Diabetes Mellitus

Diabetes mellitus (DM) is one of the leading causes of disability in persons over 45.
More than half of diabetic person will die coronary heart disease. CAD tends to
occur at an earlier age and with severenity in persons with diabetes. It also
increases the risk of dying cardiovascular disease like heart attack or stroke among
women.

Description

Diabetes mellitus is not a single disease. It is a genetically and clinically

heterogenous group of metabolic disorders characterized by glucose intolerance,
with hyperglycemia present at time of diagnosis.

Etiology/Causes

Specific cause depends in the type of diabetes; however it is easier to think of

diabetes as an interaction between two factors: genetic Predisposition (diabetogenic
genes) and Environment/lifestyle (obesity, poor nutrition, lack of exercise)

Types of Diabetes

Type I diabetes is insulin –dependent diabetes mellitus (IDDM) and type II is

noninsulin dependent diabetes mellitus (NIDDM). Gestational Diabetes is diabetes
that develops during pregnancy. It may develop into full-blown diabetes.

NDMM is more common, occurring in about 90-95% of all persons with diabetes. It is
also more preventable because it is associated with obesity and diet.

Type I DM

• Characterized by absolute lack of insulin due to damaged pancreas,

prone to develop ketosis, and dependent on insulin secretion,
peripheral insulin resistance and increased glucose production.

• Genetic, environment or may be acquired due to viruses (e.g. mumps,

congenital rubella) and chemical toxins (e.g. Nitrosamines)

Type II DM

• Characterized by fasting hyperglycemia despite availability of insulin.

 • Possible causes include impaired insulin secretion, peripheral insulin,
resistance and increase hepatic glucose production.

• Usually occurs in older and overweight person (about 80%)

Risk Factors of Type 2 Dm

• Family history of diabetes (i.e., parents or sibling with diabetes)

• Overweight (BMI 23 kg/m) and obesity (BMI >30 kg/m)

• Sedentary lifestyle

• Hypertension

• HDL cholesterol <35 mg/dl (0.90 mmol/L) and or triglycerides level>

250 mg/dl

(2.82mmol/L)

• History of Gestational Diabetes mellitus (GDM) or delivery of a baby

weighing 9 lbs

(4.0 Kgs)

• Previously identified to have Impaired Glucose Tolerance (IGT)

Complications

• Acute complication include diabetic ketoacidosis (DKA),hyperosmolar

hyperglycemic nonketotic coma (HHNK) and hypoglycemia especially
in type I diabetics

• Chronic complications cause most of the disability associated with the

disease. These include chronic renal disease (nephropathy), blindness
(retinopathy), coronary artery disease and stroke, neuropathies and
foot ulcers

Key Areas for prevention and control of Diabetes

• Maintain body weight and prevent obesity through proper nutrition and
physical activity/exercises.

• Encourage proper nutrition – Eat more dietary Fiber, reduce salt and fat
intake, avoid simple sugars like cakes and pastries; avoid junk foods

• Promote regular physical activity and exercises to prevent obesity,

hypercholesterolemia and enhance insulin action in the body

• Advise smoking cessation for active smokers and prevent exposure to

second-hand smoke. Smoking among diabetics increases risk for heart
attack and stroke.