السكري باللغة الإنجليزية

Introduction

• Diabetes, from the Greek word meaning "a siphon," refers to excessive urine formation associated with the disease.
• Mellitus, meaning "honey" or sweet (sugar), refers to the sweet smell and taste of the urine in individuals with this condition.

Characteristics

• Diabetes Mellitus is a group of metabolic disorders associated with glucose regulation and utilization.
• A key characteristic is hyperglycemia, which means elevated blood glucose concentrations.
• Disordered insulin metabolism is also a defining feature of diabetes.

Blood Glucose Regulation

• Normal blood glucose levels range between 70-100 mg/dL.
• The pancreas, an organ in the body, regulates blood glucose by releasing hormones, insulin and glucagon, into the bloodstream.
• Insulin, produced by beta cells of the pancreas, helps regulate glucose levels, promoting its uptake by cells to be used for energy.
• Glucagon, produced by alpha cells of the pancreas, works in opposition to insulin, raising blood glucose levels when needed.

Insulin Role

• Insulin's function is to unlock the body's cells, enabling the glucose carried in the bloodstream to be used for energy.

Overview

• Impaired insulin secretion, insulin resistance, or both, contribute to diabetes.
• These factors lead to excessive glucose production by the liver and abnormal responses to insulin by muscle, fat, and liver cells.
• Long-term hyperglycemia results in damage to the eyes, kidneys, nerves, heart, and blood vessels.

Overview (Type 1 & Type 2 Diabetes)

• Type 1 diabetes is less common and results from the body's inability to produce insulin.
• Type 2 diabetes is more prevalent and develops gradually. It is linked to obesity and insulin resistance.
• Insulin resistance is a condition where cells fail to respond properly to insulin.
• Impaired glucose tolerance is a condition where the blood's sugar levels are higher than normal, but not high enough to be classified as diabetes.

Overview (Pre-diabetes)

• Pre-diabetes is an intermediate state where blood sugar levels are higher than normal but not yet high enough for a diabetes diagnosis.

Impaired Fasting Glucose / Impaired Glucose Tolerance

• Impaired fasting glucose (IFG) is a condition where blood glucose is higher than normal after fasting for a while but not high enough for diabetes diagnosis.
• Impaired glucose tolerance (IGT) is defined by elevated blood glucose levels after consuming glucose, not measuring when fasting.

Diabetic Complications:

• Ketoacidosis is a serious complication of type 1 diabetes, characterized by the accumulation of ketones in the blood, which further elevates blood sugar levels and causes acidosis.
• Hypoglycemia, or low blood sugar levels, is common among individuals with diabetes and can be serious if left untreated.

Symptoms of Hyperglycemia

• Frequent urination, dehydration (dry mouth), increased thirst (polydipsia), blurred vision, weight loss, and increased hunger (polyphagia), fatigue.
• Other symptoms include dry skin, drowsiness, nausea, and extreme thirst

Prevalence

• The number of adults with diabetes is increasing in various regions, especially in the MENA region, and a significant percentage remain undiagnosed.
• Gestational diabetes, which develops during pregnancy, affects a notable percentage of pregnant women and potentially presents risks during pregnancy. Deaths related to diabetes are significant.
• Healthcare costs for people with diabetes are substantial, highlighting the burden of this disease.

Diagnosis

• Criteria for diagnosing Diabetes Mellitus include testing elevated blood glucose, fasting plasma glucose, or a two-hour post-prandial glucose tolerance test.

C-peptide Test

• Measures the amount of C-peptide, a substance released with insulin, in the blood. This can be a valuable diagnostic tool.

Type 1 Diabetes

• Usually diagnosed in childhood or adolescence.
• Characterized by classic symptoms such as frequent urination, weight loss, increased thirst, and potential ketoacidosis.

Type 2 Diabetes

• Often associated with insulin resistance.
• Patients may initially compensate by increasing insulin production, but ultimately both insulin resistance and secretion problems develop.

Gestational Diabetes

• Develops during pregnancy.
• 7% of pregnant women are affected.
• Increased risk factors include family history, obesity, and birth of infants weighing more than nine pounds.

Other Causes of Diabetes

• Genetic defects, like cystic fibrosis, can cause diabetes.
• Pancreatitis, hormonal imbalances, and drug/chemical toxicity may lead to diabetes.

Chronic Complications

• Retinopathy, nephropathy, neuropathy, and cardiovascular diseases (CVD) pose serious long-term risks.
• These complications are aggravated by advanced glycated end-products (AGEs), which accumulate in large blood vessels and small vessels of the eyes, kidneys, and nerves, as well as increase cardiovascular risks

Effects of AGEs

• Complications from advanced glycated end-products (AGEs) primarily affect large blood vessels (macrovascular complications) and small blood vessels (microvascular complications), including those in the kidneys, eyes, and nerves.

Macrovascular Complications

• Diabetes can accelerate the development of atherosclerosis(hardening of the arteries), affecting coronary arteries and arteries in the limbs.
• This can lead to compromised blood flow, claudication (pain during exercise due to reduced blood flow), and eventually foot ulcers that can progress to gangrene requiring amputation.

Microvascular Complications

• Diabetic retinopathy involves damage to small vessels in the retina, leading to impaired vision and potential blindness.
• Diabetic nephropathy causes damage to the small vessels to the glomeruli in the kidneys, typically appearing in later stages of DM.

Diabetic Neuropathy

• Nerve degeneration is a common complication in diabetes, affecting approximately 50% of cases.
• The extent of nerve damage is tied to the severity and duration of hyperglycemia.

Treatment

• Type 1 diabetes requires insulin therapy.
• Type 2 diabetes often involves diet therapy, exercise, and potentially oral medications or insulin.
• Gestational diabetes needs monitoring and a diet and exercise plan.

Goal

• Effective diabetes management aims to control blood glucose levels, prevent or reduce complications, manage blood pressure and lipid levels, and control body weight.

Evaluating Treatment

• Regular self-monitoring of blood glucose levels (SMBG), usually three or more times a day for type 1 diabetes.
• Glycated hemoglobin (HbA1c) measures average blood glucose levels over the past 2-3 months and provides a long-term assessment.
• Routine blood pressure checks, and lipid screening annually are also important parts of monitoring and treatment efficacy.

Meal Planning Strategies

• Carbohydrate counting helps manage glucose levels accurately by matching the amount of insulin administered to the carbohydrates ingested.
• Exchange lists provide a way to estimate the amount of carbohydrates consumed.

Insulin Types

• Insulin types are classified based on their onset, peak, and duration of action.
• Types include rapid-acting, short-acting, intermediate-acting, and long-acting insulins, which have distinct schedules of action to help better regulate blood glucose levels.

Insulin Delivery

• Insulin therapy includes injections via syringes or insulin pens. Insulin pumps provide continuous insulin delivery.

Insulin Therapy and Hypoglycemia

• Hypoglycemia is a common side-effect during insulin therapy.
• It requires quick intake of about 15-20 grams of carbohydrates to raise blood sugar quickly and relieve symptoms.

Options of 15g CHO

• Various options to quickly raise blood glucose levels when hypoglycemia occurs, including glucose tablets, sugar, jelly, and fruit juice.

Oral Antidiabetic Management

• Oral medications may improve insulin secretion, reduce liver glucose production, improve glucose use by tissues, and delay carbohydrate absorption in attempt to better regulate blood glucose levels.

Other Types of Drugs

• Modiifer of insulin action including Amylin Analog, incretins, and DPP-4 inhibitor types of drugs are used in more complex cases in conjunction with insulin and other types of therapies

Physical Activity

• Regular moderate-intensity physical activity enhances insulin sensitivity, improves lipid levels, lowers blood pressure, and aids in weight management.
• People with diabetes should be advised to engage in at least 150 minutes of moderate-intensity aerobic activity spread over each week, as well as include muscle training twice a week.

Physical Activity (Intensity, Example)

• Moderate intensity exercise has a noticeable breathing pattern, a slight sweating, and patients can hold conversations but not sing songs.
• Examples include brisk walking, bicycling slower, stair climbing or water aerobics.

Physical Activity (Low Intensity, Examples)

• Low-intensity activities include light walking and yoga. They can improve overall functioning and management of diabetes.

Physical Activity & Insulin Dose

• Physical activity can require adjustments to insulin doses to avoid drastic shifts in blood glucose levels. Appropriate strategies to prevent and manage hypoglycemia or hyperglycemia during and after exercises are important.

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