Diabetes Information

Diabetes is an age old disease, which is recorded as early as Greek civilization. This disease is characterized by excretion of large amount of very dilute urine. Diabetes can also be explained as a syndrome characterized by disordered metabolism and inappropriate blood sugar level.
On the basis of symptoms diabetes can be classified into two types - a) diabetes mellitus b) diabetes insipid us. While diabetes mellitus is characterized by high blood sugar level, resulting from low insulin (hormone which controls the sugar level in blood) level, the characteristic symptoms are excessive urine production (polyuria), excessive thirst, and increased fluid intake (polydipsia) and blurred vision.
On the other hand, diabetes insipid us is characterized by excretion of large amount of severely diluted urine, which can not be reduced when fluid intake is reduced, leading to severe inability of kidney to concentrate urine. World Health Organization (WHO) recognizes three main forms of diabetes mellitus; one of them is termed as gestational diabetes which occurs during pregnancy. Early diagnosis can cure the disease.
The basic cause of diabetes during pregnancy is that, mother’s body is the sole supplier of glucose (sugar that results from the digestion of food) to the baby. This glucose is delivered to the baby through placenta. in return placenta produces certain hormones which helps the baby to develop, but on other hand these hormones prevents mothers body to use insulin and at later stage placenta increases these anti-insulin hormones which blocks the movement of glucose from the blood stream to the cell of the mother’s body. This condition is termed as insulin resistance which leads to gestational diabetes.
There are several factors which increases the chance of developing diabetes during pregnancy, which includes the parents may have a family history of diabetes, obesity, the mother being over age 25 and the mother have a previous record of giving birth to a stillborn child or to a baby weighing nine pounds. Though there are no obvious symptoms of gestational diabetes, but American diabetes association recommends all women to be screened for gestational diabetes between 24th and 28th week of pregnancy. The following are the names of such screenings a) blood glucose test b) glucose tolerance test.
There can be many cases that the woman may have pre existing diabetes. In that case the mother must be warned against the complicacies that may arise during pregnancy. Careful planning and preconception care can allow the diabetic woman to have a problem free pregnancy.

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Diabetes insipidus (DI) are a disorder of which there an abnormal increase of urine output, liquid prerecording is frequently and thirst. It is caused by a deficiency of antidiuretic hormone, also known as vasopressin, or by an insensitivity of the kidneys to that hormone. It can also be induced iatrogenically by the diuretic conivaptan. Antidiuretic hormone is a hormone produced in a region of the brain called the hypothalamus. It is then stored and released from the pituitary gland, a small gland at the base of the brain. Central diabetes insipidus is caused by damage to the hypothalamus or pituitary gland as a result of surgery, infection, tumor, or head injury. Nephrogenic DI may occur as an inherited disorder in which male children receive the abnormal gene that causes the disease on the X chromosome from their mothers. It may also be caused by kidney disease, high levels of calcium in the body, and certain drugs.
Diabetes insipidus can also occur when kidneys are unable to properly respond to the hormone.When diabetes insipidus is caused by failure of the kidneys to respond to antidiuretic hormone, the condition is called nephrogenic diabetes insipidus. Adults with untreated diabetes insipidus may remain healthy for decades as long as enough water is drunk to offset the urinary losses. However, there is a continuous risk of dehydration. Diabetes insipidus and diabetes mellitus are unrelated, although they can have similar signs and symptoms, like excessive thirst and excessive urination. Patients with diabetes insipidus also must take special precautions, such as when traveling, to be prepared to treat vomiting or diarrhea and to avoid dehydration with exertion or hot weather. Diabetes insipidus can be treated by correcting the amount of urine that is produced by the body, although the condition usually requires life-long treatment.
Diabetes insipidus should not confuse with diabetes mellitus, the cause lacks or the resistance to the insulin causes the high blood glucose. Diabetes insipidus is characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. It denotes inability of the kidney to concentrate urine. Symptoms of diabetes insipidus are quite similar to those of untreated diabetes mellitus, with the distinction that the urine is not sweet as it does not contain glucose and there is no hyperglycemia. Blurred vision is a rarity. In children, diabetes insipidus can interfere with appetite, eating, weight gain, and growth as well. They may present with fever, vomiting, or diarrhea. If the diabetes insipidus is due to renal pathology, desmopressin does not change either urine output or osmolarity.
The cause of the underlying condition should be treated when possible. Habit drinking is the most common imitator of diabetes insipidus at all ages. While many adult cases in the medical literature are associated with mental disorders, most patients with habit polydipsia have no other detectable disease. Central diabetes insipidus may be controlled with vasopressin. Vasopressin is administered as either a nasal spray or tablets. Vasopressin is ineffective for patients with nephrogenic DI. In most cases, if nephrogenic diabetes insipidus is caused by medication, stopping the medication leads to recovery of normal kidney function. Because pituitary DI is sometimes associated with abnormalities in other pituitary hormones, tests and sometimes treatments for these other abnormalities are also needed. Drugs used to treat nephrogenic DI include the anti-inflammatory medication indomethacin and the diuretics hydrochlorothiazide and amiloride.

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If you are a health-conscious person, you would have come across the word diabetes mellitus or even heard of it a few times yourself. Thus, with that in mind, I will focus briefly on the aspect of classification and non-pharmacological therapy of DM.

Classification of Diabetes :
Type 1 DM
Type 1 DM is known as insulin-dependent DM as patients have little or unable to synthesize insulin hormone. Hence the name, they will eventually be dependent on insulin injection for their survival. This type of DM is a result of the autoimmune destruction of ²-cells (which produces the insulin hormone) in the pancreas. It mostly occurs in adolescent and children. In general, they are less than 30 years old with a lean body habitus. However in some cases, it could also be found at any age group.

Type 2 DM
On the other hand, Type 2 DM is different from Type 1 in which it is characterized by insulin resistance where in the initial stage, it lacks of insulin secretion. In such a case, although the pancreas retains some ability to produce insulin but it is insufficient to convert the blood glucose to glucagon following the body’s needs resulting in accumulation of blood glucose. Alternatively, the body cells can also become resistant towards the insulin produced by the ²-cells. As a result, blood glucose level is increased and led to hyperglycemia (high blood glucose level).
Most individuals with type 2 DM exhibit abdominal obesity which itself can cause insulin resistance. Furthermore, patient usually has co-existence of other medical disorders such as hypertension, dyslipidemia (high triglyceride levels and low HDL-cholesterol levels), and heart diseases. Clustering of abnormalities is normally referred as “insulin-resistance syndrome” which can also increase the risk of developing macrovascular complications (ischaemic heart disease, cerebrovascular disease and peripheral vascular disease).
Owing to its gradual development in the age of onset and average of more than 30 years old in most patients, Type 2 is also known as maturity-onset DM. This type of DM is highly genetic predisposition regardless to ethnicity.

Gestational DM
GDM is defined as glucose intolerance which is found during pregnancy. It has complicated about 7% of all pregnancies. It is important to have a early clinical detection in pregnant women whereby such therapy will help to reduce the perinatal morbidity and mortality risk.

Non-Pharmacologic Therapy
Regardless of the type of DM, patient should take initiative in preventing the complications of DM. Apart from prescribed medications by doctor; non-pharmacologic therapies should not be neglected as well.

Diet
This is one of the cornerstones in DM management. Success cannot be achieved without a proper diet therapy even though if you comply fully with your given medications. The followings are general recommendations:
1. Obtain counseling from a dietitian on individual nutrition based on your health conditions. This is aim to provide a balanced diet to achieve and maintain a healthy body weight.
2. Restrict intake of high sugar-containing foods such as cakes and ice-cream and other carbohydrates.
3. Reduction of intake of saturated fats in all diabetic patients as it can complicate their abnormal medical conditions.

Physical Activity
Most diabetic patients can benefit from increased physical activity such as walking, aerobic exercise, gardening and cycling. However, the type and intensity should be individualized. For example, an older patient should have a cardiovascular evaluation including a graded exercise test with imaging prior to beginning a moderate to intense exercise regimen.

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