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Information About Diabetes Mellitus (DM)

Diabetes Mellitus (DM)

  • What is Diabetes Mellitus?

  • Diabetes Mellitus (DM) is a group of chronic metabolic disorder characterized by high blood sugar (glucose) levels because the body does not produce enough insulin or deficiency of insulin.

    Insulin is a peptide hormone produced by the beta cells of the Islets of Langerhans which located in the pancreas, controls the amount of sugar in the blood and it is needed to turn sugar and to process carbohydrates, fat, and protein into energy. Insulin lowers the blood glucose level.

    The World Health Organization recognizes two idiopathic forms types of diabetes mellitus; type 1 {Insulin Dependent Diabetes Mellitus (IDDM) or juvenile-onset diabetes} and type 2 {Non–Insulin-Dependent Diabetes Mellitus (NIDDM) or adult-onset diabetes}. Diabetes can occur temporarily during pregnancy, these kind of diabetes known as Gestational Diabetes Mellitus (GDM).

    The most easily to recognized symptoms of diabetes mellitus are secondary to hyperglycemia (blood glucose level high than normal), glycosuria (increased urinary frequency and volume), and ketoacidosis (KA). Diabetes Mellitus can cause many complications, include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing.

    The more tightly a person with diabetes is able to control the levels of sugar in the blood, the less likely it is that these complications will develop or become worse. Commonly, Diabetes mellitus cases are cause by Genetic issues, Environmental factors, Chemical, and Other (Congenital absence of the pancreas, Pancreatectomy, Wolfram syndrome, Chromosomal disorders).
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    Signs and Symptoms Diabetes Mellitus

    The early symptoms of Diabetes Mellitus are related to the direct effects of high amount of sugar (glucose) in the blood (glucose levels), When the blood glugcose level rises above 160 to 180 mg/dL and glucose passes into the urine.

    Patients with Diabetes Mellitus has signs and symptoms include :
  • Polyuria (Passage of large volumes of urine)

  • Polydipsia (Excessive thirst)

  • Polyphagia (Extreme hunger/eating to much)

  • Glycosuria (Frequent urination)

  • Unexplained weight loss

  • Neuropathy & Nephropathy (Tingling or numbness in the hands/feet)

  • Feeling very tired/weakness much of the time

  • Sudden vision changes (blurred vision)

  • cuts and bruises that are slow to heal

  • More infections than usual

  • Extremely elevated glucose levels can lead to lethargy and coma.

  • Some of people may be they are only experience a few symptoms that are listed above. Diabetics symptoms may develop quite rapidly time to time (weeks or months), especially in the children are who diagnosed as Diabetes type 1. Onset of type 1 diabetes is most common in children and young adults, which called Insulin-dependent diabetes mellitus [IDDM] or Juvenile-onset diabetes.

    Most of people with type 2 diabetes are they do not experience any symptoms and therefore do not know they have the disease. They are suffering from both insulin resistance and decreased insulin production.
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    Type of Diabetes Mellitus

    Diabetes mellitus is classified two idiopathic forms types of diabetes, called type 1 {Insulin-dependent diabetes mellitus [IDDM] or juvenile-onset diabetes} and type 2 {Non–insulin-dependent diabetes mellitus [NIDDM] or adult-onset diabetes}. Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as, among others and gestational diabetes.

    To determine whether a patient has type 1 or type 2 diabetes is important because patients with type 1 diabetes are dependent on a continuous source of exogenous insulin and carbohydrate for survival. Diabetes type 1 may also develop in older adults and is increasingly being recognized through the measurement of islet–glutamate decarboxylase (GAD) antibodies. Patients with type 2 diabetes may not need any treatment for hyperglycemia during periods of fasting or decreased oral intake.

  • Type 1 Diabetes Mellitus

  • Type 1 diabetes is typically diagnosed in childhood, adolescence, or early adulthood. A patient who has had diabetes since childhood, who has always been dependent on insulin, or who has a history of diabetic ketoacidosis (DKA) almost certainly has type 1 diabetes. People with the new-onset adult (usually before 30 years of age) form of type 1 diabetes mellitus called latent autoimmune diabetes of the adult (LADA).

    Type 1 diabetes mellitus currently only can be treated with insulin therapy and this treatment must be continued indefinitely. Family history, diet, and environmental factors are risk factors for type 1 diabetes. Those people who has diagnosed as type 1 diabetes, They need to careful monitoring of blood glucose levels using blood testing monitors. Especially the Children who has significant dehydration, persistent vomiting, serious intercurrent illness, require inpatient management and intravenous rehydration.

  • Type 1 Diabetes Mellitus

  • Type 2 diabetes has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes (NIDDM). Type 2 diabetes mellitus is much more common and is the type of diabetes that affects most Singaporeans. Type 2 diabetes they have "insulin resistance", in which the cells and tissues of the body are unable to respond to the insulin produced by the pancreas.

    In this cases (Type 2) diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (LADA) some of them also maturity onset diabetes of the young (MODY) which is a group of several single gene disorders with strong family histories that present as type 2 diabetes before 30 years of age. As the disease progresses the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary.
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    Blood Sugar (Glucose) Level

    The blood sugar level or glucose leves and also known as serum glucose level is the amount of sugar (glucose) in the blood. Glucose can be measured in whole blood, serum, or plasma. There are two main methods to describing the concentrations of blood sugar level, by weight (in grams) and by molecular count (in moles). In both cases, the unit is usually modified by milli, micro or other prefix, and it is always "per" some volume, often a liter.

    Normally, the blood glucose level is maintained or stay within narrow limits throughout the day about 4 to 8 mmol/L {millimoles/liter (in UK units)} or 70 to 150 mg/dL {milligrams/deciliter (in US units)}. But the blood glucose level are higher after meals and usually lowest in the morning.

    The blood sugar levels increase slightly after eat and it will tightly regulated in the human body. Glucose, transported via the bloodstream to the body, is the primary source of energy for the body's cells. Blood glucose levels that remain high over time can damage human eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy), and blood vessels. It is also risk factor for the person to get cardiovascular disease, such as heart attack, hypertension, heart failure, stroke and problems caused by poor circulation, eg gangrene in the worst cases.

    Failure to maintain blood glucose in the normal range leads to conditions of persistently high (hyperglycemia) or low (hypoglycemia) blood sugar. Diabetes is typically diagnosed when fasting blood glucose levels are 126 mg/dl or higher.

  • Types of blood glucose test

  • - Fasting blood sugar (FBS). Its mean that the blood sugar level measures after someone have not eaten (fasting) for at least 8 hours. This is the first test to measure whether someone has diabetic or not with the normal amunt 4 to 7 mmol/l.

    - 2-hour postprandial blood sugar (PPBS). Blood sugar level measures exactly 2 hours after the person take his/her breakfast or eat a meal with the normal value less than 10mmol/l.

    - Random blood sugar (RBS). This is blood sugar test in the random time, measurements may be taken throughout the day. It is useful because glucose levels in healthy people do not vary widely throughout the day. RBS test also called a casual blood glucose test, If the level of sugar is between 140 mg/dL and 200 mg/dL, It is diagnosed as prediabetes. If the level of sugar exceeds 200 mg/dL, then it is diagnosed as diabetes.

    - Oral glucose tolerance test. This test is to diagnosed Gestational Diabetes which occurs during pregnancy in order to determine prediabetes and diabetes. It is the process of taking a series of blood glucose measurements after the pregnan women drinks a sweet liquid that contains a high quantity of glucose. The normal level is should be less than 140 mg/dL, more than that but lower than 199 mg/dL called prediabetes. Otherwise if the result more than 200 mg/dl diagnosed as diabetes.

    There are many kind of blood glucose meter that sell on the market such as Elite, Accu-Chek, BCJ Group, Accurate, OneTouch UltraEasy machine, ect. If you interest to buy one of them, choose which one blood glucose meter that easy to use for you.

    Note : To convert mmol/l of glucose to mg/dl, multiply by 18.
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    Hypoglycemia in Diabetes Mellitus

    Hypoglycemia is a medical condition in which the blood sugar in the body drops to an abnormally low level, under 60 mg/dl (in US units) or 3,3 mmol/L (in UK units). Hypoglycemia is associated with diabetics type 1 {Insulin-Dependent Diabetes Mellitus (IDDM) or juvenile-onset diabetes} and may occur more frequently as metabolic control approaches normal. Some people have mild hypoglycemia where they occasionally get the shakes when hungry, but are not seriously afflicted.

    In the empty stomach, the body will usually produce sugar in the liver to avoid blood sugar levels falling. But this mechanism does not always work perfectly, finally soon the blood sugar coming down under the normal level. More serious hypoglycemia can lead to confusion and even loss of consciousness, If this condition still untreat it will go to level coma which called as "hypoglycemic coma".

  • Causes of Hypoglycemia

  • - Certain medications. Some medicine may used to treat another disease (other than diabetes) can cause hypoglycemia or hide its symptoms. The medicine are aspirin, monoamine oxidase inhibitors (MAOIs), Quinine sulfate, Pentamidine (NebuPent and Pentam 300). Another medicine that also can make the blood sugar turn to down level in the long term are beta-blockers such as propranolol (for example, Inderal), nadolol (for example, Corgard), and metoprolol (for example, Lopressor).

    - Over dose of insulin. Taking large dose of insulin also risk for Hypoglycemia, In the pancrease it self if there is tumor (insulinomas) or certain disorders of the pancreas, or some autoimmune diseases can cause too much insulin to be produced event these conditions are rare.

    - Illnesses and other health conditions. Critical illnesses such as kidney, liver or heart failure it will leading to impair of liver function. In very rare cases, nonpancreatic tumors cause hypoglycemia.

    - Other causes such as Pregnancy, Alcoholism, Emotional stress, Thyroid problems. But the most common cases are the diabetics patient late to have their food after taken a diabetic madication.

  • Signs And Symptoms Of Hypoglycemia

  • The body's biochemical response to hypoglycemia usually starts when sugars are in the high/mid 60's level. The first set of symptoms are called neuro-genic (or sympathetic) because they relate to the nervous system's response to hypoglycemia. The person may may experience; nervousness, sweating, intense hunger, trembling, weakness, palpitations, and often have trouble speaking.

    When the Hypoglycemia appear as signs and symptom above and do not getting soon treatment, It will effects to the brain:

    - Confusion (inability to complete routine tasks)
    - Visual disturbances, such as double vision and blurred vision
    - Loss of consciousness and then coma (hypoglycemic coma).

  • Treatment Of Hypoglycemia

  • Different people may develop symptoms of mild, moderate, or severe hypoglycemia at varying blood sugar levels. It doesn't mean that the blood sugar levels listed above are typical, they may not apply to everyone. May be another persons when his blood sugar drops suddenly, He/She may develop symptoms even if his/her blood sugar (glucose) level is in the normal range.

    Some people who know as Hypoglycemia but He/She still in the conscious condition, start to give them regular soda, juice, lifesavers, table sugar, and the like are good options. At least about 10-15 grams of glucose followed by an assessment of symptoms and a blood glucose check if possible (after 10 minutes). If it is do not improving the blood sugar level, start to give another 10-15 grams. This can be repeated up to 3 times.

    The equivalency of 10-15 grams of glucose (approximate servings) are 1-2 teaspoons of sugar or honey, 1/2 cup of regular soda, 5-6 pieces of hard candy, 1 cup of milk, and Glucose gel or tablets (take the amount noted on the package to add up to 15 grams of carbohydrate).

    If the hypoglycemic episode has progressed to the point where the patient cannot or will not take anything by mouth, Emergency 911 (ambulance) should be called immediately. The emergency team they will take an action by giving an injection glucagon via intravenous, Glucagon is a hormone that causes the liver to release glucose in minutes and lasts for about 90 minutes.

    Glucagon for Hypoglycemia

    Many people like the idea of treating hypoglycemia with cake, cookies, and brownies. Somebody with diabetic type 1 or type 2 actually better for them if they now how to inject glucagon, at least in the family members one of them should be learn how to administer glucagon. So, they can ask the doctor to prescribe a glucagon kit for home use if the emergency condition (hypoglycemia) happen at home.
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    Hyperglycaemia in Diabetes Mellitus

    Hyperglycaemia is a condition in which the blood sugar level higher than normal, more then 180 mg/dl (in US units) or 10mmol/L (in UK units) measured two hours after food. It is generally found in people with diabetes because they did not controlled well their diabetics disease.

    Hyperglycaemia over a long period can be result an unconciousness condition. Usually the casualty will drift into this state over a few days. Hyperglycaemia requires urgent treatment in hospital. Hyperglycaemia often only affects people with type 1 diabetes. Hyperglycaemia may develop more slowly in people with type 2 diabetes but can still progress to dehydration, confusion, and coma.

  • Hyperglycaemia is most commonly caused by:

  • - Not enough insulin or missed dosage or insulin "gone off" (poor injection technique)

    - Overeating, especially eating too many carbohydrates which cause of increasing blood sugar level

    - Gastritis associated with Helicobacter pylori infection can interfere with digestion and affect blood glucose stability

    - Mental or emotional stress. Stresses can causing (release) of glucose into the bloodstream and stress hormones can bring about resistance to the action of insulin, both actions contributing to high blood sugar.

    - Infections and illnesses. being ill, suffering major physical trauma or undergoing major surgery, or having an infection, causes the body to produce more of certain hormones which stimulate the liver to make extra glucose. For example a heart attack or kidney disease, can raise blood sugar levels

    - Other tablets or medicines e.g. Cortisone.

  • Signs and symptoms of Hyperglycaemia

  • - Increased need to urinate or passing large volumes of urine
    - Rapid pulse and breathing
    - Feeling constantly thirsty
    - Feeling weak or Tiredness
    - Abdominal pains
    - Warm, dry skin
    - Blurred vision
    - Loss of appetite and weight loss
    - If untreated, drowsiness, then unconsciousness.

  • Treatment for Hyperglycaemia

  • Treatment of Hyperglycaemia involves testing blood glucose levels every 2-4 hours and recording the results, and also check for sugar and ketones in the urine. It is important to drink as much water or low calorie fluids as possible to replace fluids lost through urination. Do not drink fluids that contain sugar.

    Contact the doctor or diabetes nurse educator to get advice from them if blood sugar levels remains high, ketones are present in the urine and the nausea or vomiting happen which cause unable to eat or drink.
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    Treatment of Diabetes Mellitus

    There are two type of diabetes mellitus, diabetics type 1 {Insulin-Dependent Diabetes Mellitus (IDDM) or juvenile-onset diabetes} and diabetics type 2 {Non–Insulin-Dependent Diabetes Mellitus (NIDDM) or adult-onset diabetes}. The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar.

  • Treatment of Diabetes Mellitus Type 1

  • Those people who has diabetic type 1, most of them are treated with insulin, exercise, and a diabetic diet. Many Patients with diabetics type 1 they will get treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog, Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with the some of most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod. Treatment by using insulin must be continued indefinitely.

  • Treatment of Diabetes Mellitus Type 2

  • Diabetic type 2 the most common treatments for them are consider to the lifestyle and physical activity. Monitoring the blood sugar level is a key part of the treatment program by weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered. Diet is very important thing for diabetic type 2 as well as to decrease carbohydrate intake, and weight loss. Weight reduction and exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations.

    There is a natural methods to treat of diabetes mellitus that called "Naturopathy". Normally the natural method are use for the educated people, The programs are about how to learn and adopting the type lifestyle which promotes good health. Bellow are various types of natural methods :

    1. Treatments based on nutrition and diet. In this program, the dietician decides a menu for healthy diet for diabetic patients.

    2. Hydrotherapy. In this natural method of treating diabetes, the water is used. Actually using the water is the oldest therapeutic methods to managing physical dysfunctions. Hydrotherapy has provide lots of benefits for people suffering from Type 2 Diabetes mellitus. Some of diabetic patients by this treatment they told that they got better and improved sleep, reduces blood sugar level in the body and boasts the moral and well being of diabetic patient.

    3. Detoxification. It consists of the use of short periods of fasting or controlled diets and supplements to aid the natural process by which the body rids itself of toxic substances.

    4. Control and reduce stress. In this programs, Patients will learn how to do exercise, relaxation techniques, modification of diet and the use of supplements particularly to support the adrenal gland.

    5. Mud therapy. Diabetics disease is disturbance of the metabolic process of the entire body. When the digestive system, and endocrine glands do not work fully, the result is accumulation of impurities and toxemia in the body. Mud bath treatment has used for improving elimination and removal of the toxins on the body.

    6. Massage. Massage is highly beneficial in the treatment of diabetes, by massage the muscles and other soft tissues of the body become rilex (relieving muscle tension). Although, massage affects the body as a whole, but it particularly influences, the activity of the musculoskeltal, circulatory, lymphatic and nervous systems. Many of massage techniques use to hepl reduces stress and arises/develops the feelings of calmness, also helps in elimination of poisons and waste material through the various eliminative organs, such as the lungs skin, kidneys and bowels which useful treatment for the diabetic patients.

    7. Herbal medicines. There were some plants and the natural products also used as natural method of treatment for the diabtes mellitus.

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    Diet For Diabetes Mellitus

    Now, We will try to explain about how to manage the diet for Diabetes Mellitus. Diabetes mellitus is a disease that characterised by hyperglycaemia, whether it is cause by deficiency of insulin in the human body or diminished effectiveness of insulin it self. There are many cases why the insulin become inactive and hence induces hyperglycaemia, for example due to over production of other hormones which are antagonistic to Insulin such as glucagon, hormones of the pituitary, adrenaline and thyroid. Also due to increased production of substances which inactivate insulin (insulinase and insulin antagonists present in plasma.

    The disease is chronic and affects the metabolism of carbohydrate, protein, fat, water and electrolytes. Diabetic Diet for diabetics patient is simply a balanced healthy diet which is vital for diabetic treatment, but sometime many people are they don't understand that these diet consist only diabetic foods. Diabetes mellitus is often found to be associated with other conditions such as blood pressure, obesity, hypercholesterolaemia, cardiovascular disease, kidney disorder and the nervous system.

    Dietary control is an integral part of management for the diabetic. The diet should always provide the essentials of good nutrition and adjustments must be made from time to time for changing metabolic needs For example during growth, pregnancy, lactation or modified activity. Dietary control is very important in the treatment of diabetics. There are two simple principles in order to manage or control the diet for the diabetic patients:

  • Eat less (fewer calories) to maintain ideal body weight.

  • Eat low Glycemic Index (GI) foods that do not turn into sugar quickly

  • Glycemic Index (GI) is food's clasification according to the amount of carbohydrates, This index is a measure of how a given food affects the blood-glucose levels in the two or three hours after eating. Below are the general guidelines to what is considered high or low Glycemic Index (GI) foods.
      Foods with high Glycemic Index (GI), You have to considered do not to eat all this foods :

      - Foods containing sugar, honey, molasses, & corn syrup.
      - Fruits - bananas, watermelon, pineapple, raisins
      - Vegetables - potatoes, corn, carrots, beets, turnips, parsnips
      - Breads - all white breads, all white flour products, corn breads
      - Grains - rice, rice products, millet, corn, corn products
      - Snacks - potato chips, corn chips, popcorn, rice cakes, pretzels
      - Pasta - thick, large pasta shapes
      - Alcohol - beer, liqueurs, all liquor except red wine
      - Cereals - all cereals except those on the Low GI List below

      Foods that contents low Glycemic Index (GI), Recommendate foods for diabetic patients :

      - Breads - whole rye, pumpernickel, whole wheat pita
      - Whole Fruits - all except the High GI fruits above
      - Green leafy Vegetables - all except the High GI vegetables listed above
      - Grains - barley, bulgur, kasha
      - Snacks - nuts, olives, cheese, pita chips, fried pork rinds
      - Cereals - Special K, All Bran, Fiber One, regular oatmeal
      - Pasta - whole-wheat pasta, bean threads
      - Misc. - olives, eggs, peanut butter (no sugar)
      - All meats and All dairy products (no sugars)
      - Alcohol - red wine

    Another thing that also needs to be consider as diet for diabetes mellitus cases are Proteins, fat and Fiber Foods. The proteins should be of high biological value and provide about 20 - 25 % of the calories in the diet. Diabetics patients has best sugguested for them to control the diet system in daily lifestyle. Find more information about diet for diabetes mellitus in healthcare services in your area, ask to the doctor whether for diet for diabetics type 1 or diabetics type 2.
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