WHAT IS SUGAR DISEASE?

Diabetes Mellitus

Is a condition when glucose is not absorbed into the cells. Thus, it leads glucose to accumulate in blood circulation.

How body react to glucose in blood ?

It is important to know that insulin has an important role in controlling blood glucose level. Cells need insulin to be able to absorb glucose.

Screening for diabetes :

 

Normal Range :

Fasting blood glucose level   : 3.5-5.5 mmol/L

2-hours post-prandial          : 6.0-8.0 mmol/L

Random blood glucose level : 3.5 – 7.7mmol/L

Sign and symptoms of diabetes mellitus:

  Lethargy

  Fatigue

Polyphagia

Polydipsia

Polyuria

Weight loss

 Slow wound healing

Infection

Complication of diabetes mellitus:

Chronic kidney disease

 Foot problems – gangrene, foot ulcer, amputation.

Retinopathy

Nerve damage (Neuropathy)

Heart attack

Stroke

Anxiety

Type of diabetes mellitus :

                                Type 1 diabetes mellitus

Ø  Childhood diabetes

Ø  Caused by inadequate production of insulin (Beta cell destroyed due to autoimmune attacks)

Ø  Controlled by insulin injection

 Type 2 diabetes mellitus

Ø  Occurs after the age of 40 and obese

Ø  Pancreas retain some Beta cell function but inadequate insulin response

 Gestational diabetes

Ø  Temporary condition that occur during pregnancy

Ø  Increase risk of developing diabetes in mother and child.

Goals of therapy in diabetes:

HbA1c test : <7.0 %

Preprandial capillary plasma glucose : 3.9-7.2 mmol/L

Peak postprandial capillary plasma glucose : <10mmol/L

Blood Pressure: 140/80

How to Manage diabetes :

        Glycemic control : diet/lifestyle modification, exercise, medication

      Treat associated condition such as dyslipidemia, obese and hypertension

      Screen/ manage complication of diabetes such as retinopathy, Cardiovascular disease, neuropathy, nephropathy and foot ulcer. Patients need to check their condition at least once a year.

Treatment of Diabetes Mellitus

•         For type 1 DM patients, they depend on exogenous insulin.
•         For type 2 DM, they need to maintain glucose concentrations within normal limits to prevent long term complications. Thus, Oral hypoglycemic agents can be given. Type 2 patient also may need exogenous insulin in long term condition.

Type of Oral Hypoglycemic Agents :

  1.  Insulin secretagogues : promote insulin release from B-cells

•  Sulfonylurea
•  Non-sulfonylurea
•  Incretins effects

  2.   Insulin sensitizer: increase glucose uptake into the cell.

• biguanide: metformin
• thiazolidinediones

   3.   Alpha-Glucosidase inhibitors: delay carbohydrate digestion by inhibiting the enzyme.

Important adverse effects and expectation:

   1. Sulfonylurea : weight gain, hyperinsulinemia, hypoglycemia.

  2.  Insulin sensitizer: not common cause hypoglycemia (unless combine), drug interaction-cimetidine,      furosemide,nifedipine.

3. Alpha-glucosidase inhibitor : flatulence, diarrhea, cramping. Should not combine with metformin (decrease bioavailability)

For more information, you can refer to the video below :

What is diabetes? Causes and Symptoms.

ATTENTION!!

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REFERENCES :

1. http://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus#1

2. http://my.clevelandclinic.org/health/articles/diabetes-mellitus-an-overview

3. http://care.diabetesjournals.org/content/27/suppl_1/s5

4. Management of Diabetes Mellitus, Kementerian Kesihatan Malaysia

5. https://www.youtube.com/watch?v=X9ivR4y03DE 

6. Clinical Practice Guidelines Malaysia.

7. http://emedicine.medscape.com/article/2172160-overview

8. http://www.medscape.com/viewarticle/722513_3