Diabetes Mellitus: Types, Complications, and Management

Introduction to Diabetes Mellitus

  • Diabetes Mellitus refers to the inability to regulate glucose, leading to inadequate metabolism of macronutrients.

    • Types of Diabetes Mellitus:

    • Type 1 Diabetes: Absolute or significant deficit of insulin due to the autoimmune destruction of beta cells in the pancreas.

    • Type 2 Diabetes: Insulin resistance and reduction in adequate insulin secretion.

    • Pre-diabetes: Characterized by impaired fasting plasma glucose and impaired glucose tolerance.

Type 1 Diabetes Mellitus

  • Prevalence: Approximately 10% of those with diabetes mellitus.

  • Causes:

    • Autoimmune destruction of beta cells in pancreas (genetic-environmental influences).

    • Results in hyperglycemia, hyperketonemia, and ketoacidosis.

Clinical Manifestations

  • 3 Ps:

    • Polydipsia: Increased thirst.

    • Polyuria: Increased urination.

    • Polyphagia: Increased hunger.

  • Additional symptoms of hyperglycemia:

    • Weight loss

    • Blurred vision

    • Fatigue

    • Paresthesias (numbness)

    • Skin infections

Diagnostic Criteria

  • Tests: History examination, fasting blood glucose, random blood glucose, and glycosylated hemoglobin (HbA1C).

  • Criteria:

    • Diabetes: HbA1C ≥ 6.5%, Fasting Plasma Glucose ≥ 126 mg/dL, Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dL.

    • Prediabetes: HbA1C 5.7-6.4%, Fasting Plasma Glucose 100-125 mg/dL, OGTT 140-199 mg/dL.

Treatment

  • Components:

    • Carbohydrate intake management

    • Regular exercise

    • Insulin replacement therapy

Type 2 Diabetes Mellitus

  • Prevalence: More common than type 1 (90% of diabetes cases).

  • Risk Factor: Obesity is the greatest risk factor.

  • Symptoms: Often asymptomatic; manifestations may include fatigue, visual changes, nephropathy, coronary artery disease, peripheral vascular disease, recurrent infections, and neuropathy.

Diagnostic Criteria

  • Similar to Type 1, focus on distinguishing between Type 1 and Type 2.

Treatment

  • Focus on:

    • Weight control through diet and exercise

    • Use of oral glycemic agents

    • Goal: Maintain optimal blood glucose levels.

Acute Complications of Diabetes

  • Hypoglycemia:

    • Causes include excessive insulin, inadequate food intake, exercise, infection, and antihyperglycemic medications.

    • Symptoms: Shakiness, heart palpitations, dizziness, anxiety, weakness.

    • Management: Check glucose, treat with glucose tablets or sugary drinks, and retest.

  • Diabetic Ketoacidosis (DKA):

    • Related to insulin deficiency; results in severe hyperglycemia, ketogenesis, and acidosis.

    • Symptoms include fruity breath, Kussmaul respiration, nausea, abdominal pain, tachycardia, and altered consciousness.

  • Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHS):

    • Responses to severe dehydration, very elevated blood sugar (>600 mg/dL), and lack of ketones.

Chronic Complications of Diabetes

  • Macrovascular Complications:

    • Includes coronary artery disease, stroke, and peripheral vascular disease.

  • Microvascular Complications:

    • Diabetic Retinopathy: Vision changes due to retinal impairment.

    • Diabetic Nephropathy: Kidney damage leading to chronic renal failure.

    • Diabetic Neuropathies: Affects sensory, motor, and autonomic function.

  • Increased Infection Risk:

    • Common infections involve feet, legs, urinary tract, and gum disease.

    • Risk factors include neuropathy and reduced blood flow.

  • Other Complications:

    • Cataracts: Opacity of the lens due to glucose metabolism abnormalities.

    • Pregnancy Risks: Increased complications for both mother and infant, including a higher likelihood of hypoglycemia for newborns and miscarriages.

Additional Concepts

  • Somogyi Effect:

    • Nighttime hypoglycemia results in rebound hyperglycemia in the morning.

    • Tx involves decreasing evening insulin.

  • Dawn Phenomenon:

    • Elevated morning blood glucose due to early morning hormone release without preceding hypoglycemia.

    • Tx can include limiting evening snacks or adjusting insulin dosage.

  • Understanding proper management and prevention of complications is critical for individuals with diabetes mellitus, focusing on blood glucose control and awareness of symptoms.