Diabetes Treatment

Diabetes Evaluation and Treatment

Diabetes mellitus often referred to simply as diabetes (Ancient Greek: “to pass through”), is a syndrome of disordered metabolism, usually due to a combination of hereditary and environmental causes, resulting in abnormally high blood sugar levels (hyperglycemia).

Blood glucose levels are controlled by a complex interaction of multiple chemicals and hormones in the body, including the hormone insulin made in the beta cells of the pancreas.

It refers to the group of diseases that lead to high blood glucose levels due to defects in either insulin secretion or insulin action.

Diabetes develops due to:

• A diminished production of insulin (in type 1)
• Resistance to its effects (in type 2)
• Both lead to hyperglycemia, which largely causes the
• Acute signs of diabetes:
• excessive urine production
• resulting compensatory thirst and increased fluid intake
• blurred vision
• unexplained weight loss
• lethargy and changes in energy metabolism.

All forms of diabetes have been treatable since insulin became medically available in 1921, but there is no cure.

The injections by a syringe, insulin pump, or insulin pen deliver insulin, which is a basic treatment of type 1.

Type 2 is managed with a combination of

• dietary treatment
• exercise
• medications
• insulin supplementation

Diabetes and its treatments can cause many complications.
Acute complications (hypoglycemia, ketoacidosis, or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled.

Serious long-term complications include:
cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause erectile dysfunction and poor wound healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, and possibly to amputation.

To avoid the serious long-term complications:
Adequate treatment of diabetes as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and maintaining a healthy body weight), may improve the risk profile of most of the chronic complications.

In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.

The term diabetes, without qualification, usually refers to diabetes mellitus, which is associated with excessive sweet urine (known as “glycosuria”) but there are several rarer conditions also named diabetes.

The most common of these is diabetes insipidus in which the urine is not sweet (insipidus meaning “without taste” in Latin); it can be caused by either kidney or pituitary gland damage
The term “type 1 diabetes” has universally replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes (IDDM).

The term “type 2 diabetes” has replaced several former terms, including adult-onset, obesity-related, and non-insulin-dependent diabetes (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined “type 3 diabetes” as, among others, gestational diabetes, insulin-resistant type 1 diabetes, type 2 diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults. There is also maturity onset diabetes of the young (MODY) which is a group of several single gene (monogenic) disorders with strong family histories that present as type 2 diabetes before 30 years of age.

Signs and symptoms

The classical triad of diabetes symptoms is polyuria, polydipsia and polyphagia, which are, respectively:

• frequent urination
• increased thirst and consequent increased fluid intake
• increased appetite

Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes symptoms usually develop much more slowly and may be subtle or completely absent.

Type 1 may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue.

All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled.

When the glucose concentration in the blood is raised beyond its renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst.

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected.