Diabetes mellitus

 

Diabetes mellitus is a disorder in which blood sugar levels (glucose) are abnormally high because the body does not produce enough insulin to meet its needs؛

Urination and thirst increase and people may lose weight even if they don't try to do so.

* Diabetes damages the nerves, causing sensation problems.

* Diabetes mellitus also causes damage to blood vessels, increases the risk of heart attack, stroke, chronic kidney disease, and vision deficiency.

* Doctors diagnose diabetes by measuring blood sugar levels.

* People with diabetes need a healthy diet that is poor in refined carbohydrates (including sugar), saturated fats and prepared foods.They also need to exercise with medications that usually lower blood sugar levels.

Diabetes mellitus is a disorder in which the amount of sugar in the blood rises.Doctors often use the full name of diabetes, rather than the term diabetes alone, to distinguish this disorder from uremia (non-diabetic uremia); uremia is a relatively rare disorder, which does not affect blood glucose levels, but also causes increased urination like diabetes mellitus.

(See also Diabetes Mellitus in children and adolescents).

 

Blood sugar.

 

The three main nutrients that make up most of the food are carbohydrates, proteins and fats. Sugars are one of three types of carbohydrates, along with starch and fiber.

 

There are many types of sugar. Some sugars are simple and some are complex. Table sugar (sucrose) consists of two simple sugars, namely glucose and fructose. Milk sugar (lactose) is made up of glucose and a simple sugar called galactose. Carbohydrates found in starches, such as bread, pasta, rice and similar foods, are composed of long chains of various simple sugar molecules. Sucrose, lactose, carbohydrates and other complex sugars should be broken down into simple sugars, by enzymes in the digestive tract, before the body can absorb them.

 

Once the body absorbs simple sugars, it usually turns them into glucose, an important source of fuel in the body.Glucose is a sugar that is transported through the bloodstream and consumed by cells.The body can also synthesize glucose from fats and proteins."Sugar" of blood actually means blood glucose.

 

You know...

 

* Blood "sugar" actually means blood glucose.

Insulin

Insulin is a hormone released by the pancreas (an organ located behind the stomach, which also produces digestive enzymes), and works to control the amount of glucose in the blood.

 The presence of glucose in the bloodstream activates the production of insulin by the pancreas. Insulin helps glucose move from the blood to the cells; it is converted into energy once it enters the cells; it is either used directly or stored as fat or glycogen until it is used.

Blood glucose levels vary naturally throughout the day; they rise after a meal, and return to pre-meal levels within about two hours of eating; then insulin production decreases once blood glucose levels return to their pre-meal levels. The variation in blood glucose levels is usually within a narrow range, ranging from about 70 to 110 milligrams per deciliter (mg/ 100 ml) or 3.9 to 6.1 mmol per liter of blood in healthy people.If people eat too much carbs, the levels may increase further. These levels tend to be slightly higher at People over 65 years of age, especially after eating.

If the body does not produce enough insulin to move glucose into the cells, or the cells stop responding normally to insulin (the condition is called insulin resistance), high blood glucose levels and insufficient intracellular glucose lead to diabetes symptoms and complications.

Types of diabetes mellitus

Prediabetesr IR

Prediabetes is a condition in which blood glucose levels are too high to be considered normal, but not high enough to be classified as diabetes.People have prediabetes if the fasting blood glucose level is between 100 mg/dL (5.6 mmol/L) and 125 mg/dL (6.9 mmol/L), or if the blood glucose level two hours after a glucose tolerance testuuuu ranges between 140 mg/dL (7.8 mmol/l) and 199 mg/dL (11 mmol/l).The risk of diabetes and heart disease is higher in people with prediabetes Diabetes.Reducing body weight by 5 to 10%, through diet and exercise, can significantly reduce the risk of developing diabetes in the future.

 

The first type of diabetes mellitus.

 

When Type I diabetes (formerly called "insulin-dependent diabetes" or juvenile diabetes) occurs, the body's immune system attacks insulin-producing cells in the pancreas, permanently destroying more than 90% of them. Therefore, the pancreas produces little or no insulin. The percentage of patients with Type I diabetes does not exceed about 5 to 10% of the total diabetes patients. 

In most people with Type I diabetes, this condition occurs before they reach the age of Thirty, although it may occur later.

Scientists believe an environmental factor - possibly a viral infection or a nutritional factor during childhood or early post-puberty-causes the immune system to disrupt insulin-producing pancreatic cells. Genetic predisposition makes some people more susceptible to the influence of environmental factor.

 

The second type of diabetes mellitus.

 

In the second type of diabetes (formerly called non-insulin-dependent diabetes or adult diabetes), the pancreas often continues to produce insulin, sometimes even to levels above normal, especially in the early stage of the disease; however, resistance to the effects of insulin occurs in the body, so there is not enough insulin to meet the body's needs.As Type II diabetes progresses, the pancreas's ability to produce insulin decreases.

 

The incidence of Type II diabetes has been rare in children and adolescents but has become more common in recent times. But it usually begins in people over the age of 30 and becomes more common with age. About 26% of people over the age of 65 have Type II diabetes. 

People from certain racial and ethnic backgrounds face an increased risk of developing Type II diabetes: Blacks, Asian Americans, American Indians and people of Hispanic or Latino descent living in the United States have two or three times greater risk than whites. Type II diabetes also tends to be transmitted in families.

Obesity is the main risk factor for Type II diabetes, with 80-90% of people with the disorder being overweight or obese.As obesity causes insulin resistance, corpulent individuals require exceptionally huge sums of affront to preserve ordinary blood glucose Certain disorders and medications can affect the way the body uses insulin and can lead to type II diabetes.

Examples of common conditions that lead to insulin imbalance:

* High levels of corticosteroids (often caused by the use of corticosteroid drugs or by Cushing's disease).

* Pregnancy (gestational diabetesll).

 

Diabetes may also occur in people with excessive growth hormone production (acromegaly), and in people with certain hormone-producing tumors.Severe or recurrent pancreatitis, and other disorders that directly damage the pancreas, can lead to diabetes.

Symptoms.

 

The two types of diabetes can have very similar symptoms if the blood glucose level rises significantly.

Symptoms of high blood glucose levels include:

* Extreme thirst

* Increased urination

* Increased hunger.

Glucose leaks into the urine when the blood sugar level rises above 160 - 180 mg/dL (8.9 to 10 mmol / L) . But, when the glucose level in the urine rises further, the kidneys release additional water to extend or dilute a large amount of glucose. 

As a result of excessive production of urine by the kidneys, people with diabetes urinate in large quantities and frequently (polyuria). Excessive urination leads to a feeling of unusual thirst (polydipsia). Weight loss may occur as a result of excessive loss of calories in the urine.To compensate, people often feel very hungry.

Other symptoms of diabetes mellitus include:

* Blurred vision

* Drowsiness

* Nausea

* Reduced endurance during exercise

Type I diabetes mellitus.

 

Symptoms often begin suddenly and noticeably in people with Type I diabetes. A serious condition called diabetic ketoacidosis, a complication in which the body produces an excessive amount of acid, can quickly occur.In addition to the typical symptoms of diabetes, involving excessive thirst and urination, the initial symptoms of diabetic ketoacidosis include nausea, vomiting, fatigue, and abdominal pain, especially in children.

 

Breathing tends to become deep and fast as the body tries to correct the acidity of the blood (see acidosis), and when breathing emits a fruity aroma that It smells like nail polish remover. Neglecting treatment of diabetic ketoacidosis can lead to coma and death, sometimes very quickly.

 

Some people after Type I diabetes go through a long but temporary phase of near-normal glucose levels (honeymoon phase) due to partial restoration of insulin secretion.

 

Type II diabetes mellitus.

 

People with Type II diabetes may have no symptoms for years or decades before being diagnosed. 

Symptoms can also be subtle; increased urination and thirst are mild at first, and gradually worsen over weeks or months. People end up feeling very tired, with a high chance of vision clouding and possible dehydration.

 

* Neurology (diabetic neuropathy), which leads to a lack of sensation in the feet

High blood glucose levels also cause disturbances in the body's immune system, so people with diabetes are particularly susceptible to bacterial and fungal infections.

Diagnosis.

* Measurement of blood glucose level.

 

The diagnosis of diabetes is made when people have abnormally high blood glucose levels. Doctors perform screening tests on people at risk of diabetes without showing any symptoms.

You know...

Many people have Type II diabetes without knowing it.

 

Blood glucose measurement.

 

Doctors check blood glucose levels in people with symptoms of diabetes, such as increased thirst, urination, or hunger.In addition, doctors can check blood glucose levels in people with disorders that can be complications of diabetes, such as recurrent infections, foot ulcers and yeast infections.

To measure blood glucose levels, a blood sample is usually taken after people have fasted overnight; however, blood samples can be taken after patients have eaten. A slight rise in blood glucose levels is normal after eating, but levels should not be too high even after a meal. Blood glucose levels on an empty stomach should not exceed 125 mg/dL (6.9 mmol / L). Blood glucose levels even after eating should not exceed 199 mg/dL (11 mmol / L).

 

Glycated hemoglobin1 1C.

 

Doctors can measure the level of protein and glycated hemoglobin1 1. (called glycosylated or glycol-bound hemoglobin), in the blood as well. Hemoglobin is a red substance that carries oxygen in red blood cells. The presence of elevated levels of glucose in the blood for a period of time causes glucose to bind to hemoglobin and the formation of glycosylated hemoglobin. Hemoglobin a 1 (recorded as a percentage of hemoglobin.1) reflects long-term trends in blood glucose levels rather than rapid changes.

Hemoglobin 1 measurements can be used to diagnose diabetes when tested by a certified laboratory (not by instruments used at home or in a doctor's office).People who have a hemoglobin level of a 1 6.5% or more have diabetes.If the level is between 5.7-6.4%, they have prediabetes.

 

Oral glucose tolerance test.

 

Another blood test, an oral glucose tolerance test, can be done in certain situations, such as screening for gestational diabetes in pregnant women or testing for older people with diabetes symptoms with glucose levels remaining within normal limits when fasting; however, it cannot be used routinely to check for diabetes because the test can be very troublesome.

To perform this test, a blood sample is drawn after fasting to determine the level of glucose in the fasting blood, then the person drinks a special solution containing a standard large amount of glucose; more blood samples are then drawn over the next two to three hours and tested for abnormally high blood glucose levels.

Diabetes screening.

Blood glucose levels are often checked during a routine clinical examination. Annual blood glucose checks are especially important in older people because diabetes is very common with age; you can have diabetes, especially Type II, without feeling it.

 

Routine tests for Type 1 diabetes are not available even in people at high risk (such as siblings or children of people with Type 1 diabetes); however, screening tests are important for people at high risk for Type 2 diabetes, including:

 

* Persons over the age of 45

* People with prediabetes

* Suffering from excess weight or obesity

* Those who lead an inactive or inactive lifestyle

* Have high blood pressure or a lipid disorder, such as high cholesterol

* People with cardiovascular disease

* Family history of diabetes

* The occurrence of diabetes during pregnancy or the weight of the newborn exceeds 4 kg at birth

* Polycystic ovary disease cr cr

* The person must be African American, Asian, Indian, or Hispanic.

 

People with these risk factors for diabetes should be screened at least once every three years. The risk of diabetes can be estimated by using online risk calculators.Doctors can also measure fasting blood glucose levels and diabetes hemoglobin1 1.or take an oral glucose tolerance test.If the test results are on the boundary between normal and abnormal level, doctors should repeat screening tests, at least once a year.

Processing

* The diet

* Exercise

* Lack of weight

* Education

* Use of insulin injections in people with Type I diabetes

* Use of oral medications, and sometimes insulin injections in patients with Type II diabetes.

Diet, exercise, and learning are the cornerstones of diabetes management and are often the first recommendations for people with mild diabetes. It is necessary to lose weight to people who are overweight. People who continue to have high blood glucose levels despite lifestyle changes, or have very high blood glucose levels and people with Type I diabetes (regardless of blood glucose levels) also need medication.

As a result of the low chance of complications in people with diabetes whose blood glucose levels are well controlled, the goal of diabetes management is to keep blood glucose levels as close to normal as possible.

 

Managing high blood pressure and high cholesterol levels, which may contribute to circulatory problems, can also help prevent diabetes complications. People with heart disease risk factors are advised to use a low dose of aspirin daily. Statins (drugs to lower cholesterol levels) are used in people with diabetes between the ages of 40 and 75, regardless of cholesterol levels. People under the age of 40 or older than 75 with an increased risk of heart disease should also take statin medication.

 

It is useful for people with diabetes to carry or wear a medical identification card (such as a bracelet or card) to alert health care practitioners to the presence of diabetes; this information allows health care practitioners to start life-saving treatment quickly, especially in the case of injuries or a changed state of mind.

Diabetic ketoacidosis and hyperosmolar hyperglycemia are emergency medical conditions, as they can cause coma and death. Treatment is similar for both cases, focusing on intravenous fluids and insulin.

 

Objectives of diabetes treatment.

 

Experts recommend people to maintain blood sugar levels.

* The ratio should be between 80-130 mg/dL (4.4-7.2 mmol/L) after fasting (before meals).

* Be less than 180 mg / dL (10 mmol/L) two hours after meals

Hemoglobin levels should also be -1-less than 7%.

 

Since intensive treatment to reach these goals increases the risk of a drop in blood glucose (hypoglycemia), these goals are adjusted for some people for whom hypoglycemia is particularly undesirable, such as in the elderly.

Other goals include maintaining systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg.For diabetics with heart disease or at risk of heart disease, the blood pressure goal is below 130/80 mmHg.

General treatment of diabetes mellitus.

 

People with diabetes benefit greatly from knowing information about this disorder, understanding how diet and exercise affect blood glucose levels, and knowing how to avoid complications.A nurse trained in diabetes education can provide information about diet, exercise, blood glucose monitoring and medication use.

 

Diabetics should also stop smoking, consuming only moderate amounts of alcohol (one glass per day for women and a maximum of two glasses for men).

 

Diet for diabetics.

 

Diet control is very important in people with both types of diabetes; where doctors recommend a healthy balanced diet, and care to maintain a healthy weight.People with diabetes can benefit from meeting a dietitian or diabetes health education professional, to develop an optimal nutritional plan.This plan includes avoiding simple sugars and prepared foods, increasing the intake of high-fiber foods, and limiting the intake of carbohydrate-rich foods and fatty foods (especially saturated fats).People who use insulin should also Avoid lengthening the intervals between meals to prevent hypoglycemia.Although protein and fat in the diet contribute to the number of calories a person gets, the number of carbohydrates has a direct impact on blood glucose levels.The American Diabetes Association has a lot of useful diet tips, including healthy dishes.People who follow an appropriate diet also need to use cholesterol-lowering drugs to reduce their risk of heart disease . , Or to both.

 

Weight loss in people with diabetes.

 

Many people, especially those with Type II diabetes, are overweight or obese.Therefore, some people with Type II diabetes may be able to avoid or delay medication use by reaching and maintaining a healthy weight.It is also necessary to lose weight in those people, because being overweight contributes to the development of complications of diabetes mellitus.When people with diabetes have difficulty losing weight by simply dieting and exercising, doctors may recommend weight-loss medications or surgery to treat obesity (surgery Lose weight).

Prevention of complications of diabetes mellitus

Proper foot care and regular eye exams can help prevent or delay the onset of diabetes complications.Patients with diabetes are vaccinated against Streptococcus pneumoniae, and doctors recommend the use of the annual flu vaccine, because diabetics are at risk of infection.

You know...

 

General treatment for Type II diabetes often requires lifestyle changes, including weight loss, diet, and exercise. Regular monitoring of blood glucose levels is necessary to avoid complications of diabetes.

 

Pharmacological treatment of diabetes mellitus.

 

There are many drugs that are used to treat diabetes. People with Type I diabetes need insulin injections to lower blood glucose levels; most Type II diabetes patients need oral medications to lower blood glucose levels, but some also need insulin or other injectable medications.

Monitoring diabetes treatment.

Monitoring blood glucose levels is an essential part of diabetes care.They provide the necessary information to make the necessary adjustments in medication, diet, and exercise. Waiting until symptoms of low or high blood glucose levels appear is extremely risky.

 

Many things cause blood glucose levels to change, such as:

 

* The diet

* Aerobic exercise

* Psychological distress

* Disease

* Medicines

* Time of day.

Blood glucose levels may jump after people eat foods they weren't aware were high in carbohydrates. Psychological distress, infections, and the use of too many medications also tend to increase blood glucose levels. Many people's blood glucose levels increase in the early morning hours as a result of the natural release of hormones (growth hormone and cortisol), and this reaction is called Dawn. Blood glucose can rise dramatically if the body releases certain hormones in response to low blood glucose levels (sooji effect.).Exercise may result in Sports leading to a decrease in blood glucose levels.

Monitoring blood glucose levels.

Blood glucose levels can be easily measured at home or anywhere.

A finger prick glucose test is often used to monitor blood glucose levels.Most blood glucose monitors (glucose meters) use a drop of blood obtained by pricking the tip of the finger with a small prick. The prick carries a fine needle that can be inserted into the finger or placed in a device that has a spring to puncture the skin easily and quickly. Most people find the discomfort caused by the tingling to be slight; a drop of blood is then applied to a reagent strip. The tape contains chemicals that undergo changes depending on the level of glucose. 

The glucose meter reads the changes in the test strip, and records the result on a screen Digital. Some devices allow the blood sample to be obtained from other positions, such as the palm, forearm, upper arm, thigh, or calf (duck leg).Home glucometers are smaller than a stack of Cards.

Continuous glucose monitoring systems use a small glucose sensor placed under the skin.The sensor measures blood glucose levels every few minutes.There are two types of continuous glucose monitoring systems, depending on the purpose of their use:

* Specialist

* Personality

Specialized continuous glucose monitoring systems continuously collect blood glucose information over a period of time (ranging from 72 hours to 14 days). Health care providers use this information to develop treatment recommendations. Specialized continuous glucose monitoring systems do not provide data to the diabetic؛.

Personal continuous glucose monitoring systems are used by the person, providing instant blood glucose data on a small portable screen or on connected smartphones.The continuous glucose measurement system can be set to sound a warning sound when the glucose level drops or rises dramatically, helping patients to quickly alert for dangerous changes in blood glucose.

Previously, continuous glucose monitoring required repeated calibration with finger prick glucose tests. Their results were not accurate enough, as patients always had to take a finger-prick glucose test to check their continuous glucose monitoring system Reading before calculating their insulin dose (e.g., before meals or to correct high blood sugar); however, recent technological advances have improved continuous glucose monitoring systems and heralded a continuation of this for the foreseeable future.It can be installed for up to 14 days now and does not need to be calibrated often, and can be used to give Insulin doses without knowing the amount of glucose through a finger prick. 

Finally, systems are now available in which continuous glucose monitoring systems connect to insulin pumps, either to stop insulin production when blood glucose is low (linked to the threshold level) or for daily insulin use (closed-circuit hybrid system).

Continuous glucose monitoring systems are particularly useful in certain situations, such as in people with Type I diabetes who experience frequent and rapid changes in blood glucose (especially when glucose levels are sometimes very low), which are difficult to identify with finger-prick tests.

Most people with diabetes should keep a record of their blood glucose levels, and share it with their doctor or nurse, to get the recommendation associated with adjusting the dose of insulin or oral hypoglycemic medication. Many people can learn to adjust their insulin dose on their own when necessary. Some people with mild or early type II diabetes, well-controlled with one or two medications, may be able to monitor glucose levels by pricking fingers relatively far apart.

Although a urine test can be done to check for glucose, a urine test is not a good way to monitor or control treatment.A urine test can be misleading, because the amount of glucose in the urine may not reflect its current level in the blood. Blood glucose levels can be very low or logically high without any change in urine glucose levels.

Glycated hemoglobin1 1C.

Doctors can monitor the treatment by using a blood test called glycated hemoglobin1 1 where high blood glucose levels cause changes in hemoglobin, the protein that carries oxygen in the blood. These changes are directly proportional to long-term blood glucose levels; the higher the glycated hemoglobin a 1 the higher a person's glucose levels are. Thus, unlike blood glucose measurement, which detects the level at a given moment, the measurement of glycated hemoglobin1 1 shows whether blood glucose levels have been adjusted within a few months Past.

Diabetics are intended to have a hemoglobin level -of 1-less than 7%.It is difficult to achieve this level, but a low level of hemoglobin -1-leads to a reduced chance of complications. Doctors may recommend a slightly higher or lower level for some people, depending on their health condition. However, levels above 9% show weak adjustment, and levels above 12% show very weak adjustment. Most doctors who specialize in Diabetes Care recommend measuring hemoglobin a 1 every 3-6 months.

Fructose Min.

Fructose is a glucose-binding amino acid that is also useful for determining blood glucose control within a few weeks and is usually used when hemoglobin 1 results are not reliable, such as in people with defective forms of hemoglobin.

Pancreas transplant.

People with Type I diabetes sometimes undergo a complete pancreas transplant, or a transplant limited to insulin-producing cells from a donor's pancreas. This procedure may allow people with Type I diabetes to maintain normal glucose levels; however, as immunosuppressive drugs are needed to prevent the body from rejecting the transplanted cells, pancreatic transplantation is usually limited to people with serious complications from diabetes or who have undergone another organ transplant (such as a kidney), and they will need to use immunosuppressive drugs on anyway.

People who have difficulty maintaining blood glucose levels.

The term fragile diabetes YL y has been used to refer to people who have sudden fluctuations in blood glucose levels, often for no apparent reason. However, this term is no longer in use. People with Type I diabetes may experience more frequent fluctuations in blood glucose levels because insulin production is completely stopped. Infections, delayed movement of food through the stomach and other hormonal disorders can also contribute to blood glucose fluctuations.In people who have difficulty adjusting their blood glucose levels, doctors investigate other disorders that may be They also provide additional information about the way diabetes is monitored and the use of its medications.

Elderly people with diabetes.

Older people need to follow the same general principles of diabetes management as younger people - education, diet, exercise and medication.However, the risk of hypoglycemia (low blood glucose), by trying to strictly control blood glucose levels, can be harmful for people with multiple health problems.