Diabetes Mellitus is a chronic systemic disease, characterized by either a deficiency of insulin or a decreased ability of the body to use insulin. Diabetes is sometimes referred to as “high sugar” by both clients and health care providers. It is due to failure of the pancreas to secrete sufficient insulin to meet the body’s requirements to metabolize carbohydrate, fats, and protein. High sugar is a syndrome involving both metabolic and vascular abnormalities. It is a chronic disease that can affect the entire body system and tends to run in families. It requires lifelong management.
Classification of Diabetes Mellitus
There are two main types of diabetes:
- Type I insulin dependent Diabetes Mellitus (IDDM)
This type of diabetes occurs because the pancreas produces no usable insulin. Juvenile onset diabetes which needs insulin finds in children and adults under 40 years of age.
- Type II Non-insulin dependent diabetes mellitus (NIDDM)
This type is more common than type I. It usually occurs in people over the age of 40 years and in obese people. It is also called as adult-onset diabetes. In this type, the pancreas produces insulin but not enough. Meal planning and exercise alone can control adult-onset diabetes. Sometimes it needs oral medications and insulin injections.
Other types of diabetes associated with:
- Pancreatic disease e.g. pancreatitis
- Excess of certain hormones e.g. glucocorticoids, steroids and growth hormone
- Drugs or chemical-induced disease e.g. thiazide diuretic, certain, estrogen
- Certain genetic syndromes
- Genetically predisposed develop clinical diabetes although the exact inheritance pattern is not known.
- Age over 40-50 years
- Physical stress- corticosteroids are antagonistic to insulin (ineffective)
- Traumatic injury to the pancreas
- Other endocrine syndromes such as acromegaly, Cushing syndrome and thyrotoxicosis I which excess hormone promotes hyperglycemia.
- Psychological stress (e.g. divorce, the death of loved one). Stresses require an increased amount of insulin in the body.
- Overnutrition and obesity, excess weight plays a significant role in the story of diabetes. 80% of all people with DM are overnight at the time of diagnosis.
- This may be seen in a condition that places extra demand on the body. Diabetes may be diagnosed in mothers who deliver large babies or who have repeated miscarriages.
The metabolism of the tissues in the body involves three food components
These substances are consumed, each is broken down in the intestine into their simple building blocks, and then they are absorbed into the bloodstream and built back up into large particles of storage in different tissues.
Super Metabolism: Weight loss. Check this video out.
Abnormalities in the metabolism of all these three components can occur in diabetes:
There are two kinds of carbohydrates. They are:
- Simple carbohydrates: composed of only or few building blocks and are broken down quickly by the intestine and rapidly absorbed into the bloodstream like candy, table sugar, pies, cakes etc.
- Complex carbohydrates: complex carbohydrates are storage e.g. rice, potatoes, cereals, beans and bread which are broken down slowly in the intestinal tract. Because of that, glucose concentration builds up gradually in the bloodstream.
The bodily function and tissue repair use protein. Meat, fish products pulses and beans etc. it is absorbed as amino acids into the bloodstream after digestion. Protein stimulates insulin secretion. It can convert to glucose in the liver.
It doesn’t provide energy as quickly as glucose. Its main sources are dairy products, oils, and meat. Fatty acids after digestion absorb fat. Adipose tissue stores fat for future use. Ketones are produced as by-products after fat is metabolized in the liver for energy.
- Polyuria: The higher concentration of glucose in the filtrate increases osmotic pressure which hampers the reabsorption of water by the renal tubules so that large volume of urine formed.
- Polydipsia: As polyuria leads to dehydration and thirst, the patient drinks large quantities.
- Polyphagia: intense hunger, fat utilized for energy production instead of carbohydrate and toxic acid products (ketone) accumulates in blood and urine. Ketone is also excreted in breath, giving a characteristic smell.
- Extreme tiredness and wasting of muscles
- Infection such as boils or carbuncles is liable to occur. Diabetic patient is prone to tuberculosis
- Ketoacidosis causes vomiting and drowsiness lead to coma and death
Urine routine/ Microscopic Test
- Volume increase
- Specific gravity high
- Acetone presents in ketoacidosis
Blood glucose test
- Postprandial or after lunch (2 hours)
Oral glucose tolerance test
Treatment of Diabetes Mellitus
Medical management for clients with Diabetes Mellitus includes restoring and maintaining blood glucose levels to as near normal as possible by balancing diet, exercise and the use of oral hypoglycemic agents or insulin.
Treatment varies for two group of Diabetes Mellitus
- Type I Diabetes Mellitus: often young, underweight people who rapidly develop fatal ketoacidosis if not given insulin.
- Type II Diabetes Mellitus: often middle-aged or elderly or obese. Most of the patient produces some insulin so, they are less prone to developing ketoacidosis
Aim of treatment is to re-establish normal Metabolism
There are 3 methods:
- Diet alone
- An oral hypoglycemic drug
- Insulin and diet
- Diet alone
Dietary control alone is suitable for most mature onset diabetics. Weight reduction is important. According to individual needs, diet ranging prescribes to 3400-5000 calories daily. An individual body recommends high fiber. Suitable foods include:
- Wholemeal bread
- Whole grain cereals
- Raw fruit with its skin
- Plant origin vegetables which contain fiber (roughage)
Diabetic meal plan
A diabetic meal plan is a diet modified slightly to restrict simple carbohydrates. Meals and snacks should be low in fat and high in fiber. People should calculate their total considering age, sex, weight, and kind of occupation.
- Sedentary habit: 30 Cal/kg body weight
- Average physical activities need: 40 Cal/kg
- Heavy manual laborer needs: 50 Cal/kg of body weight
Foods not allowed (forbidden foods)
- Sugar, jam, sweets, honey, glucose, cake, biscuits, syrups, chocolates, food sweetened milk sugar, tinned fruit, ice cream, beer and fried foods etc.
Restriction of food amount
- Cereals e.g. rice wheat, maize, chiura, macoronies, spaghetti, bread oils and ghee etc.
People should take food in moderation
- Dals and legumes e.g. gram, pulses, lentils, beans etc. milk and milk products, meat and fish, fruits like orange, papaya, apple etc.
People should take food as their desire
- Vegetables: cauliflower, cabbage, carrots, mushrooms, asparagus, cucumber, onions, ladies finger, radish, turnips, tomatoes etc.
- Fruits: lemon watermelon
- Drinks like tea, coffee, mineral water, coconut water.
- Soups: homemade vegetable soups
- Others: herbs, spices, saccharine and salad
- Oral drugs and diet: Oral hypoglycemic drugs are prescribed for those who cannot be controlled by diet alone. They fall into two main groups:
- Sulphonylureas: These act by stimulating the pancreas to produce more insulin and reduce the release of glucose from the liver.
- The biguanides: It lowers the blood glucose level possibly by increasing glucose uptake in the tissue. If a patient becomes resistant to Sulphonylureas alone, a biguanide may be added. The only tablet of this type used is metformin dose: 0.5 to 3 gm daily in divided dose.
- Insulin and diet
Insulin-dependent diabetes requires insulin injections and diet prescribed to match their physical activities and maintain their weight. Blood glucose and urine test indicate its balance.
The pancreas of the cattle, pigs, and sheep prepares insulin. People cannot get oral method because gastric juices destroy insulin.
Insulin is given before breakfast, lunch, and dinner. An area between fat and muscle injects insulin.
Clients taking insulin should note the following instructions carefully:
- People should take meal at a specified time and in a specified quantity
- One should avoid fasting or be missing a meal without consulting a doctor
- Do not omit insulin during illness
- One should learn to recognize the symptoms of hypoglycemia
Complications occur more often in poorly controlled disease
- Visual defects
- Retinal disease
- Vitreous hemorrhage: it is one of the major causes of blindness. In this condition, there is a growth of new vessels out from the retina into the vitreous and complete blindness
- Neuropathy: peripheral neuropathy mainly affects the lower limbs and leads to gradual loss of both ankle and knee reflexes and sensation.
- Nephropathy: renal biopsy shows glomerulosclerosis changes or nodular sclerosis in glomerular capillaries known as KW syndrome (Kimmel site) – Wilson syndrome). There is no known treatment for it.
- Atherosclerosis: the risk of coronary artery, cerebral vascular and peripheral vascular diseases are common.
Hypoglycemia (Insulin Coma)
When the blood sugar level falls too low, hypoglycemia occurs. It is due to:
- People delaying in meal
- Unusual exertion or exercise is undertaken
- Excessive insulin dose
Sign/ symptoms of Diabetes Mellitus
- Sudden, patient well and active taking insulin
- Infection: No usual present
- Quiet regular breathing
- Sweating, moist skin
Management of hypoglycemia is having a food rich in glucose, chocolate or juice.