DIABETES MELLITUS

The term "diabetes mellitus" refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's your brain's main source of fuel. What Causes Diabetes:  To understand diabetes, first you must understand how glucose is normally processed in the body.

How glucose normally works Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells, with the help of insulin.  The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key, unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas. Your liver acts as a glucose storage and manufacturing center. When you haven't eaten in a while your liver releases stored glucose to keep your glucose level within a normal range.

Symptoms Of Diabetes  Diabetes symptoms vary depending on how high your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, however, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes include: Increased thirst Frequent urination Extreme hunger Unexplained weight loss Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough insulin) Fatigue Blurred vision

    

 

  

Slow-healing sores Mild high blood pressure Frequent infections, such as gum or skin infections and vaginal or bladder infections STAGES OF DIABETES MELLITUS

Type 1 diabetes mellitus is a chronic metabolic syndrome defined by an inability to produce insulin, a hormone which lowers blood sugar. This leads to inappropriate hyperglycaemia (increased blood sugar levels) and deranged metabolism of carbohydrates, fats and proteins. Insulin is normally produced in the pancreas, a glandular organ involved in the production of digestive enzymes and hormones such as insulin and glucagon. These functions are carried out in the exocrine and endocrine (Islets of Langerhans) pancreas respectively. Causes:

In type 1 diabetes, your immune system which normally fights harmful bacteria or viruses attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear. Risk Factors: DM 1

The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But, not everyone who has these autoantibodies develops type 1. Dietary factors. A number of dietary factors have been linked to an increased risk of type 1 diabetes, such as low vitamin D consumption; early exposure to cow's milk or cow's milk formula; or exposure to cereals before 4 months of age or after 7 months of age. However, none of these factors has been shown to cause type 1 diabetes. Race. Type 1 diabetes is more common in whites than in other races. Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes. Symptoms of Diabetes Mellitus Type 1 The symptoms of type 1 diabetes mellitus usually develop rapidly and may include:

 

 

Polyuria : increased frequency of urination, and particularly urination at night (nocturia). Polydipsia: increased thirst.

 

Polyphagia: increased hunger. Fatigue or lethargy. Type 2 Diabetes Mellitus

Type 2 diabetes is the most common form of diabetes, accounting for 90 - 95% of cases. In type 2 diabetes, the body does not respond properly to insulin, a condition known as insulin resistance. Insulin is a hormone produced by the pancreas that regulates how the body converts sugar (glucose) into energy CAUSES:

in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although as in type 1 diabetes, it's believed that genetic and environmental factors play a role in the development of type 2. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight. Risk Factors:

 

Weight. The more fatty tissue you have, the more resistant your cells become to insulin. Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Exercising less than three times a week may increase your risk of type 2 diabetes. Family history. Your risk increases if a parent or sibling has type 2 diabetes. Race. Although it's unclear why, people of certain races Indians and Asians are at higher risk. including blacks, Hispanics, American

 

Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is increasing dramatically among children, adolescents and younger adults. Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes. High blood pressure. Having blood pressure over 140/90mm Hg is linked to an increased risk of type 2 diabetes. Abnormal cholesterol levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Low levels of HDL are defined as below 35 mg/dL.

Symptoms:      The main symptoms are similar to those of Type 1 diabetes. Polydypsia Polyuria Tiredness. Weight loss may sometimes be present, but is not as marked as in Type 1 diabetes. Most people with Type 2 diabetes are overweight. Itchiness, especially around the genitals, due to yeast infection (thrush). Recurrent infections on the skin, eg yeast infections or boils.

 

How Thyroid Dysfunction May Affect Diabetic Patients  How Thyroid Dysfunction May Affect Diabetic Patients The presence of thyroid dysfunction may affect diabetes control. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. There is underlying increased hepatic gluconeogenesis, rapid gastrointestinal glucose absorption, and probably increased insulin resistance. Indeed, thyrotoxicosis may unmask latent diabetes. In practice, there are several implications for patients with both diabetes and hyperthyroidism. First, in hyperthyroid patients, the diagnosis of glucose intolerance needs to be considered cautiously, since the hyperglycemia may improve with treatment of thyrotoxicosis. Second, underlying hyperthyroidism should be considered in diabetic patients with unexplained worsening hyperglycemia. Third, in diabetic patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly. Restoration of euthyroidism will lower blood glucose level.

Gangrene
Gangrene is a severe form of tissue necrosis, and is a very serious and often life-threatening condition. Reduced blood supply to the affected tissue is the primary cause, but there are many underlying causes of the reduced blood flow, such as injury, infection, and chronic health problems.     WAGNER CLASSIFICATION OF DIABETIC FOOT ULCERS Grade 0: No ulcer in a high risk foot. Grade 1: Superficial ulcer involving the full skin thickness but not underlying tissues. Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation. Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis. Grade 4: Localized gangrene. Grade 5: Extensive gangrene involving the whole foot.

  

Gangrene r/t Diabetes:  Diabetes - the high blood sugar levels, which are common in diabetes, may eventually damage the nerves, especially in the feet. When the nerves are damaged the patient does not feel pain and will not know if he/she has an injury. The patient may continue walking without protecting the wound. The wound may get worse and develop into a foot ulcer. High blood sugar levels may also damage blood vessels, resulting in poor blood supply to the area. Less blood means less nutrients and oxygen for the tissue cells, and fewer white blood cells and T-cells to fight off infection. The ulcer becomes infected; the infection grows rapidly and gangrene develops. The oxygen/nutrient deprived cells are weak and rapidly die.