Diabetes Mellitus Type – 1 and Diabetes Mellitus Type – 2

Diabetes Mellitus

Type 1 Diabetes MellDiabetes Mellitus Type – 1itus (DM) is a chronic disease characterized by the autoimmune destruction of the beta cells in the pancreas which leads to decreased insulin production. Most often it occurs in young age groups, but the disease can also develop in adults between 30 to 40 years of age group. Enterovirus infection may be associated with an increased risk of type 1 diabetes.

As many as 3 million Americans may have type 1 diabetes. Approximately 80 people per day are diagnosed with type 1 diabetes in the United States. Approximately 85 percent of people living with this disease are adults, and 15 percent are children. The rate of type 1 diabetes incidence among children under age 14 is estimated to increase by 3 percent annually worldwide.

Signs and Symptoms of Diabetes:

American Diabetes Association (ADA) Diagnostic criteria are:

Fasting blood glucose (FPG) level ≥126 mg/dL  or

2-hour blood glucose level ≥200 mg/dL  after 75-g oral glucose tolerance test (OGTT), or

A random blood glucose ≥200 mg/dL in a patient with classic symptoms of hyperglycemia.

Control: If you are a Diabetic, these tips will help you. The first step in managing Type 1 Diabetes Mellitus is diet control or strict control in diet, in which Calorie intake is a paramount aspect of dietary planning,  recommended intake of calorie is 20% for breakfast, 35% for lunch, 30% for dinner, and 15% for evening snacks. Protein requirement in Diabetes Mellitus is 0.9 g/kg/day (usual range, 1-1.5 g/kg/day) but this may vary in patient complicated with diabetic nephropathy, reduced sugar and fat intake with increased intake of fiber. Changing their lifestyle like exercise is an important aspect of Diabetes management which includes daily walking; this helps in the utilization of insulin by muscles. For individual diet plans, one should consult their physician and dietitian.

These patients generally require lifelong insulin therapy. Long-term management requires a multidisciplinary approach. Various types of insulin are present like rapid-acting, intermediate-acting, short-acting and long-acting insulin, let your physician may decide about which type and the dosage of insulin required for your body weight.

Continuous glucose monitors are the most essential part of therapy, with which one can adjust doses of insulin injection on the basis of self-monitoring of blood glucose levels.

Common Diabetes Symptoms:

The most common complication of insulin therapy is hypoglycemia which means decreased blood glucose level. Common diabetic symptoms of hypoglycemia are light-headache, dizziness, confusion, shivering and sweating. The patient should be aware and educated to respond to hypoglycemia with a rapid intake of sugar. These patients are advised to carry some chocolates or sugar with them.

What is Diabetes Mellitus type 2

Unlike Diabetes Mellitus Type 1 it is caused by resistance to insulin hormone which is produced by the pancreas in our body. Diabetes deal with increased blood sugar known as hyperglycemia, it is also a result of decreased secretion of insulin or excessive or inappropriate glucagon secretion. Men above 40 years of age having a family history of Type 2 DM, obese and hypertension are at great risk of developing Type 2 Diabetes Mellitus.

Signs and Symptoms:

Many of the patients are asymptomatic and those who experience symptoms are as given below:

  • Polyuria
  • Polydipsia
  • Polyphagia
  • Weight loss
  • Blurred vision
  • Lower-extremity paresthesias
  • Yeast infections (eg, balanitis in men)

American Diabetes Association (ADA) includes the following:

A fasting blood glucose level (FBS) of 126 mg/dL,

A 2-hour blood glucose level of 200 mg/dL after 75-g oral glucose tolerance test (OGTT), or

Random blood glucose of 200 mg/dL

An HbA1c of less than 6% means normal glucose tolerance. An HbA1C of 6-6.4% is neither normal glucose tolerance nor diabetes, and HbA1c more than 6.5% is taken as diabetes, whereas HbA1c more than 7% is considered to be poorly controlled hyperglycemia. Reasons to get done glycated hemoglobin (HbA1c) is to look for long term glycemic control, it does not require fasting or timed samples.

Some additional investigation such as annual screening for microalbuminuria, which is a good indicator of early kidney damage in type 2 Diabetes mellitus patient. Yearly consultation to ophthalmologist an eye specialist just to rule out any diabetic retinopathy as these patients are at higher risk of getting microvascular complications. To prevent macrovascular complications like cerebrovascular disease, peripheral vascular disease, and coronary disease, one should get their lipid profile done every 6 months.

Management: Step in managing high blood sugar starts with involving in a new diet plan with proper nutrition, and modifying their lifestyle, reducing weight with regular walking and exercise, this helps insulin transport into muscles from blood ultimately increasing muscle sensitivity for insulin.

In uncontrolled high blood sugar patients are managed with Antidiabetic drugs. A combination of drugs is used to control blood sugar with their different mechanisms of action, such as Metformin works by decreasing hepatic gluconeogenesis which means decreased production of new glucose in the liver. It also decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization, most effective and safe to use. It rarely causes hypoglycemia.

Glimepiride from the sulfonylurea group is insulin secretagogues that stimulate insulin release from pancreatic beta cells and probably have the greatest efficacy for the glycemic lowering of any of the oral drugs. Alpha-glucosidase inhibitors agents delay sugar absorption and help to prevent postprandial (postmeal) glucose surges. Patients with long term uncontrolled blood sugar with oral drugs may require insulin injections to lower down their blood sugars. Let your consultant physician decide what is best for you.

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