Diabetes mellitus (DM) is a metabolic condition characterized by high blood sugar (glucose) levels. It happens when the body is either not making enough insulin or fails to use the insulin, or both.
Glucose is a raw form of energy that is generated from most of the food we eat and is converted into a usable form of energy in the cells. Insulin, secreted by the pancreas, facilitates the movement of glucose into the cells for its conversion into energy.
Diabetes is divided mainly into three types:
- DM type 1 (absolute deficiency of insulin)
- DM type 2 (relative deficiency of insulin)
- Gestational DM (occurs during pregnancy)
Signs and symptoms
There are 3Ps that serve as identifiers for DM type 1: polyuria (frequent urination, particularly at night), polydipsia (frequent thirst) and polyphagia (frequent feeling of hunger).
Several other identifiers also exist:
- Weakness or fatigue
- Unexplained weight loss and muscle mass loss
- Itching all over the body, especially around the genitals
- Frequent episodes of thrush — a fungal infection in the mouth, throat or other parts
- Slow healing of cuts and wounds
- Blurred vision
- Pain, numbness or tingling in lower legs or sudden onset of a wound (gangrene)
- Dry skin
Causes
DM is caused by several factors, including:
- The body’s immune system destroys the pancreas, leading to a deficiency of insulin
- The body fails to use insulin
- Pregnancy causes high glucose levels without a previous diagnosis of DM
- Genetic defects of the pancreatic cells such as in Modified Onset Diabetes of Young (MODY)
- Inflammation of pancreas (pancreatitis) or cysts in the pancreas
- Removal of the pancreas (pancreatectomy)
- Hormonal disease such as in cushing syndrome, hyperthyroidism, acromegaly
- Medications that reduce the insulin action (steroids) or destroy pancreatic cells
Diagnosis
A doctor can rule out the type and severity of DM based on the collaborating inferences from physical examinations, signs and symptoms, and a series of laboratory tests. Early detection can help in better treatment outcomes. Pre-diabetics – those who are at risk of developing DM – should be more proactive when it comes to detection and therapy.
| Diagnosis | HbA1c (Glycosylated hemoglobin) | Fasting Plasma Glucose Test (FPG) in mg/dl | Random Plasma Glucose Test (RBG) in mg/dl | Oral Glucose Tolerance Test (OGTT) in mg/dl |
| Normal | Less than 5.7 % | Less than 100 | – | Less than 140 |
| Pre-diabetes | 5.7 – 6.4 | 100 – 125 | – | 140 – 199 |
| Diabetes Mellitus | Higher than 6.5% | 126 or higher | 200 or above | 200 or higher |
Key:
mg/dl: Milligram per deciliter
HbA1c: Attachment of glucose in red blood cells after increased levels of blood glucose for more than five months
FPG: Evaluation of glucose levels in the blood after eight hours of fastin
RBG: Evaluation of blood glucose any time of that day
OGTT: Evaluation of blood glucose two hours before and after giving 75grams of glucose in 100 ml of water
Source: https://www.diabetes.org/diabetes/a1c/diagnosis
Treatment
Insulin and oral medications are available to treat or control DM. Insulin is the first choice in DM type 1 and oral medication in DM type 2. However, insulin may also be prescribed in type 2 in cases where oral medication alone is not responding to DM. Several oral medication classes are used alone or in combination that proved to be effective. They are:
- Biguanides such as Metformin
- Sulfonylureas such as Glimepiride. Glipizide, Glyburide
- Meglitinides like Repaglinide
- Thiazolidinediones such as Pioglitazone
- DPP4 inhibitors such as Sitagliptin, Vildagliptin
- Alpha-glucosidase inhibitors like Acarbose
Moreover, physical activity and a balanced diet along with medications can help in better treatment outcomes. If left untreated or uncontrolled, DM can affect other parts of the body such as kidneys, lower limbs, eyes, blood, and brain.
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