Diabetes mellitus is a common problem in India,its root cause is still not known. Diabetes mellitus is multifactorial clinical syndrome of glucose metabolism due to absolute or relative deficiency of insulin secreted by beta cells of pancreas or its diminished biologic effectiveness resulting in impaired carbohydrate tolerance and persistent hyperglycaemia with or without glycosuria,and characterised by polyuria,polydipsia,polyphagia and weight loss.
Cause of diabetes is divided according to clinical types as
- Primary Diabetes mellitus
- Secondary Diabetes mellitus.
Cause for primary Diabetes mellitus
It is of two types
- Type 1 Diabetes mellitus or insulin dependent Diabetes mellitus(IDDM)- onset is usually juvenile age,exact cause is not known. probably its ia auto-immune disorder resulting in destruction of pancreatic islet cells by anti-islet cell antibodies,also associated with HLA-DR3 and HLA-DR4.
- Type 2 Diabetes mellitus or non insulin dependent Diabetes mellitus(NIDDM)-exact cause is not known. predisposing causes are familial predisposition,ageing,obesity,inactivity. physical and mental stress especially in precipitaing latent form of disease.
Cause for secondary Diabetes mellitus
Endocrinal disorders-impaired glucose intolerance and increase insulin resistance. Common conditions like acromegaly,cushing’s syndrome could be the cause for Diabetes mellitus.
chronic pancreatitis-reduction in beta cell mass,80% of islet mass must be destroyed for clinical hyperglycaemia.
Haemochromatosis-pancreatic destruction due to excessive iron accumulation(bronze diabetes),due to dark skin pigmentation due to iron deposition.
Pregnancy(gestational Diabetes mellitus)-state of glucose intolerance occuring in late second trimester.
- Pathogenesis of Diabetes mellitus is still not clear,but factors possibly responsible for development of Diabetes mellitus include deficiency of insulin,presence of antagonists,excessive neoglucogenesis.
Onset of symptoms is insidious. Clinically characterised by symptoms like polyuria(increased frequency micturation),polydipsia,compensatory mechanism to prevent dehydration by excessive thirst,dryness of mouth,throat,polyphagia(excessive hunger),inspite of good appetite,there is lack of energy,weakness,tiredness,weight loss,rapid emaciation due to starvation,neoglucogenesis. Constipation-bowels occurs every 2-3 days once,with hard stools.
Pruritis-intense itching especially in anus or external genitalia,which is thought to be due to irritant action of sugar on tissues,superimposed fungal or bacterial infection. Other features include burning of feet,impotency in males,tendency to infections,delayed wound healing.
Complications of Diabetes mellitus are diabetic neuropathy,diabetic nephropathy. other complications include-diabetic foot,diabetic ketoacidosis,presenile cataract. complications of gestational diabetes- maternal risks-polyhydramnios,pre-eclamptic toxaemia. fetal risks if left untreated-abortion,foetal growth disturbance,stillbirth,increased in perinatal morbidity and mortality.
measures to correct/modify predisposing causes,adequate physical and mental rest,reduce weight if obese,abstain from smoking and alcohol,regular monitoring of blood pressure,blood sugar,serum cholesterol,serum creatinine.
diet therapy-follow strict diet to be followed in proper proportion of carbohydrates,fats and proteins according to the caloric need.
example for calories of 1300-proteins(60 grams),carbohydrates(180 grams),fats(33 grams) along with lemon tea or nimbu pani early in the morning.