Diabetes Mellitus

Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder. In Greek (Diabetes – running through; mellitus- sweet). It is characterised by increased blood glucose level due to insufficient, deficient or failure of insulin secretion. This is the most common pancreatic endocrine disorder. The incidence of Type- 1 and Type-2 diabetes is increasing worldwide.

1. Type-1 Insulin Dependent Diabetes Mellitus (IDDM)

IDDM accounts for 10 to 20% of the known diabetics. The condition also occurs in children ( juvenile onset diabetes) and young adults, the onset is usually sudden and can be life threatening. This is caused by the destruction of β -cells of the pancreas. It is characterized by abnormally elevated blood glucose levels (hyperglycemia ) resulting from inadequate insulin secretion.

Causes : Genetic inheritance and environmental factors (infections due to virus, acute stress) are the cause for this condition.

2. Type-2 Non-Insulin Dependent Diabetes Mellitus (NIDDM)

This is also called as adult onset diabetes and accounting for 80 to 90% of the diabetic population. It develops slowly, usually milder and more stable. Insulin production by the pancreas is normal but its action is impaired. The target cells do not respond to insulin. It does not allow the movement of glucose into cells.

Causes: The causes are multifactorial which include increasing age (affecting middle aged and older people), obesity, sedentary life style, overeating and physically inactive.

Symptoms: Diabetes mellitus is associated with several metabolic alterations.The most important symptoms are

·                 Increased blood glucose level (Hyperglycemia)

·                 Increased urine output (Polyuria) leading to dehydration

·                 Loss of water leads to thirst (Polydipsia) resulting in increased fluid intake

·                 Excessive glucose excreted in urine (Glycosuria)

·                 Excess hunger (Polyphagia) due to loss of glucose in urine.

·                 Fatigue and loss of weight

3. Prevention and Control of Diabetes

Diet, hypoglycemic drugs, insulin injection and exercise are the management options based on the type and severity of the condition. The overall goal of diabetes management is to maintain normal blood glucose level.

Dietary management: Low carbohydrate and fibre rich diets are more appropriate. Carbohydrates should be taken in the form of starch and complex sugars. Refined sugars (sucrose and glucose) should be avoided. Diet comprising whole grains, millets (jowar, bajra, ragi), green leafy vegetables, wheat and unpolished rice should be included in diet regularly.

Carbohydrates is maintained to about 50-55% of the total calories. High protein content of 10-15% of the total intake is required to supply essential amino acids. Fat content in the diet should be 15-25% of the total calories. Saturated fat intake should be reduced. Polyunsaturated fatty acid content should be higher.

Management with insulin: Commercially available insulin preparations (short and long acting) are also used to maintain blood glucose levels.

Physical activity: Exercise plays an important role in facilitating a good control of diabetes, in addition to strengthening and toning up the muscles.

Education and Awareness: People with diabetics should be educated on the nature of disease they have and the possibility of complications of the disease, if blood sugar is not kept under control. Instructions regarding diet, exercise and drugs should be explained.