Understanding Diabetes Mellitus: Types, Symptoms, Diagnosis and Treatment

What is Diabetes

Diabetes mellitus refers to a group of metabolic disorders characterized hyperglycemia (high blood sugar levels) resulting from defects in insulin secretion, insulin action, or both. It happens when the pancreas doesn’t make enough insulin, or no insulin at all for uptake by the body, or the pancreas does make insulin but the body is not responding to the insulin properly. Glucose, mainly from carbohydrate, is the main source of fuel for the brain. It is also an important source of energy for the body cells that manufacture muscles and tissues. This condition can lead to long-term damage and dysfunction of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels.

Insulin, is a peptide hormone produce by the beta cell of islets of Langerhans in the pancreas to regulate the metabolism of glucose. That is, it moves glucose from the bloodstream to the cells and stores excess glucose in the liver for later use. When this malfunctions, it leads to diabetes.

There are several type of diabetes, but the most common type is Type 2 diabetes, which occurs when the body doesn’t make enough insulin, or becomes resistant to insulin. This type is usually common among adults. Diabetes mellitus is a common condition that affect individuals of all ages. A combination of treatment options is available to help manage and treat complications. Lifestyle management and dietary factors are mainly the recommended management and preventive strategies.

Risk factors of Diabetes

Several factors contribute to the development and the risk of diabetes, which depend on the type of DM

Type 1 Diabetes

• Family history
• Genetics
• Environmental factors

Type 2 Diabetes

• Family history
• Physical inactivity – sedentary lifestyle increase risk for D2M
• Excessive weight (obesity)
• Ethnicity (Race) – African American, Hispanic, Black, Asian and Indian American are at increased risk
• Age – particularly adults 45 or older
• Prediabetes
• Certain conditions - HPT

Causes of Diabetes

The exact cause of diabetes depends on the type

Type 1 DM

The exact cause of type 1 DM is unknown (idiopathic) but it is thought to be autoimmune reactions that attack and destroy the insulin –producing beta cells in the pancreas, leading insulin deficiency. Genetic, environmental and geographical factors are also contributory factors.

Type 2 DM

Type 2 diabetes is primarily caused by insulin resistance, where the body or cells in the liver and muscles does not respond to the insulin effectively, and or there is inadequate secretion of the insulin. Several factors such as obesity, physical inactivity, and genetic predisposition, hormonal imbalances, diet and certain medications play a significant role to this varying degree of resistance.

Types of Diabetes

Type 1 diabetes

Type 1 is an autoimmune disease. The cause is unknown. The immune system attacks and destroys the insulin –producing beta cells in the pancreas. About 10% of individuals with diabetes have Type 1 DM. it can develop at any age, but usually affect children and young adult

Prediabetes

Prediabetes indicates elevated blood glucose levels than expected. It occurs when the body cells do not respond to insulin the way it should, but not higher enough to diagnose as Type 2 DM. It can lead to Type 2 DM when regular attention is not seeking.

Type 2 diabetes

The most common type of diabetes mellitus. It develops when the body doesn’t make enough insulin (inadequate insulin secretion) or does not respond to insulin (insulin resistant). About 90% of people living with diabetes have Type 2 DM. It mainly affects adults 45year or older

Gestational diabetes

This is high glucose levels in the bloodstream during pregnancy. It usually goes away after the pregnancy. Gestational diabetes is thought to be caused by an insulin-blocking hormones produced by the placenta. However, gestational diabetes can develop to Type 2 diabetes mellitus, putting pregnant women and their born babies at higher risk in the future. Gestational diabetes is best diagnosed at prenatal screening. Women with gestational diabetes are at an increased risk of complications during pregnancy and delivery

Pathophysiology of Diabetes

The pathophysiology of Diabetes Mellitus involves complex factors leading to chronic hyperglycemia. Hyperglycemia, which is central to both diabetes – Type 1 and 2, impairs pancreatic beta cells functions resulting in insufficient insulin secretion. In Type 1 DM is characterized by autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency.
In Type 2 DM, while insulin is produced, it is often inadequate to overcome insulin resistance in adipose tissues, liver and muscle cells. This resistance prevents effective glucose uptake from the bloodstream, causing the liver to increase glucose production (Gluconeogenesis). However, as insulin levels remain low, the body compensates by producing more glucagon, which exacerbates hyperglycemia through glycogenolysis. As a result, glucose level becomes higher in the bloodstream hastening the process, leading to damages and result in complications such as retinopathy and neuropathy

Signs & Symptoms of Diabetes

People with gestational diabetes, prediabetes, or type 2 diabetes may not have any symptoms at all, or not notice them because they slowly develop than type 1 diabetes which tends come quickly and are more severe. Also in type 2 DM, symptoms can be mild, often going unnoticed for years.

Common symptoms of diabetes are

• Increased thirst (polydipsia)
• Urinating more often than usual (polyuria)
• Unexplained weight loss
• Blurred vision
• Feeling tired
• Numbness or tingling in your hands or feet
• Slow-healing sore
• Frequent infections

Diagnostic Investigations & Test

Basically diagnosis of diabetes is made through blood tests that measure blood glucose levels. Common diagnostic tests include:

Fasting Plasma Glucose (FPG) Test:Also known as Fast blood sugar (FBS) Measures blood sugar after fasting for at least 8 hours or an overnight fast. A glucometer reading of 126 miligram per deciliter (g/dL) (11.1 millimoles per liter (mmol/L)) or higher on two separate test indicates diabetes. FBS of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. Below 100mg/dL (5.6mmol/L) is normal.

Random blood sugar (RBS) Test:This test measures a random blood sample at any time within the day. Not considering when you last ate. RBS level of 200mg/dL - 11.1mmol/L or higher indicates diabetes.

Oral Glucose Tolerance (OGTT) Test:Blood sugar levels are measures before and 2 hours after consuming a sugary drink containing 75g glucose. A reading of 200mg/dL (11.1mmol/L) or higher indicates diabetes. Reading less than 140 mg/dL (7.8 mmol/L) is normal. Any readings between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) suggest prediabetes

A1C Test:This test is used to measure an average blood sugar level over the past 2 - 3 months. An A1C results below 5.7% is considered normal. Results between 5.7% and 6.4% indicates prediabetes. A1C result of 6.5% or higher indicates diabetes. This test can monitor how well you manage diabetes.

Treatment of Diabetes

Managing diabetes depend on the type but, generally taking into consideration, several factors such as lifestyle modification, dietary management, and or controlling certain conditions such as Hypertension play a significant role in the treatment of diabetes. Keeping a healthier lifestyle is a key and primary goal to managing diabetes.

Medications prescriptions are secondary option to primary management, and help prevent complications

Lifestyle modification:This factor includes in it are several components to consider. Regular physical activity, a balanced diet, weight management – thus, maintaining a healthy weight are all crucial in DM management.

Medications:Depending in the type of DM, people with type 2 diabetes will need to include medications to help manage their blood glucose level. These include insulin injection therapy such as Rapid-acting or short-acting insulins (e.g. ultrafast-acting aspart (Fiasp) and Insulin Lispro) and Long-acting, ultralong-acting or intermediate-acting insulins (e.g. Glargine and Detemir) and oral hypoglycemic agents (oral antihyperglycemic agents) such as sulfonylureas, metformin, thiazolidinediones, and alpha-glucosidase inhibitors

Blood glucose monitoring:regular blood glucose monitoring is effective for managing DM and preventing complications

Nursing Management of Diabetes

The following are the measures to put in place in the care of patient's with Diabetes

• Monitor blood glucose level
• Monitor vitals
• Use sliding scale to treat high levels of glucose
• Educate patient on condition (diabetes)
• Explain the importance of exercise in maintaining or reducing weight.
• Advise patient to assess blood glucose level before strenuous activity
• Examine feet and skin and teach patient foot care
• Educate the patient on the importance of foot protection
• Teach the patient about insulin self-injections
• Educate patient on the importance of insulin preparation and accurate meal timing to avoid hypoglycemia.
• Teach the patient about hypoglycemia and how to manage it
• Advice patient to eat carbohydrate snack before and during exercising to avoid hypoglycemia.
• Advice patient to reduce or stop smoking, if possible

Preventive measures of Diabetes

Prevention of diabetes mellitus is mainly achieved through lifestyle changes. Since type 1 diabetes is an autoimmune, it can't be prevented. Healthy lifestyle changes can help treat prediabetes. Preventing type 2 diabetes and gestational diabetes can also help prevent them. Prevention factors includes:

• Limit alcohol intake
• Getting adequate sleep
• Eat healthy foods
• Exercise regularly
• Managing stress
• Maintain a healthy weight
• Quitting smoking.
• Regular check ups
• Taking medications as prescribe