What is Diabetes Mellitus? What are the types & Causes of DM? What is Gestational Diabetes? Diagnostic criteria of DM with complications & treatment.

in #diabetes7 years ago

Diabetes Mellitus

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Diabetes mellitus is a common endocrine disorder in Bangladesh. In 2015 one in 11 adults has diabetes. Diabetes is the fastest growing endocrine disease in our country.

Defination :

Diabetes mellitus is a metabolic disorder characterized by hyperglycaemia with or without glycosuria due to absolute or relative deficiency of insulin.

Classifications of DM :

  1. Type-I or Insulin dependent diabetes mellitus (IDDM).
  2. Type-II or non insulin dependent diabetes mellitus (NIDDM).
  3. Gestational diabetes mellitus : Diabetes during pregnancy.

Causes of DM :

  1. Genetic defect of beta cell of pancreas because insulin is secreted from beta cell of pancreas & alpha cell secret glucagon.
  2. Genetic defect of insulin action.
  3. Infection of pancreas is called pancreatitis.
  4. Any neoplastic disease in pancreas.
  5. Acromegaly.
  6. Cushing's syndrome.
  7. Thyrotoxicosis.

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Type-I DM :

  1. Age of onset - Usually less than 40 years.
  2. Duration of symptoms - Weeks.
  3. Body weight - Normal or low.
  4. Rapid death without treatment with insulin.
  5. Auto antibodies - Present.
  6. Family history of DM - Uncommon.
  7. Acute complications - Diabetic ketoacidosis.

Type-II DM :

  1. Age of onset - Usually more than 50 years.
  2. Duration of symptoms - Months to year.
  3. Body weight - Obese.
  4. No Rapid death without treatment with insulin.
  5. Auto antibodies - Absent.
  6. Family history of DM - Common.
  7. Acute complications - Hyperosmolar non-ketotic coma.

Symptoms of DM :

  1. Polyuria.
  2. Polydipsia.
  3. Polyphagia.
  4. Weight loss.
  5. Fatigue.

Diagnostic criteria of DM (The American Association criteria) :

HbA1c ≥ 6.5% in DCCT standard. Or
Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl) or
2hrs after 75 gm glucose ≥ 11.1 mmol/L (200 mg/dl) or
Classical symptoms with Random plasma glucose ≥ 11.1 mmol/L (200 mg/dl).

Investigations :

A. In Blood -
1. HbA1c.
2. FBS, RBS or 2 hrs after breakfast or 2 hrs after 75 gm glucose.
B. In Urine -
1. Ketonuria (Rotharas test).
2. Glycosuria (Benedict's test)
C. Others -
1. CBC.
2. CXR.
3. ECG.

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Complications :

A. Acute complications :
1. Hypoglycaemia coma.
2. Diabetic ketoacidosis.
3. Non ketotic hyperosmolar diabetic coma.
4. Lactic acidosis.
5. Acute circulatory failure.

B. Chronic complications :

(a). Microvascular-
1. Retinopathy.
2. Neuropathy.
3. Nephropathy.

(b). Macrovascular-
1. MI.
2. Stroke.
3. TIA.
4. Ischemia.

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