Diabetes Mellitus
DM
Diabetes mellitus is a common metabolic disorder of multiple etiology, characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism due to defects in insulin secretion, insulin action, or both. There are four main types of diabetes mellitus: type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes and other specific types (genetic syndromes, pancreatitis, cystic fibrosis, exposure to certain drugs, etc.).
Presentation
Patients with type 1 diabetes mellitus usually present with classic acute symptoms of hyperglycemia. These include:
- Polyuria (due to osmotic diuresis when blood glucose level exceeds renal threshold)
- Thirst (as a consequence of loss of fluids and electrolytes by osmotic diuresis)
- Postural hypotension (due to reduction of plasma volume by osmotic diuresis)
- Loss of weight (due to depletion of glycogen stores by glycogenolysis and triglyceride stores by lipolysis; and the reduction of muscle mass as a consequence of the diversion of amino acids for gluconeogenesis)
- Blurring of vision (because of the exposure of the lens and retina to hyperosmolar fluids)
Around 25% of the cases of diabetes mellitus present with the acute complication of ketoacidosis.
In contrast, most of the patients of type 2 diabetes mellitus do not have acute symptoms. The disease may be present for an average of 4 to 7 years before it is detected. The patients have a history of increased urination and thirst but most are asymptomatic initially. The presenting complaints of the patients include lack of energy, delayed wound healing, visual blurring and fungal infections such as pruritis vulvae or balanitis [5].
In addition, the following complications may be the initial presenting feature in chronically undetected cases.
- Infections (such as urinary tract infections, tuberculosis and skin infections)
- Deterioration of vision (owing to diabetic retinopathy)
- Paresthesia, pain and atrophy of the leg muscles (due to neuropathy)
- Ulcerations of the foot/feet (caused by a combination of neuropathy, infection and peripheral vascular disease) [6]
- Myocardial infarction (because of atherosclerosis)
Entire body system
Weight Loss
- The eating trait of being unsuccessfully dietary restrained is associated with weight-loss failure after a six-month lifestyle intervention in people with T2DM.[ncbi.nlm.nih.gov]
- Advantages of ertugliflozin include reduction in glycated hemoglobin, weight loss and blood pressure lowering with a low risk of hypoglycemia. The main adverse effects likely to be seen are genital fungal infections.[ncbi.nlm.nih.gov]
- The patient was admitted due to polyuria and weight loss in the past few days. The initial blood glucose level was 1167mg/dL. On the basis of clinical manifestations and laboratory results, she was diagnosed with T1DM and HHS.[ncbi.nlm.nih.gov]
- This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss.[kidshealth.org]
Fatigue
- Myasthenia gravis (MG) is an acquired disease of the neuromuscular junctions characterized by muscular weakness and fatigue, with a prevalence of 50-125 cases per million population in western countries.[ncbi.nlm.nih.gov]
- Since 6 months ago, she often seemed like having less concentration or daydreaming, chronic fatigue, depression, and low food intake. Her body weight had been increasing over time.[ncbi.nlm.nih.gov]
- Nine weeks after initiation, he developed fatigue and polyuria with blood glucose 336 mg/dL, c-peptide 0.6 ng/mL, A1C8.2% and GAD antibodies 28.4 U/mL (normal, 1 U/mL).[ncbi.nlm.nih.gov]
- […] intervention, there was a statistically significant reduction in the mean value of HbA1c from 9.8 to 7.7 (P 0.001), and there was significant improvement in the mean scores of the following HRQoL scales: role limitations due to emotional problems, energy/fatigue[ncbi.nlm.nih.gov]
- The signs and symptoms of both types of diabetes include increased urine output and decreased appetite as well as fatigue .[medicinenet.com]
Coronary Artery Disease
- In the present review we discuss the evidence linking leptin levels with the presence, severity and/or prognosis of both coronary artery disease and non-cardiac vascular diseases such as stroke, carotid artery disease, peripheral artery disease (PAD)[ncbi.nlm.nih.gov]
- Global longitudinal strain (GLS) at rest on two-dimensional speckle tracking echocardiography (2D STE) was demonstrated to help detect coronary artery disease (CAD).[ncbi.nlm.nih.gov]
- Screening for coronary artery disease in patients with diabetes. Diabetes Care 2007; 30:2729–2736. Handelsman Y, Bloomgarden ZT, Grunberger G, et al.[clevelandclinicmeded.com]
- Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis).[mayoclinic.org]
- In diabetic patients without coronary artery disease, those with impaired coronary flow reserve have event rates similar to those with prior coronary artery disease, while patients with preserved coronary flow reserve have event rates similar to non-diabetic[emedicine.medscape.com]
Abdominal Obesity
- Your doctor will examine you to look for: Obesity, especially abdominal obesity—a condition that greatly raises a person's risk for type 2 diabetes.[drugs.com]
- The increase in diabetes mellitus in Africa has been attributable in part to urbanization, urban residence, acculturation, abdominal obesity, globalization, westernization, sedentary lifestyle, behavioural habits, systemic arterial hypertension, physical[intechopen.com]
- Med Clin North Am . 73 : 111 – 138 . 46 Bjorntop P. 1988 Abdominal obesity and the development of non-insulin dependent diabetes mellitus.[academic.oup.com]
Family History of Diabetes Mellitus
- There was a strong family history of diabetes mellitus. At age 17 months hypoglycemic seizures occured (blood glucose 5 mg/100 ml). An oral glucose tolerance test was abnormal. Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured.[pediatrics.aappublications.org]
Gastrointestinal
Polydipsia
- Generally, people with Type 1 diabetes have increased thirst (polydipsia), frequent urination (polyuria), and increased hunger (polyphagia). Symptoms may develop over weeks to months.[aapos.org]
- Symptoms of diabetes The main symptoms of diabetes are three – polydipsia, polyphagia and polyuria. These mean increased thirst, increased hunger and increased frequency of urination.[news-medical.net]
- Children with this type of diabetes (formerly known as juvenile-onset diabetes) often develop diabetes symptoms (polydipsia, polyuria, weight loss, hunger) rapidly.[medscape.org]
- Clinical manifestations include polyuria, polydipsia, and polyphagia. Type 1 DM (prevalence 0.4%) is caused by pancreatic islet cell destruction, usually beginning in childhood. These patients are at increased risk for diabetic ketoacidosis .[openanesthesia.org]
- In Type 1 diabetes, the classic symptoms are excessive secretion of urine (polyuria), thirst (polydipsia), weight loss and tiredness. These symptoms may be less marked in Type 2 diabetes.[who.int]
Abdominal Pain
- pain, rapid deep breathing, loss of appetite, reddened and warm skin, headache, drowsiness, fruity-smelling breath, restlessness and ketones in our urine.[nhforsythendocrineconsultants.org]
- Presents as dehydration, hypotension, n/v, abdominal pain, altered mental status. Urine and serum ketones elevated. Total body K depleted.[openanesthesia.org]
- Patients diagnosed with DKA develop very high blood sugar levels, abdominal pain, fruity-smelling breath, dehydration, severe weakness, lethargy, and coma.[innerbody.com]
- During Diabetic Ketoacidocis (DKA) the patient might experience abdominal pain, anorexia, nausea, vomitting or diarrhea. This occurs more in children. Patient will have confusion and dull mental state which can lead to coma.[physio-pedia.com]
- Fibrocalculous pancreatopathy may be accompanied by abdominal pain radiating to the back and pancreatic calcifications identified on X-ray examination. Pancreatic fibrosis and calcium stones in the exocrine ducts have been found at autopsy.[care.diabetesjournals.org]
Diarrhea
- Proprotein convertase 1/3 (PC1/3) deficiency is a very rare disease characterized by severe intractable diarrhea in the first years of life, followed by obesity and several hormonal deficiencies later.[ncbi.nlm.nih.gov]
- Contact your doctor immediately if you develop vomiting or diarrhea and are not able to drink enough fluids. Monitor your blood sugar as advised by your health care team. Report any significant deviations in blood sugar levels.[drugs.com]
- During Diabetic Ketoacidocis (DKA) the patient might experience abdominal pain, anorexia, nausea, vomitting or diarrhea. This occurs more in children. Patient will have confusion and dull mental state which can lead to coma.[physio-pedia.com]
- Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction. Kidney damage (nephropathy).[mayoclinic.org]
- Galen named the disease "diarrhea of the urine" (diarrhea urinosa). [103] The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE).[en.wikipedia.org]
Increased Appetite
- Amidst the increased appetite and craving for food, persons with DM (usually Type 1) may still experience weight loss because of the improper fat metabolism and breakdown of fat stores.[physio-pedia.com]
- Increased appetite and excessive hunger? If you have diabetes, do you have any complications from it? Retinopathy in particular can worsen during pregnancy and should be assessed with a retinal exam prior to pregnancy. 2.[clinicaladvisor.com]
- The loss of glucose in the urine results in weakness, fatigue , weight loss, and increased appetite (polyphagia).[britannica.com]
- Signs and symptoms of type 1 and type 2 diabetes with hyperglycemia may include: Increased thirst Increased urination Increased appetite (with type 1, weight loss is also seen) Fatigue Nausea, vomiting, abdominal pain (especially in children) Blurred[labtestsonline.org]
- Effects can range from feelings of unease , sweating , trembling, and increased appetite in mild cases to more serious issues such as confusion , changes in behavior such as aggressiveness, seizures , unconsciousness , and (rarely) permanent brain damage[en.wikipedia.org]
Constipation
- Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction. Kidney damage (nephropathy).[mayoclinic.org]
- Clinical features of type I diabetes Some of the symptoms include weight loss, polyurea, polydipsia, polyphagia, constipation fatigue, cramps, blurred vision, and candidiasis [ 21 ].[omicsonline.org]
- These include impotence, orthostatic hypotension, delayed gastric emptying, diarrhea or constipation, and asymptomatic retention of urine in the bladder.[medical-dictionary.thefreedictionary.com]
Liver, Gall & Pancreas
Hepatomegaly
- Glycogenic hepatopathy is a rare condition that causes significant hepatomegaly and elevated liver enzyme levels in uncontrolled type 1 diabetic patients. It develops due to excessive accumulation of glycogen in the hepatocytes.[ncbi.nlm.nih.gov]
Musculoskeletal
Prayer Sign
- Consider screening with “prayer sign” (unable to approximate fingers and palms while pressing hands together). GI: consider RSI (although not supported by any evidence!!! Regardless, note that gastroparesis occurs in 25% of diabetics).[openanesthesia.org]
Eyes
Background Retinopathy
- Follow-up eye examinations should be performed annually in patients with no or minimal background retinopathy. More frequent follow-up examinations are needed in those who have more advanced retinopathy.[clevelandclinicmeded.com]
Skin
Flushing
- The body tries to rid the blood of excess glucose by flushing it out of the system with increased urination. This process can cause dehydration and upset the body's electrolyte balance as sodium and potassium are lost in the urine.[labtestsonline.org]
- Abdominal pains or cramps, sometimes acute Nausea and vomiting Nausea and vomiting Central nervous system Headache Confusion, delirium, or seizures Double or blurred vision Irritability Cardiovascular Tachycardia Variable Orthostatic hypotension Skin Flushed[medical-dictionary.thefreedictionary.com]
Delayed Wound Healing
- The presenting complaints of the patients include lack of energy, delayed wound healing, visual blurring and fungal infections such as pruritis vulvae or balanitis.[symptoma.com]
- Poor blood circulation in the legs and feet contribute to delayed wound healing.[medical-dictionary.thefreedictionary.com]
Pruritus
- This risk is likely outweighed by the benefits of reducing cardiovascular risk. [ 8 ] Presentation Patients with all types of diabetes may present with polyuria, polydipsia, lethargy, boils, pruritus vulvae or with frequent, recurrent or prolonged infections[patient.info]
Urogenital
Polyuria
- The patient was admitted due to polyuria and weight loss in the past few days. The initial blood glucose level was 1167mg/dL. On the basis of clinical manifestations and laboratory results, she was diagnosed with T1DM and HHS.[ncbi.nlm.nih.gov]
- Nine weeks after initiation, he developed fatigue and polyuria with blood glucose 336 mg/dL, c-peptide 0.6 ng/mL, A1C8.2% and GAD antibodies 28.4 U/mL (normal, 1 U/mL).[ncbi.nlm.nih.gov]
- This is because both disorders cause polyuria , or excessive urine output. Diabetes insipidus is a disorder of urine concentration which we will discuss in spring quarter.[courses.washington.edu]
- These include: Polyuria (due to osmotic diuresis when blood glucose level exceeds renal threshold) Thirst (as a consequence of loss of fluids and electrolytes by osmotic diuresis) Postural hypotension (due to reduction of plasma volume by osmotic diuresis[symptoma.com]
- Generally, people with Type 1 diabetes have increased thirst (polydipsia), frequent urination (polyuria), and increased hunger (polyphagia). Symptoms may develop over weeks to months.[aapos.org]
Pruritus Vulvae
- This risk is likely outweighed by the benefits of reducing cardiovascular risk. [ 8 ] Presentation Patients with all types of diabetes may present with polyuria, polydipsia, lethargy, boils, pruritus vulvae or with frequent, recurrent or prolonged infections[patient.info]
Neurologic
Stroke
- Leptin levels have been positively associated with the presence, severity, extent and lesion complexity of coronary atherosclerosis as well as with the presence, severity and poor clinical outcomes of both ischemic and hemorrhagic strokes.[ncbi.nlm.nih.gov]
- ., nonfatal myocardial infarction or stroke, transient ischemic attack, or vascular death, excluding confirmed intracranial hemorrhage). The secondary outcome was a first serious vascular event or any arterial revascularization.[ncbi.nlm.nih.gov]
- Cardiovascular Quality & Outcomes Journal Home Current Issue See All Issues Circ: Heart Failure Journal Home Current Issue See All Issues Circulation Research Journal Home Current Issue See All Issues Hypertension Journal Home Current Issue See All Issues Stroke[circ.ahajournals.org]
- ., myocardial infarction, stroke or transient ischemic attack, or death from any vascular cause, excluding any confirmed intracranial hemorrhage).[ncbi.nlm.nih.gov]
- Even more serious is the increased risk of heart disease and stroke . Treatment for type 1 diabetes involves taking insulin, which needs to be injected through the skin into the fatty tissue below.[webmd.com]
Peripheral Neuropathy
- We presented apical healing of the upper central incisor, retrofilled with TSC, in a diabetic patient (type 2 DM) with peripheral neuropathy.[ncbi.nlm.nih.gov]
- Also, there were significant changes in clinical findings for diabetic peripheral neuropathy. LLLT with specific exercises can promote healing of skin manifestations in individuals with type 2 diabetes mellitus.[ncbi.nlm.nih.gov]
- The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD).[ncbi.nlm.nih.gov]
- Maintenance: CNS: peripheral neuropathies (?increased risk of neurologic injury?), autonomic neuropathy (?hemodynamic control?).[openanesthesia.org]
- Figure 11 Bilateral painless ulcers in a patient with diabetic peripheral neuropathy.[bjsm.bmj.com]
Workup
The following investigations are helpful in establishing the diagnosis of diabetes mellitus.
- Random blood sugar: Diabetes is labelled if the random blood sugar is found to be greater than 200 mg/dL. It is not sufficient for diagnosing diabetes and fasting blood sugar should always be checked subsequently.
- Fasting blood sugar: Diabetes is confirmed if the fasting blood sugar is more than 126 mg/dL on more than one occasion.
- Glucose tolerance test: Glucose tolerance test is required for the confirmation of diabetes when the fasting blood sugar is more than normal but less than the diabetic range.
- Glycosylated hemoglobin: Level of glycosylated hemoglobin reflects the state of glycemia over the preceding 8 to 12 weeks.
- Serum fructosamine: Serum fructosamine reflects the state of glycemic control for the preceding 2 weeks.
Urine
Glycosuria
- Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. Serum immunoreactive insulin following intravenous tolbutamide rose, suggesting endogenous insulin production.[pediatrics.aappublications.org]
- Characteristically the course is progressive and includes polyuria, polydipsia, weight loss, polyphagia, hyperglycemia, and glycosuria.[medical-dictionary.thefreedictionary.com]
- Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible.[care.diabetesjournals.org]
- […] ītus , [107] whose meaning is the same as that of the English suffix "-ite". [109] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste ( glycosuria[en.wikipedia.org]
- In patients with severe coexisting conditions that could interfere with implementation of the management strategy, the goal is prevention of clinically significant glycosuria, water and electrolyte loss, infections, and the development of non ketotic[omicsonline.org]
Ketonuria
- Although neither ketoacidosis nor ketonuria was detected, the markedly acute onset of the hyperglycemia was consistent with the typical clinical course of fulminant type I diabetes mellitus, and this diagnosis was supported by clinical data.[ncbi.nlm.nih.gov]
- Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. Serum immunoreactive insulin following intravenous tolbutamide rose, suggesting endogenous insulin production.[pediatrics.aappublications.org]
- Patients with type 1 diabetes may also present with weight loss, dehydration, ketonuria and hyperventilation. Presentation of type 1 diabetes tends to be acute with a short duration of symptoms.[patient.info]
- Characterized by hyperglycemia, glycosuria, polyuria, hyperlipemia (caused by imperfect catabolism of fats), acidosis, ketonuria, and a lowered resistance to infection.[medical-dictionary.thefreedictionary.com]
Serum
Hypertriglyceridemia
- Current ACC/AHA guidelines continue to endorse the treatment of patients with fasting triglycerides 500 mg/dl to prevent more severe hypertriglyceridemia and pancreatitis (54) .[onlinejacc.org]
- Hemolytic anemias Patients receiving antiretroviral treatment for human immunodeficiency virus Pregnancy Vitamins E and C Lower or elevate A1C Hemoglobinopathies or hemoglobin variants Malnutrition Falsely elevate A1C Aplastic anemias Hyperbilirubinemia Hypertriglyceridemia[aafp.org]
Hyponatremia
- In this T1D case with CKD, severe hyperglycemia in conjunction with other metabolic insults, such as uremia, hyponatremia, and hypocalcemia, probably provoked his seizure despite the severe ketonemia.[ncbi.nlm.nih.gov]
Nodular Glomerulosclerosis
- Renal glomerulus, nodular glomerulosclerosis, microscopic. Renal glomerulus, nodular glomerulosclerosis, hyaline arteriolosclerosis, PAS stain, microscopic. Kidney, acute pyelonephritis, microscopic.[library.med.utah.edu]
Glucose Increased
- Regular exercise lowers blood glucose, increases the body's sensitivity to insulin, and increases circulation. Type 1 diabetics must self-check their glucose levels and inject themselves with insulin several times a day.[labtestsonline.org]
Insulin Increased
- Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function. [30] Being diabetic, especially when on insulin, increases the risk of falls in older people. [31] Causes Comparison of type[en.wikipedia.org]
HLA Type
HLA-DR3
- There is around 30 to 35% concordance in monozygotic twins. 95% of the patients carry HLA-DR3, HLD-DR4 or both genes.[symptoma.com]
- Associated with HLA DR3 and DR4 and islet cell antibodies around the time of diagnosis. Patients always need insulin treatment and are prone to ketoacidosis. The most at-risk population for type 1 diabetes is Caucasian of northern European ancestry.[patient.info]
- Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Heterozygotes for those haplotypes are at significantly greater risk for DM than homozygotes. HLA-DQs are also considered specific markers of type 1 DM susceptibility.[emedicine.medscape.com]
HLA-DR4
- Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Heterozygotes for those haplotypes are at significantly greater risk for DM than homozygotes. HLA-DQs are also considered specific markers of type 1 DM susceptibility.[emedicine.medscape.com]
Treatment
The treatment methods available for diabetes mellitus include:
- Diet alone
- Diet and insulin
- Diet and oral hypoglycemic drugs
Diet
Around 60% of the patients can be treated adequately with diet alone. A proper diet regimen should be prepared based upon the age, sex, weight and caloric requirements of the patient. Readily absorbable carbohydrates such as sugars should be avoided. Non-nutritive sweeteners such as asparmate, saccharine or sucramate should be used if needed.
Oral hypoglycemic drugs
Oral hypoglycemic agents are useful for the treatment of type 2 diabetes mellitus. A wide number of oral hypoglycemic agents are available. They are prescribed individually or in combinations according to the patient. Common oral hypoglycemic agents include sulphonylureas (e.g. glimepride and glipizide), biguanides (e.g. metformin), alpha glucosidase inhibitors (e.g. acarbose and migitol), thiazolidinedions (e.g. pioglitazone and rosiglitazone), D-phenylalanine derivatives (e.g. nateglinide) and insulin stimulators (e.g. repaglinide) [7][8].
Insulin
Insulin is used in the treatment of all patients of type 1 diabetes mellitus and in those patients of type 2 diabetes whose hyperglycemia is not controlled by diet and oral hypoglycemic agents. Various preparations of insulin are available and are selected according to each patient.
Prognosis
Diabetes mellitus is a chronic disease that disturbs the quality of life of all the patients [4]. The patients are forced to take daily insulin injections and/or oral hypoglycemic drugs. Lifestyle and diet modifications also become essential. However, with early diagnosis and proper control of the disease, the risk of development of associated diseases and complications can be reduced and the patients enjoy a life expectancy that approaches those without the disease. Untreated diabetes mellitus is associated with a high mortality and morbidity rate.
Etiology
Diabetes mellitus may be primary or secondary.
Primary diabetes mellitus has two types [2].
- Insulin dependent diabetes mellitus (Type 1)
- Non-insulin dependent diabetes mellitus (Type 2)
Type 1 diabetes mellitus usually results from an autoimmune disease process. It is associated with a positive family history. The child of a patient having type 1 diabetes has a greater risk of developing the disease. The risk is greater with diabetic father as compared to the diabetic mother. There is around 30 to 35% concordance in monozygotic twins. 95% of the patients carry HLA-DR3, HLD-DR4 or both genes. Infection with coxsackievirus B4
Type 2 diabetes mellitus has a 100% concordance in identical twins, implying a much stronger genetic association. Around 25% of the patients have a first degree relative suffering from this disease. Overeating combined with obesity acts as a diabetogenic factor.
Epidemiology
Type 1 diabetes mellitus is the most common metabolic disease in childhood. It is present in around 1 in every 500 child or adolescent.
Type 2 diabetes mellitus is very common worldwide, particularly the US because of the high caloric diet. Its incidence is on the rise and it is said that type 2 diabetes is rapidly becoming a global “epidemic”. It is estimated that around 552 million people worldwide will be suffering from it by the year 2030.
Pathophysiology
Type 1 diabetes mellitus is caused by an autoimmune process in which there is lymphocytic infiltration and subsequent destruction of the beta cells in the pancreas. These cells are responsible for the production of insulin and their destruction causes the level of insulin to fall leading to hyperglycemia.
In type 2 diabetes mellitus, there is both reduced secretion of insulin as well as insulin resistance in the peripheral tissues [3]. As a result, hyperglycemia develops.
Prevention
There is no effective preventive measure against type 1 diabetes mellitus as it is an autoimmune disease that occurs early in childhood.
Type 2 diabetes mellitus can be prevented by adopting a healthy lifestyle. Eating a healthy diet, avoiding overeating, controlling obesity and performing daily exercise greatly reduce the risk of development of type 2 diabetes mellitus [9] [10].
Summary
Diabetes mellitus is a clinical syndrome that is characterized by chronic hyperglycemia along with disturbances in the metabolism of carbohydrates, lipids and proteins [1]. It is of two main types, type 1 and type 2 diabetes mellitus. The former is also referred to as insulin dependent diabetes mellitus while the latter is also known as non-insulin dependent diabetes mellitus.
Patient Information
Diabetes mellitus is a disease in which the level of sugar in the blood is raised. It is of two types, one usually affecting people since childhood and the other appearing late in adulthood. Diabetes is associated with many diseases and complications and should be diagnosed and treated early to ensure better expectancy and quality of life.
References
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- Ionova TI, Odin VI, Nikitina TP, Kurbatova KA, Shablovskaia NE. [Quality of life and problems posed by hypoglycemia in type 2 diabetes mellitus during oral hypoglycemic therapy]. Klinicheskaia meditsina. 2013;91(9):34-40.
- Ratner RE. Type 2 diabetes mellitus: the grand overview. Diabetic medicine : a journal of the British Diabetic Association. 1998;15 Suppl 4:S4-7.
- Bustos-Saldana R, Prieto-Miranda S, Grupo de Estudio de Factores de Riesgo de Ulceraciones en los Pies de los Pacientes Diabeticos T. [Foot ulceration risk factors in type 2 diabetes mellitus]. Revista medica del Instituto Mexicano del Seguro Social. Sep-Oct 2009;47(5):467-476.
- McAvoy KH. Oral hypoglycemic agents in the management of non-insulin-dependent diabetes mellitus among the elderly. The Diabetes educator. Sep-Oct 1991;17(5):411-413.
- Lubbos H, Miller JL, Rose LI. Oral hypoglycemic agents in type II diabetes mellitus. American family physician. Nov 15 1995;52(7):2075-2078.
- Olmsted WH. Obesity: key to the prevention of diabetes. Journal - Michigan State Medical Society. Oct 1953;52(10):1057-1061.
- Boulin R, Rambert P. [Prevention of diabetes mellitus]. La Semana medica. Oct 22 1952;28(38):429-430.