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3 p symptom
(Diabetes means any disorder which cause polyuria, mellitus means honey)
- DM first time described by Thomas willis who discovered sweetness of urine from dibetic in 1675.
- Dm is chronic disoder of immpaired carbohidread metabolism due to defficiency of insulin and inability to use insulin (insulin help to aid entry of glucose into cell) which characterized by increase blood glucose level.
- It is caused by imbalance between insulin supply and insulin demand or ineffectiveness of insulin.
- It is a most common endocrine disorder.
Classification of Diabetes mellitus(DM)
Based on the cause there are two types of DM, they are-
(A) Primary DM (98%) –
It is unrelated to another disease, it again divided into two types
- Insulin-dependent diabetes mellitus (IDDM) or Type I- diabetes mellitus
Types I occur due to deficient secretion of insulin.
- Destruction of pancreas by infections such as of coxsackievirus & streptococcus bacteria.
- Auto-antibodies may destroy beta cells of pancreas.
- Hereditary also believed to play role.
- IDDM develop in people below 20 years of age
- When it develop at infancy & childhood it is called juvenile DM
- It is not associated with obesity but may be associated with acidosis & ketosis.
- non-Insulin Dependent Diabetes M (NIDM) or Type II- diabetes melius
In NIDDM the number of insulin receptor on cell decrease or/and insulin receptor give no response to insulin,so insulin become ineffective or unable to work.
- Obesity (major risk factor, 80-90 % patient are overweight at the time of diagnosis).
- Old age (after 40 years of age).
- Stress and heredity.
- It is more common in type (90% of all diabetes patients are II type)
- DKA not occur in type second bcz presence of insulin prevent break down of fat
(B) Secondary diabetes mellitus (2%)
DM that results from other disorders like damage of pancreas after frequent episodes of pancreatitis or from drugs such as corticosteroids (it increase resistance to the effects of insulin).
C/M of Diabetes mellitus(DM)
- Cardinal signs are Polyuria, Polyphagia. Polydipsia (more common into type ).3P
- Weight loss (more comm in type I & rare into type II).
- Asthenia (loss of strength) and weakness
- Blurred vision either due to cataract formation (excess glucose attaches to lens protein) or due to damage of blood vessels of retina.
- Slow wound healing.
- Paresthesia & signs of inadequate circulation in feet (due to atherosclerosis) which cause wet gangrene
- (necrosis or death of tissue, usually resulting from deficient or absent blood supply).
- Glucosuria (glycosuria), if blood glucose level above 180 mg/dl.
- Erectile dysfunction
Glucose Tolerance Test (GTT)
- Keep the patient overnight fasting (10-12hours).
- Avoid alcohol, coffee, smoking & strenuous exercise 8 hour before test.
- Draw fasting blood sample then give 100gm glucose to drink.
- Blood and urine sample are taken at 30 minute interval for minimum 2 hours.
- Results are plotted on a graph and see the time to return normal blood glucose level.
- In non diabetes patient blood sugar returns to normal in 2 hours with peak of 120- 160 mg/dl.
- More than 200 mg/dl of blood glucose after 2 hour of ingestion confirm the diagnosis of DM.
Glycosylated Hb (HbAIc)
- Amount of blood glucose bound to hemoglobin.
- HbAIC indicate how well blood glucose level controlled for prior three month (90 days)
- Normal range of HbAIC-4 to 6 %.
- The goal for DM client is HbAic should be 7% or lower.
Management of Diabetes mellitus(DM)
Advised to take low sugar and fat diet in small amount and frequently.
The disturbation of calories are-
- Carbohydrate (mainly complex carbohydrate not simple sugar)-50-60%.
- Monosaccharide and disaccharide known as simple sugar.
- Complex carbohydrate(a starch) is a molecule made of several linked saccharides e.g polysaccharide
- Diet should be containing soluble and insoluble fibers.
- Soluble fibers decrease cholesterol & blood glucose level and insoluble fibers inhibit constipation.
- Exercise lowers blood glucose level and improves cardiovascular fitness & muscles tone.
- Exercise decrease weighı, dercase insuli resistancs, glucose intoleranoce, cholesterol & triglyeeride level.
- Monitor blood glucose level before, during and after exercise.
Oral hypoglycemic agent
- Administer oral hypoglycemic agents in patient with NIDDM to lower blood glucose level.
- These agent increase the number of insulin receptor on cell to enhance insulin action, examples are
- metformin, glimepiride, glipizide, pioglitazone, chlorpropamide etc.
- Insulin is mainly used to treat type I DM
- Insulin may be used in type II DM if diet, exercise and oral hypoglycemic agent fail to control blood glucose level
- Type of insulin based of duration of action
- Type of insulin Duration of action
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