Diabetes Mellitus - An Insight

Today around 15-18 percent of the country's population is afflicted by Diabetes mellitus, the urbane residents more at risk. What makes it even more important is the wide range of multisystem afflictions caused by this metabolic disorder. Since glucose is present as the source of energy in basically every nook and corner of the body, diabetes impacts almost every every organ system, some of the complications being life threatening.

Diabetes is broadly divided into two types, type 1 and type 2 with similar symptoms but different pathogenesis. Type 1 DM is caused by an autoimmune insult to the pancreas leading to the loss of beta cells that produce insulin - a hormone required in internalising glucose into cells for its metabolism and energy generation. Onset in type 1 usually occurs before 30 years of age. On the other hand type 2 DM is caused by an insulin receptor defect which leads to inability to internalize glucose by the cells despite adequate or increased levels of insulin hormone. Type 2 DM usually occurs after 30 years of age and is associated with risk factors like obesity, sedentary lifestyle, PCOS, or other endocrine disorders like Cushing's syndrome, heredity playing a major role. Symptoms include polyuria, polydipsia, polyphagia, weight loss, fatigue etc.

The diagnosis of diabetes mellitus may be preceded by a stage of prediabetes where a person has an increased chance of developing diabetes in the future. A fasting blood glucose of 100-125 mg/ dl, a post prandial blood glucose of 140-199 mg/dl or an HbA1c of 5.7-6.5 percent places you in this prediabetic category. Values higher than these indicate the diagnosis of diabetes. HbA1c is the test used to detect the percentage of Hb covalently linked to glucose molecules in the blood. Since average lifespan of Rbcs is 3-4 months, HbA1c values indicate the mean glycemic status of the individual over the past 3-4 months. 

Lifestyle changes are at the centre stage to prevent, delay or even manage diabetes mellitus. Loss of excess body weight, regular physical exercise, moderation in intake of refined carbohydrates and fats go a long way to maintain a healthy body in diabetes. Other than that if the blood glucose is on the higher side it is advisable to go in for treatment instead of letting the excessive glucose run amok in the blood and play havoc with a multitude of organ systems. Type 1 DM generally needs insulin whereas early stages of type 2 DM can be well controlled with oral hypoglycemic drugs, lifestyle and dietary modifications playing a positive adjuvant role. 

Certain emergency situations may arise like diabetic ketoacidosis in type 1 or hyperosmolar coma in type 2 which need immediate attention and hospitalization and can be life threatening. In addition to these acute complications diabetes has a multitude of chronic complications which are directly related to the duration of disease and the glycemic control. Glucose damages the arteries and leads to narrowing which could lead to strokes and heart attacks. DM is associated with a disturbance in lipid metabolism which aggravates atherosclerosis. It may bind to and damage neurones leading to neuropathy causing tingling and paraesthesias. DM has a notorious effect on the kidney leading to characteristic glomerular lesions and end stage renal failure. It can have effect on the eyes leading to retinopathy leading to loss of visual acuity over time.

Given the complications and life damaging effects of diabetes it is imperative to keep yourself checked and if afflicted to keep yourself tested for the associated complications as well to maintain a decent lifestyle as well as to keep your blood glucose under control with diet and drugs. For the drugs won't have as grave side effects as the consequences of the disease. Better to be safe than sorry.