By Taiwo Adeniji RN,C MSN ANP.
Definition: DM is a group of metabolic diseases characterized by an abnormal increase in the concentration of blood glucose (hyperglycemia). DM occurs when the human body does not produce insulin or use insulin properly (insulin resistance),
DM affects the body ability to use sugars, starches, fats, and protein. Our bodies normally change sugars and starches into soluble form called glucose, which is carried into skeletal muscle and liver by insulin (a hormone produced by the pancreas), to be broken down and used for energy or stored for later use.
DM is the fourth leading cause of death in United States killing more than 180,000 American each year (Barker, et al, 1999). Nearly 1 in 12 New Yorkers have DM, and thousands have long-term diabetes related complications. Throughout the past decade, a 30% increase in the prevalence of DM has been recorded in the United States, with the increases in younger individual. Ethnic populations at higher risks are Hispanic American, African-American, Native Americans, Asian American, and Pacific Islander.
DM is a serous life-long disease, associated with a significant health & economic burdens, and it’s too serious to ignore! Only a doctor can determine if you have DM. See a doctor and find out for sure.
Causes/Classification and Clinical Presentation of DM
The classification of DM is based on the cause (etiology). The following are the types:
Type 1: formerly called Insulin Dependent Diabetes Mellitus (IDDM), accounts for approximately 10 to 12% of cases in the United States generally has it’s onset in childhood (with the highest incidence between ages 10 to14), once called juvenile onset diabetes, can also develop in adulthood.
Causes (etiology): It may be an autoimmune disease, where the body’s immune (defense)
system attacks the body cells. The B cell in the pancreas (organ that make insulin) is
destroyed, thereby, the body does not produce insulin at all, so, the person must have
daily insulin injections (for life) to stay alive and prevent Ketosis-Acidosis.
Only 2% of siblings of type1 diabetic patients develop diabetes (Barker, et el, 1999). Other causes are idiopathic (unknown). Type 1 DM can be successfully managed but not prevented. The goal is to keep the blood sugar at near normal levels.
Treatment: Insulin, individualized healthy diet planned with a registered dietitian (low in saturated fat & cholesterol, no trans fats, foods in fiber) and exercise (at least 30 minutes of moderate physical activity –such as brisk walk, at least 5 days/week. Quit smoking.
Type 2 DM: formerly called Non-insulin Dependent Diabetes (NIDM) or Non-Ketosis DM, is also called Adult onset diabetes, because onset generally occurs in adult over age 40. It is the most common form of DM, and accounts for approximately 80-90% of diabetes cases in the United States (Barker et, el, 1999). It has gradual onset and slow progression of symptoms. Frequently, patients have complications before they are diagnosed! People with type 2 DM usually produce insulin but cannot use the insulin effectively. Initially not insulin dependent (use antidiabetic medications, diet & exercise), but may need insulin for the control of persistent high blood sugar. The biggest risk factor for type 2 DM is overweight (>20% over ideal body weight), and obesity. Other risk factors include family history of DM, race (African American, Hispanic, American Indian), age >45 years, hypertension, hyperlipidemia, and women with a history of gestational diabetes.
Gestational DM (GDM): refers only to women who become diabetic during pregnancy (does not include diabetic who becomes pregnant). Most patients return to a state of normal glucose tolerance after delivery (postpartum). GDM occurs in 1-14% of all pregnancies. Such patients are at increased risk of perinal complications and future diabetes (approximately 30%) within 5-10 years after parturition (Barker, et, el, 1999).
Other Types of DM: (also called secondary diabetes) they are associated with other diseases or drug/chemical ingestion (steroids, antidepressants, etc). Diagnosis demands usual abnormalities of glucose handling and documentation of associated condition.
Impaired Glucose Tolerance (IGT): This is another type of DM where plasma glucose levels are higher than normal but not diagnostic of DM. This is intermediate stage between glucose homeostasis and diabetes (borderline).
Signs and Symptoms of DM
Most diabetic patients at the time of diagnosis usually complain of increased frequency of urination (polyuria), excessive thirst with increased fluid intake (polydipsia), increased appetite and food consumption (polyphagia), associated with weight loss. Other symptoms include fatigue, blurred vision, dehydration, nausea, vomiting, vaginitis, candidiasis, glucosuria (sugar in urine), and urinary tract infections.
Diagnosis of DM
A routine blood test that reveals elevation of blood sugar concentration is the hallmark of DM. A positive blood result should be repeated the next day. Any of the following blood sugar tests can be done-Plasma Glucose (PG), Fasting Plasma Glucose (FPG), or oral glucose tolerance test (OGTT). A single elevation of FPG or OGTT does not establish the diagnosis. Portable devices for monitoring blood glucose (at home) are not sufficiently accurate to be used in diagnosis.
Management of DM
Lifestyle modifications that address the underlying risk factors such as obesity, physical inactivity, smoking, and atherogenic diet must be implemented. DM patients must know and control their ABCs (A1c, BP, cholesterol, and smoking).
. A1c (Glycosylated hemoglobin-HbA1 or HbA1c): a blood test that reflects average glucose levels for preceding 2-3 months and determines the degree of the sugar control must be done every 3 or 6 months. Level <7.5% (target) indicates good diabetes control.
. Blood Pressure should be treated aggressively with the goal to below 130/85 mm Hg.
. Cholesterol: The LDL (bad) cholesterol must be less than 100.
. Smoking: If you smoke, quit. Smoking or second-hand smoking contributes to early development or worsening DM. (For free help to quit call smoker quit line at 311).
Complications of DM
Most of deaths related to DM are caused by the complications of the disease especially arteriosclerosis (caused by hyperlipidemia, can lead to heart attack, hypertension, stoke) and chronic Renal (Kidney) Failure (life-threatening). Others are nerve dysfunction with loss of sensation to pain, hot/cold, numbness, foot ulcers (that can lead to amputation), blindness, impotence, neurogenic bladder, and Alzheimer’s disease.
Advise: Remember to stick to your diet & exercise program, take your medications (also get pneumonia & flu vaccines), and keep your appointments.
