcinoma of the pancreas. Pancreatectomy, haemcohro-matosis and cystic fibrosis.

II. Insulin, antagonism-Steroid therapy, Cushing's syndrome ,Acromegaly (growth hormone) ,hyperthyroidism, phaeoachrocytoma (catecholamines) HPL (Pregnancy),glucagonoma (glucagon)

III.Medication with- Thiazide diuretics, corticosteroids phenytoin.

IV. Advanced liver disease.

C) Associated with genetic syndrome- Diabetes insipidus optieatropy, lipoatropy muscular dystrophies,Down's syndrome, Klinefelter's syndrome, Turner's syndrome etc.

Who goes it and when?

Although diabetes can occur at anytime, it is a condition that increases with age.
+ M>F in Juveniles.
+ F>M in nature onset (type II)

* Causes:

Uncertain but may be a form of an autoimmune disorder.
+ Family history-one fifth of diabetes have a diabetic relative (more so in type II)
+ Racial more than expected in Jews Asians/ Indians/West Indians/Malaysia less than expected in maltere.
+ Obesity is a factor in type II

Diagnosis:

I) For the diagnosis of diabetes should take 75 gm of glucose in the blood is observed. lt is the most acceptable test for the diagnosis of diabetes.

II)Random blood sugar:
A random blood sugar exceeding 250 mg/100ml (14 mmol/ L) is almost certain to indicate diabetes.Glucose Tolerance Test (Glucose in blood mmol / liter)

In normal State Diabetes :
Empty Stomach <6.1>/7.8

After 2 hours of taking 75 mg of glucose <8.9 >11.1

Prevention of Diabetes :

"Prevention is better than cure" to prevent type-II diabetes we always have to consider the following points:

I. Take limited (moderate) foods.
II. Have exercise regularly.
III.Do not let your body to be too fatty.
IV. Do not smoke.
V. Do not drink wine.
VI.Each day have your food at the same time.

Management:

What results of treatment?

Aims of Treatment:

* Relief of symptoms: fatigue, thirst, polyuria, loss of weight.
* Prevent /delay complications may be possible in retinopathy, neuropathy, nephropathy ,
* Prolong life.

Considerations involved in management:

* Treatment of diabetes.
* Responsibilities of diabetic self care GP and Primary health care team hospital specialties.

Types of treatment available:

+ Diet (20%)
+ Oral drug +diet (40%)
+ Insulin+ diet (40%)

Diet:

* Maintain habitual eating pattern if possible.
* Reduce total fat to about 30% of total calories.
* High fiber foods advisable:

I. Whole grain food
II. Beans.
III.Row vegetable.
IV. Bran Products.

* Children -review dietary needs with growth.
* Elderly- not restrictive diet as it may precipitate dietary deficiencies.

Oral drugs:

• Indications :

Hyperglycaemia and/or diabetic symptoms without ketonuria failing to respond to diet over month.

* Drugs available:

I) Sulphonylureas:Such as ;Tolbutamide 250mg-lg bd. ,Chlopropamide 125-500mg bd.

2) Biguanides: Such as ; Metformin (Glucophage) 500 mg t.d.s- 850 mg bd.

Recent Theory:

(I) Oral insulin (enteric coated)
(II) Continuous subcutaneous infusion of soluble insulin through a pump system.
(III) Intravenous infusion of soluble insulin is used routinely in emergency treatment of diabetic, keto acidosis, in conjunction with large volumes of isotonic saline and potassium chloride.
(IV) Intra peritoneal insulin is used in IDDM patients with end-stage renal failure treated by ambulatory peritoneal dialysis.
(V) Administration of insulin by the intranasal route with adjutants to facilitation transmucosal absorption.
(VI) The incorporation of insulin into biodegradable polymer micro spheres which can be injected.
(VII) The encapsulation of insulin with a lactin in glucose permeable membrane.

Insulin

Uses:

Insulin are prescribed as replacement therapy in some forms of diabetes mellitus.

Side Effect:

Allergic reactions may occur; repeated use of insulin may cause wasting of the fatty tissues beneath the skin.
Warnings: Changes in diet, weight reduction, mood fluctuations and other factors may affect blood sugar levels and alter insulin requirement.

Interactions:

Hormones and analogues of hormonal substances administered in medicine affect insulin, usually reducing its action. Cardiac drugs and Aspirin may change insulin requirement.

Dose: Insulin units are now standardized to contain 100 units per 1 ml and insulin syringes are calibrated accordingly.

Traditional used drugs :

From primitive Leaves of Brideliaferruginea, fruits of Coccinea indica, seeds of Eugenia jambolana, bark of Ficus bengalensis and tubers of Dioscorea dioscorea dumetorum are used in traditional medicine for treating diabetic patients.

A few advises for diabetic patients:

(I) Always keep you neat and clean.
(II) Please wash your teeth and mouth before bed time at night and after meal each time.
(III) According to the physician's advice, control diet, control weight and take medicine as prescribed.
(IV) Always take a balanced diet.
(V) Test blood and urine regularly.
(VI) Take exercise regularly.
(VII) Do not be idle.
(VIII) Sleep and have rest according to your need.

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