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Diabetes Mellitus

Diabetes mellitus is a collective term for several conditions that interfere with the normal processes of glucose metabolism. While there are several types of diabetes, they are all characterized by high levels of glucose in the bloodstream. The presence of high levels of glucose in and of itself is a big problem and it is a consequence of an off kilter metabolic process, starring the pancreas-produced hormone – Insulin – and our main source of energy – Glucose –  playing lead roles.

When we consume food, our body converts it to usable energy. In the case of carbohydrates, our body uses the oxygen we breath and other catalysts as a tool to breakdown carbohydrates to produce what our organ’s cells will “swallow”, namely glucose, the basic sugar molecule our cells use for energy.

However, glucose cannot simply show up to a cell’s outer membrane and expected to be granted entrance. It must show up with its chaperone, Insulin. This hormone is produced and secreted by pancreatic cells called Beta cells, with the purpose of transporting glucose to our organ’s cells. Most notably, our brain and muscles.

Insulin also serves as a regulator of glucose in another way. Our bodies have a reservoir of glucose in the liver to use for energy should the need arise. The liver stores this glucose reserve in the form of glycogen, which is simply a polysaccharide of glucose (many glucose molecules chained together to form one giant chain). Insulin is responsible for “telling” the liver to stop releasing more glucose into the blood stream.

What can go wrong with these seemingly simple metabolic mechanisms? The consequence is Diabetes Mellitus and the causes are varied as we shall see in each diabetes type below.

Diabetes Mellitus Types/Causes

There are three main types along with corresponding causes:

  • Diabetes Mellitus Type 1:  Formally known as Insulin-dependent Diabetes or Juvenile Diabetes, is a consequence of the autoimmune destruction of the aforementioned Beta-cells of the pancreas. If the cells that produce insulin are destroyed then there is no insulin to transport glucose to our cells and therefore, our cells cannot break down glucose for energy. This scenario leads to an abnormal increase in the levels of blood glucose.

The causes for the autoimmune response of the body towards beta-cells are not fully understood though it has been determined there are a combination of factors that cause an autoimmune revolt against our pancreas such as:

– Environmental factors: Genetic susceptibility

– Drugs and other chemicals: Persistent organic pollutants (POPs are resistant to environmental degradation like plastic exudates and cigarette smoke), Arsenic, Phthalates (found in hairspray, nail polish, perfumes, soaps), Polychlorinated biphenyls (PCBs) to name a few.

– Viral: The rubella family of viruses, particularly the Coxsackie Virus, has been theorized to influence an autoimmune response towards infected cells as well as the pancreatic beta cells. However, the evidence for this is incomplete and the mechanisms involved are not yet fully understood.

– Stress: This is something every human in history has experienced and is a normal response to dealing with our external as well as internal environment. Stress will cause a person to release a hormone called cortisol (also called the stress hormone). However, chronic stress like that observed in our modern environment causes a prolonged presence (and thus influence) of cortisol circulating in our bodies. Among other things, cortisol increases blood glucose and raises blood pressure. None of which are conducive to avoiding diabetes.

  •  Diabetes Mellitus Type 2: Also known as insulin-dependent diabetes, occurs to those who’s cells are resistant to insulin’s influence. Initially, our bodies counter this insulin inadequacy by simply producing more insulin so as to compensate. However, as the months and years go by, insulin resistance comes into full swing and insulin injections are a necessary part of treatment going forward.

Causes of Diabetes Type 2:

– Genetic predisposition such as is the case with Donohue Syndrome and Rabson-Mendenhall Syndrome

– Obesity

– Diet

– Sedentarism

– Other medical conditions such as testosterone deficiency, hyperthyroidism and Cushing’s syndrome to name a few.

  • Gestational Diabetes Mellitus: Some women will present increased levels of plasma glucose during the third trimester of pregnancy, known as Gestational Diabetes. For the most part this is a temporary condition that often times disappears after giving birth. However, some women may be susceptible to developing type 2 Diabetes since a hormone produced during pregnancy called human placental lactogen does tend to hamper the effectiveness of insulin receptors and thusly may progress into Diabetes Type 2.

Some risk factors for developing Gestational Diabetes are:

– Polycystic Ovarian Syndrome

– Obesity

– Sedentarism

– Family history of Diabetes

– Cigarette smoke

– Ethnicity

Symptoms of diabetes mellitus

The general symptoms include:

  • Excessive thirst
  • Increased urine output
  • Unusual hunger
  • Loss of weight
  • Increased tiredness
  • Impaired vision
  • Difficulty of wounds self-repairing.
  • Recurrent fungal infections of the gums, vagina, glans penis and the skin.
  • Ketone-breath if the patient has gone into acidosis.

In a state called pre-diabetes, the blood sugar is usually high but not high enough to present any symptoms. Some people with diabetes type 2 can remain symptomless for life and are only discovered during routine screening.

Complications of diabetes

If not treated effectively, high blood sugar can lead to both acute and chronic complications. They include:

  • Dehydration
  • Coma
  • Acidosis
  • Electrolyte imbalance
  • Recurrent infections
  • Sexual Dysfunction
  • Chronic wounds
  • Poor circulation to the extremities, gangrenes and amputation
  • Loss of sensation
  • Vision problems
  • Kidney damage
  • Cardiovascular disorders including hypertension.

Management of Diabetes Mellitus

There is no remedy or known method to completely cure diabetes. The key is managing and controlling the disease by making certain lifestyle changes. Regardless of the treatment, it will most likely comprise of:

1) A balanced diet, an uptick in physical activity and medication. This should help keep blood glucose at normal levels.

2) Maintain a healthy blood pressure at 130/80

3) Reducing saturated lipids and cholesterol from your diet.

4) Prevention of complications that arise from diabetes by following the recommendations of your healthcare practitioner.

Treatment of gestational diabetes mellitus

The treatment of choice is insulin injections. This is because insulin doesn’t cross the placenta barrier and so cannot interfere with the fetus physiology.

A hypoglycemic drug called glyburide is also safe to use during pregnancy and its use is on the rise due to its convenience of administration and low cost.

Effective management of any of the type of diabetes is a collective effort. It involves the input of various specialists including:

  • Physicians
  • Nutritionists
  • Nurses
  • Social worker
  • Physical and occupational therapists (especially where complications have occurred)
  • Pediatrician (in cases of gestational diabetes)

Such an approach helps to keep the blood sugar levels within normal range and to prevent complications of diabetes mellitus.

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