Diabetes is a
multi-system disease that can affect people of all ages. A high level of plasma glucose beyond normal
ranges is characteristic of this syndrome. Diabetes is diagnosed when the blood
sugar is found to be continuously above 11mmol/L even during fasting.
It can be caused by many things
leading to the different classes used in describing it such as Type I and II, gestational
and juvenile diabetes. These descriptive classes could be different in terms of
the commonest population affected, median age at diagnoses and the symptomatology.
Type I variant is commonly
due to the body’s immune system recognizing the beta cells of the pancreas
which secrete insulin as foreign and attacks them. This leads to complete
deficiency of the insulin in the blood stream. It is the insulin that is
responsible for breaking down glucose for use by other tissues and for storage
into fats. Continuous and progressing loss of these cells happens over a long
period of time during which the patient could be symptomless. Evidence has
shown a genetic component involving human leukocyte antigens (HLA) in its
pathogenesis. Some presenting features due to the hyperglycemic state are
considered classical like polyuria, polydipsia and polyphagia. Others include
fatigue, unintentional loss of body weight, increased levels of ketones in the
body, increased risk for infections especially involving the genitourinary systems
and has a common age at diagnosis below forty years..
In Type II diabetes on
the other hand, there is insulin production but the quantities produces are not
sufficient to offset the cellular sugar imbalance. This causes glucose levels
to be higher in the blood stream but very low in the tissues that need it like
the peripheral muscles. This variant of diabetes is believed to be caused by
decreased sensitivity of peripheral tissues to insulin. The pancreas attempts
to compensate by increasing production but this is also overwhelmed. It is
commonly diagnosed in older patients but of late, it has been diagnosed in way
younger patients. This is because of the many risks that predispose to its
development among the younger population. Increasing appeals of sedentary lifestyles
and poor eating habits involving lots of junk and sweetened foods leading to
obesity has been deemed the main culprit in this case, though there is also a
genetic component involved it its pathogenesis. The presenting signs are the
same as in Type I with the exception of associated weight gain.
Gestational diabetes is
the syndrome of hyperglycemia that occurs in pregnant women. In order to support
the growth of a fetus, some of the metabolic changes that occur in a gravid woman
include increase in resistance to insulin with concomitant decrease in the
sensitivity to the same caused by the hormones secreted by the placenta. It can
occur in women who were previously diabetic or in previously normal patients. However
some degree of impaired glucose tolerance is usually evident from previous
medical history. The symptoms are the same as in Type II disease and some women
return to normal glucose levels after delivery while others continue to have
refers to the presentation of clinical and laboratory signs of diabetes in
children. It is commonly referred to as Type I since both occur in childhood and
have the same symptomatology therefore, both names could be used interchangeably.
in treatment Type II Diabetes
Metformin is an
anti-diabetic drug of the biguanide class that functions to reduce the
production of glucose from the liver and its absorption from the
gastrointestinal tract and is excreted by the tubular system of the kidneys.
It is recommend as a
first lime therapy for Type II diabetes and can be given alone or combined with
other diabetes medications such as sulfonylureas and insulin. In addition, it
has been found to be more effective in achieving glucose control when used together
with insulin. Metformin is administered as tablets of immediate or extended
release dosed at 500mg to 1000mg for adults and children. The oral solution is
usually dosed at 100mg/mL. tIt is not recommended in the geriatric patients
because of reduced kidney functions.
considerations in treatment.
Type II diabetes is
usually considered under the spectrum of lifestyle diseases and thus nutrition
therapy forms an integral component in its prevention, management and self-education.
All individuals are usually considered for individualized nutrition management
by a qualified nutritionist. The advised route is to avoid complete overhaul of
the patient’s diet and instead focus of calorie intake restriction, consumption
of lesser quantities of foods high in saturated fats and those containing lots
of sugar. Consumption of greens, fruits and vegetables is also advised that
aids in weight reduction.
usually occur mainly as a direct influence of the excess glucose on body
tissues. The development of ketoacidosis due to dehydration and loss of
electrolytes can lead to cerebral edema and cardiac problems due to potassium
depletion which are medical emergencies. Other short term effects include Hyperglycemic
hyperosmolar states and hypoglycemia. Other effects are due to the presenting
signs and symptoms like respiratory distress, excessive thirst and hunger, dyslipidemias,
hypertension, infections and obesity.
these long term effects of diabetes occur slowly over time and patients usually
present with symptoms in other systems of the body. They are usually classified
as micro-vascular and macro-vascular. Hyperglycemia affects the small
capillaries of major organs such as the kidney, heart and the eyes and causes
their hardening. This can lead to blockage of these vessels causing diabetic
retinopathy which can cause blindness, diabetic nephropathy which can lead to
renal failure. The accompanying dyslipidemias can cause cerebrovascular
accidents and myocardial infarctions which can lead to paralysis and death. Other
complication is diabetic neuropathy resulting in dysfunction involving the
peripheral nerves. Loss of sensations in peripheral limbs is usually the
commonest presentation with occasional foot ulcers.
of drug treatment
medications just like most other classes of drugs have unintended effects on
their users. Some of these include hepatotoxicity, gain of weight and risk for
fractures for thiazolinediones, gastrointestinal discomfort, rashes, and kidney
dysfunction among many more. These effects may vary from one patient to another
and each is required to seek medical help if they notice any unusual effects
The commonest side
effect of insulin is rebound hypoglycemia especially when not taken
appropriately. This calls for proper patient education on the usage of insulin.