What is diabetes mellitus?

Diabetes is a disease in which the body doesn't produce or properly use insulin. Insulin is a
hormone produced in the pancreas, an organ near the stomach. Insulin is needed to turn sugar
and other food into energy. When you have diabetes, your body either doesn’t make enough
insulin or can’t use its own insulin as well as it should, or both. This causes sugars to build up too
high in your blood.

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose)
levels, which result from defects in insulin secretion, or action, or both. Diabetes mellitus,
commonly referred to as diabetes (and in this article will be referred to as "diabetes"), was first
identified as a disease associated with “sweet urine," and excessive muscle loss in the ancient
world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine,
hence the term sweet urine. Normally, blood glucose levels are tightly controlled by insulin, a
hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood
glucose elevates (for example, after eating food), insulin is released from the pancreas to
normalize the glucose level. In patients with diabetes, the absence or insufficient production of
insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning although it can
be controlled, it lasts a lifetime.

Diabetes mellitus is defined as a fasting blood glucose of 126 milligrams per deciliter (mg/dL) or
more. “Pre-diabetes” is a condition in which blood glucose levels are higher than normal but not
yet diabetic. People with pre-diabetes are at increased risk for developing type 2 diabetes, heart
disease and stroke, and have one of these conditions:

Diagnosis and Classification of Diabetes Mellitus

New recommendations for the classification and diagnosis of diabetes mellitus include the
preferred use of the terms "type 1" and "type 2" instead of "IDDM" and "NIDDM" to designate the
two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus
to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose
(126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These
changes provide an easier and more reliable means of diagnosing persons at risk of
complications from hyperglycemia. Currently, only one half of the people who have diabetes
mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age
and should be repeated every three years in persons without risk factors, and should begin earlier
and be repeated more often in those with risk factors. Risk factors include obesity, first-degree
relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of
impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of
blood glucose levels and a reduction in the severity of complications associated with this disease

Both forms of diabetes may be inherited in genes. A family history of diabetes can significantly
increase the risk of developing diabetes. Untreated diabetes can lead to many serious medical
problems. These include blindness, kidney disease, nerve disease, limb amputations and
cardiovascular disease (CVD).

How are insulin resistance, diabetes and CVD related?

Diabetes is treatable, but even when glucose levels are under control, it greatly increases the risk
of heart disease and stroke. In fact, most people with diabetes die of some form of heart or blood
vessel disease.

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Pre-diabetes and subsequent type 2diabetes usually results from insulin resistance. When insulin
resistance or diabetes occur with other CVD risk factors (such as obesity, high blood pressure,
abnormal cholesterol and high triglycerides), the risk of heart disease and stroke rises even more.

Insulin resistance is associated with atherosclerosis (fatty buildups in arteries) and blood vessel
disease, even before diabetes is diagnosed. That’s why it’s important to prevent and control
insulin resistance and diabetes. Obesity and physical inactivity are important risk factors for
insulin resistance, diabetes and cardiovascular disease.

The Warning Signs of Diabetes Mellitus

Insulin-Dependent Diabetes Mellitus (IDDM)

These symptoms often occur suddenly and generally seem to have no reason for being.

• Frequent urination
• Excessive thirst
• Extreme hunger
• Dramatic weight loss
• Irritability
• Weakness and fatigue
• Nausea and/or vomiting

Non-Insulin-Dependent Diabetes Mellitus (NIDDM)

Generally these symptoms occur less suddenly, over a longer period of time and may also
immediately seem to have no reason for their occurrence.

• Any of the insulin-dependent symptoms

• Recurring or hard-to-heal skin, gum, or bladder infections
• Drowsiness
• Blurred vision or significant visual changes
• Tingling or numbness in hands or feet
• Itching, anywhere on the body, or in genital area

Symptoms or Problems That Require Prompt Attention:

Hypoglycemia or low blood sugar sometimes thought of as a reaction to too much insulin, also
called insulin shock. This may occur suddenly in people using insulin, especially if too little food is
eaten, if a meal is delayed, or if extra exercise is done. It is less common in people whose
diabetes is treated with oral medication but certainly does occur in oral medication users. Low
blood sugar must be treated quickly, with sugar or sugary foods because, untreated,
hypoglycemia can lead to unconsciousness.

The typical symptoms include feeling cold, clammy, nervous, shaky, weak, or very hungry. Some
people become pale, have sudden or gradual onset of headaches, or act strangely. If a person
becomes unconscious, glucagon, a hormone (available by prescription) that raises blood sugar,
must be injected.

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Hyperglycemia, or high blood sugar, occurs when too much food is eaten or not enough insulin
is taken. Illness and emotional stress can also cause high blood sugar. The warning signs are
large amounts of sugar in the urine and blood. Often the first sign is frequency of urination,
excessive thirst, and feeling nauseated. Treatment high blood sugar may require insulin, increase
dosages of injectable or oral medication or if very high hospitalization. If these symptoms occur,
you should consult your doctor immediately.

Diabetes Mellitus Symptoms

It's not unusual to have diabetes mellitus and yet have no symptoms. Type 2 diabetes, in
particular, develops slowly. Many people have type 2 diabetes for as long as eight years before
it's diagnosed. When symptoms do develop, they often vary. But two symptoms that occur in
many people with the disease are increased thirst and frequent urination.

That's because excess glucose circulating in your body draws water from your tissues, making
you feel dehydrated. To quench your thirst, you drink a lot of water and other beverages, and that
leads to more frequent urination.

Another condition, diabetes insipidus, also causes increased thirst and urination, but despite the
similar name and symptoms, it's not related to diabetes mellitus. Diabetes insipidus isn't caused
by a problem with blood sugar, but rather by a hormone disorder originating in the pituitary gland
in your brain that makes your kidneys unable to conserve water.

Other warning signs of diabetes mellitus include:

• Flu-like symptoms. Diabetes can sometimes feel like a viral illness, with fatigue,
weakness and loss of appetite. Sugar is your body's main fuel, and when it doesn't reach
your cells you may feel tired and weak.

• Weight gain or loss. Because your body is trying to compensate for lost fluids and
sugar, you may eat more than usual and gain weight. But the opposite also can occur.
You may eat more than normal, but still lose weight because your muscle tissues don't
get enough glucose to generate growth and energy. This is especially true if you have
type 1 diabetes, in which very little sugar gets into your cells. In fact, most people with
type 1 diabetes are at or below their normal weight.

• Blurred vision. High levels of blood sugar pull fluid out of the tissues in your body ?
including the lenses of your eyes. This affects your ability to focus. Once your diabetes is
treated and your blood sugar levels drop, your vision should improve. Over a period of
years, however, diabetes can also cause new blood vessels to form in your retina ? the
back part of your eye ? as well as damage old vessels. For most people this causes only
mild vision problems. But for others, the effects may be much more serious. In some
cases, diabetes can lead to blindness.

• Slow-healing sores or frequent infections. Diabetes affects your body's ability to heal
and fight infection. Bladder and vaginal infections can be a particular problem for women.

• Nerve damage (neuropathy). Excess sugar in your blood can damage the small blood
vessels to your nerves, leading to a number of symptoms. The most common are tingling
and loss of sensation in your hands and especially your feet. You may also experience
burning pain in your legs, feet, arms and hands. In addition, more than half the men age
50 and older with diabetes may experience some degree of sexual dysfunction from

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 damage to the nerves that help produce an erection.

• Red, swollen, tender gums. Diabetes increases the risk of infection in your gums and in
the bones that hold your teeth in place. As a result, your gums may pull away from your
teeth, your teeth may become loose, or you may develop sores or pockets of pus in your
gums. This is especially true if you have a gum infection before the onset of diabetes.

Causes of Diabetes

Diabetes mellitus occurs when the pancreas doesn't make enough or any of the hormone insulin,
or when the insulin produced doesn't work effectively. In diabetes, this causes the level of glucose
in the blood to be too high.

In Type 1 diabetes the cells in the pancreas that make insulin are destroyed, causing a severe
lack of insulin. This is thought to be the result of the body attacking and destroying its own cells in
the pancreas - known as an autoimmune reaction.

It's not clear why this happens, but a number of explanations and possible triggers of this reaction
have been proposed. These include:

• infection with a specific virus or bacteria;

• exposure to food-borne chemical toxins; and
• exposure as a very young infant to cow's milk, where an as yet unidentified component of
this triggers the autoimmune reaction in the body.

However, these are only hypotheses and are by no means proven causes.

Type 2 diabetes is believed to develop when:

• the receptors on cells in the body that normally respond to the action of insulin fail to be
stimulated by it - this is known as insulin resistance. In response to this more insulin may
be produced, and this over-production exhausts the insulin-manufacturing cells in the
pancreas;
• there is simply insufficient insulin available; and
• the insulin that is available may be abnormal and therefore doesn't work properly.

The following risk factors increase the chances of someone developing Type 2 diabetes:

• Increasing age;
• obesity; and
• physical inactivity.

Rarer causes of diabetes include:

• Certain medicines;
• pregnancy (gestational diabetes); and
• any illness or disease that damages the pancreas and affects its ability to produce insulin
e.g. pancreatitis.

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What doesn't cause diabetes

It's important to also be aware of the different myths that over the years have arisen about the
causes of diabetes.

Eating sweets or the wrong kind of food does not cause diabetes. However, it may cause obesity
and this is associated with people developing Type 2 diabetes.

Stress does not cause diabetes, although it may be a trigger for the body turning on itself as in
the case of Type 1 diabetes. It does, however, make the symptoms worse for those who already
have diabetes.

Diabetes is not contagious. Someone with diabetes cannot pass it on to anyone else.

Risk Factors

In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that
allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel.

Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The
body is unable to use this glucose for energy despite high levels in the bloodstream, leading to
increased hunger.

In addition, the high levels of glucose in the blood causes the patient to urinate more, which in
turn causes excessive thirst. Within 5 to 10 years after diagnosis, the insulin-producing beta cells
of the pancreas are completely destroyed, and no more insulin is produced.

Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms
are usually severe and occur rapidly.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new
cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases
are less common among adults older than 20.

Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the
time of diagnosis. However, Type 2 diabetes can also develop in those who are thin, especially
the elderly.

Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and
excess body weight (especially around the waist) significantly increase your risk for type 2
diabetes.

Gestational diabetes is usually diagnosed during the 24th to 28th weeks of pregnancy. In many
cases, the blood glucose level returns to normal after delivery.

It is recommended that all pregnant women be screened for gestational diabetes during the 24th
and 28th weeks of their pregnancy. The symptoms are usually mild and not life-threatening to the
pregnant woman.

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However, the increased maternal glucose (blood sugar) levels are associated with an increased
rate of complications in the baby, including large size at birth, birth trauma, hypoglycemia (low
blood sugar), and jaundice. Rarely, the fetus dies in the womb late in the pregnancy.

Maintaining control of blood sugar levels significantly reduces the risk to the baby. The risk
factors for gestational diabetes are being older when pregnant, African or Hispanic ancestry,
obesity, gestational diabetes in a previous pregnancy, having a previous baby weighing over 9
pounds, an unexplained death in a previous fetus or newborn, a congenital malformation (birth
defect) in a previous child, and recurrent infections.

There are many risk factors for diabetes, including:

• A parent, brother, or sister with diabetes

• Obesity
• Age greater than 45 years
• Some ethnic groups (particularly African-Americans and Hispanic Americans)
• Gestational diabetes or delivering a baby weighing more than 9 pounds
• High blood pressure
• High blood levels of triglycerides (a type of fat molecule)
• High blood cholesterol level

Diabetes Treatment
(Treatment of Diabetes Mellitus)

Controlling your blood sugar is essential to feeling healthy and avoiding long-term complications
of diabetes. Some people are able to control their blood sugar with diet and exercise alone.
Others may need to use insulin or other medications in addition to lifestyle changes. In either
case, monitoring your blood sugar is a key part of your treatment program.

A healthy diet and exercise should be placed as a priority for diabetes treatment. Second, you
might also try some of the diabetes treatment using alternative medicine. Third, follow your
doctor's prescriptions. And last, pancreas or islet cell transplantation may be an option for people
whose kidneys are failing or who aren't responding to other treatments.

Monitoring blood sugar

If you've just received a diagnosis of diabetes, monitoring your blood sugar may seem like an
overwhelming task. But once you learn to measure your blood sugar and understand how
important it is, you'll feel more comfortable with the procedure and more in control of your
disease. Testing is crucial because it tells you whether you're keeping your glucose levels in the
range you and your doctor have agreed on.

The best range for you depends on your age and the type of diabetes you have. For younger
adults who don't have complications of diabetes, a typical target range might be 80 to 120 mg/dL
before meals, and below 180 mg/dL after eating. Older adults who have complications from their
disease may have a fasting target goal of 100 to 140 mg/dL and below 200 mg/dL after meals.
That's because blood sugar that falls too low in older adults can be more dangerous than in
younger people.

How often you test your blood sugar depends on the type of diabetes you have. If you take
insulin, test your blood sugar at least twice a day, and preferably three or four times a day. But if
you have type 2 diabetes and don't use insulin, you may need to test your blood sugar levels only
once a day or as little as twice a week.

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Keep in mind that the amount of sugar in your blood is constantly changing. Self-monitoring helps
you learn what makes your blood sugar levels rise and fall, so you can make adjustments in your
treatment. Factors that affect your blood sugar include:

• Food. Food raises your blood sugar level ? it's highest one to two hours after a meal.
What and how much you eat, and the time of day, also affect your blood sugar level.
• Exercise and physical activity. In general, the more active you are, the lower your
blood sugar. Physical activity causes sugar to be transported to your cells, where it's
used for energy, thereby lowering the levels in your blood. Aerobic exercises such as
brisk walking, jogging or biking are especially good. But gardening, housework and even
just being on your feet all day also can lower your blood sugar.
• Medications. Insulin and oral diabetes medications deliberately work to lower your blood
sugar. But medications you take for other conditions may affect glucose levels.
Corticosteroids, in particular, may raise blood sugar levels. Medications such as
thiazides, used to control high blood pressure, and niacin, used for high cholesterol, also
may increase blood sugar. If you need to take certain high blood pressure medications,
your doctor will likely make changes in your diabetes treatment.
• Illness. The physical stress of a cold or other illness causes your body to produce
hormones that raise your blood sugar level. The additional sugar helps promote healing.
But if you have diabetes, this can be a problem. In addition, a fever increases your
metabolism and how quickly sugar is utilized, which can alter the amount of insulin you
need. For these reasons, be sure to monitor your glucose levels frequently when you're
sick.
• Alcohol. Even a small amount of alcohol ? about 2 ounces ? can cause your sugar levels
to fall too low. But sometimes alcohol can cause sugar levels to rise. If you choose to
drink, do so only in moderation. And monitor your blood sugar before and after
consuming alcohol to see how it affects you. Also, keep in mind that alcohol counts as
carbohydrate calories in your diet.
• Fluctuations in hormone levels. The female hormone estrogen typically makes cells
more responsive to insulin, and progesterone makes cells more resistant. Although these
two hormones fluctuate throughout the menstrual cycle, the majority of women don't
notice a corresponding change in blood sugar levels. Those who do are more likely to
experience changes in blood sugar during the third week of their menstrual cycle, when
estrogen and progesterone levels are highest.

Hormone levels also fluctuate during perimenopause ? the time before menopause. How this
affects blood sugar varies, but most women can control any symptoms with additional exercise
and changes in their diet. If your symptoms are more severe, your doctor may recommend oral
contraceptives or hormone replacement therapy (HRT). After menopause, many women with
diabetes require about 20 percent less medication because their cells are more sensitive to
insulin.

A healthy diet

Contrary to popular myth, there's no "diabetes diet." Furthermore, having diabetes doesn't mean
you have to eat only bland, boring foods. Instead, it means you'll eat more fruits, vegetables and
whole grains ? foods that are high in nutrition and low in fat and calories ? and fewer animal
products and sweets. Actually, it's the same eating plan all Americans should follow.

Yet understanding what and how much to eat can be a challenging task. Fortunately, a registered
dietitian can help you put together a meal plan that fits your health goals, food preferences and
lifestyle. Once you've decided on a meal plan, keep in mind that consistency is extremely
important. To keep your blood sugar at a consistent level, try to eat the same amount of food with
the same proportion of carbohydrates, proteins and fats at the same time every day.

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But even with all the information you need and the best intentions, sticking to your diet can be
one of the most challenging parts of living with diabetes. The key is to find ways to stay
motivated. Don't let others undermine your determination to eat in the healthiest way possible.
You have to believe that what you're doing matters ? and that you're worth it.

Exercise

Everyone needs regular aerobic exercise, and people with diabetes are no exception. The good
news is that the same exercises that are good for your heart and lungs also help lower your blood
sugar levels.

Healthy weight

Being overweight is the greatest risk factor for type 2 diabetes. That's because fat makes your
cells more resistant to insulin. But when you lose weight, the process reverses and your cells
become more receptive to insulin. For some people with type 2 diabetes, weight loss is all that's
needed to restore blood sugar to normal. Furthermore, a modest weight loss of 10 to 20 pounds
is often enough.

Yet losing even 10 pounds can be a challenge for most people. Fortunately, you don't have to do
it alone. A registered dietitian can help you develop a weight-loss plan that takes into account
your current weight, activity level, age and overall health. Ultimately, however, the motivation has
to come from you.

Medications

When diet, exercise and maintaining a healthy weight aren't enough, you may need the help of
medication. Medications used to treat diabetes include insulin. Everyone with type 1 diabetes and
some people with type 2 diabetes must take insulin every day to replace what their pancreas is
unable to produce. Unfortunately, insulin can't be taken in pill form because enzymes in your
stomach break it down so that it becomes ineffective. For that reason, many people inject
themselves with insulin using a syringe or an insulin pen injector ? a device that looks like a pen,
except the cartridge is filled with insulin. Others may use an insulin pump, which provides a
continuous supply of insulin, eliminating the need for daily shots.

An insulin pump is a pumping device about the size of a deck of cards. You wear it outside your
body. A small tube connects the reservoir of insulin to a catheter that's inserted under the skin of
your abdomen. The pump dispenses the desired amount of insulin into your body and can be
adjusted to infuse more or less insulin depending on meals, activity and glucose level. Insulin
pumps aren't for everyone. But for some people they provide improved blood sugar control and a
more flexible lifestyle.

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DIABETES MELLITUS
ELDERLY CARE
(Ms. Joanne Calma)

Melanie G. Villaluz

Batch No. 26