Diabetes Mellitus Overview

Diabetes Mellitus & Metabolic Syndrome

• Diabetes Mellitus is a group of metabolic disorders characterized by high blood glucose levels due to problems in insulin management.
• Causes include the body's inability to produce sufficient insulin or properly use the insulin it produces, resulting in hyperglycemia.
• Symptoms include frequent urination (polyuria), dehydration, excessive thirst (polydipsia), weight loss, excessive hunger (polyphagia), blurred vision, increased infections, and fatigue.
• Diagnosis is primarily based on plasma glucose levels, with additional tests like a glucose tolerance test. Specific glucose concentration criteria, including random blood glucose, fasting plasma glucose, and post-75-gram glucose load, determine the diagnosis of diabetes.
• Prediabetes is a condition with blood glucose levels higher than normal but not yet in the diabetic range. Fasting levels are 100-125 mg/dL, and 2-hour levels are 140-199 mg/dL.
• Types of Diabetes: Type 1 diabetes is an autoimmune disease where the body's immune system destroys insulin-producing cells in the pancreas. It requires insulin injections. Type 2 diabetes, the most common form, is characterized by insulin resistance, where the body's cells don't respond effectively to insulin, often accompanied by the pancreas secreting more insulin over time.
• Acute Complications: Diabetic ketoacidosis (DKA) is a serious complication in type 1 diabetes involving excessive ketone production and acidosis, often triggered by insufficient insulin. Hyperosmolar hyperglycemic syndrome (HHS) is another acute complication mainly in type 2 diabetes associated with very high blood sugar and dehydration.
• Chronic Complications: Macrovascular complications include accelerated atherosclerosis in the coronary arteries and those supplying the limbs, leading to cardiovascular disease. Microvascular complications involve damage to small blood vessels, causing conditions like retinopathy (retinal damage), neuropathy (nerve damage), and nephropathy (kidney damage). Problems with the feet, like ulcers and gangrene, can also occur.
• Hypoglycemia: Reduced blood sugar levels due to factors like excess insulin, prolonged exercise, or skipped meals. Symptoms include hunger, sweating, shakiness, weakness, dizziness, palpitations, slurred speech, and confusion.
• Diagnosis of Diabetes (Cont'd.): Criteria for diagnosis, as noted above, include random plasma glucose ≥200 mg/dL, plasma glucose ≥126 mg/dL after an 8-hour fast, and plasma glucose >200 mg/dL 2 hours after a 75-gram glucose load.

Treatment of Diabetes Mellitus

• Treatment is lifelong, based on meal planning, timing of medications, physical activity, and maintaining blood glucose levels within a specific range. Certified Diabetes Educators provide support.

Nutrition Therapy

• Dietary Recommendations: Benefits include improved glycemic control and slowing the progression of complications, tailored to personal preferences and lifestyles. Needs adjust with growth and aging. Macronutrient intake, particularly carbohydrate intake, is carefully planned. Glycemic index (GI) and minimally processed foods often receive particular attention. Sugars are often counted in a daily allowance with moderation. Fiber and fat recommendations often follow general population guidelines, but monounsaturated fats can improve glycemic control and CVD risks.
• Meal Planning Strategies: Strategies typically include controlling carbohydrate intake, portions, and coordinating the intake with meals and medications, and adjusting dosages to carbohydrate intake (Carbohydrate counting in particular).

Insulin Therapy

• Insulin Preparations: Various types are available, differing in onset, peak action, and duration of action. Examples include rapid-acting, short-acting, intermediate-acting and long-acting insulins.
• Insulin Delivery: Typically administered by subcutaneous injection using syringes, pens, or insulin pumps.

Evaluating Diabetes Treatment

• Monitoring includes regular monitoring of blood glucose, blood pressure, lipid profile, urine proteins, and physical examinations to detect early, long-term complications like retinopathy, neuropathy, and foot problems. Ketoacidosis monitoring is also important.

Physical Activity and Diabetes Management

• Exercise and appropriate medical evaluation is important for preventing or managing diabetes. Appropriate intensity (initially mild to moderate), hydration, and consideration of illness are included.

Maintaining Glycemic Control

• Dietary adjustment of food intake and medication dosages is crucial to prevent hypoglycemia or hyperglycemia during/after activity.

Sick-Day Management

• Monitoring of blood glucose and ketones during illness, injury, or infection is strongly recommended along with adjusting food intake and medications as needed.

Diabetes in Pregnancy

• Pregnancy significantly impacts blood sugar regulation, with an increased need for insulin therapy. Women experience increased health risks and those with uncontrolled diabetes face more difficulties. Blood glucose monitoring and proper treatment are crucial.

Gestational Diabetes

• Factors for gestational diabetes include family history, obesity, certain racial groups and a history of delivering babies over nine pounds. Testing around weeks 24–28 of gestation is encouraged. Careful control of glucose and carbohydrates is important.

Metabolic Syndrome

• Metabolic syndrome is a cluster of conditions, including factors like excessive abdominal obesity, hyperglycemia, high blood pressure, and abnormal cholesterol/triglyceride levels, that raise the risk of cardiovascular disease.

Treatment for the Metabolic Syndrome

• Treatment involves diet, lifestyle, and exercise changes to correct the abnormalities.

Antidiabetic Drugs

• Medications are often used to help control blood sugar and achieve more rapid and sustainable glycemic control.

This quiz explores the key concepts related to Diabetes Mellitus and Metabolic Syndrome. It covers causes, symptoms, and diagnostic criteria pertinent to understanding diabetes and prediabetes. Test your knowledge on this crucial health topic.