Diabetes Mellitus

Introduction

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia and abnormalities in carbohydrate, fat, and protein metabolism.

TYPE 1 DIABETES MELLITUS

• The most common initial symptoms are polyuria, polydipsia, polyphagia, weight loss, and lethargy accompanied by hyperglycemia.
• Individuals are often thin and are prone to develop diabetic ketoacidosis if insulin is withheld or under conditions of severe stress.
• Between 20% and 40% of patients present with diabetic ketoacidosis after several days of polyuria, polydipsia, polyphagia, and weight loss.

TYPE 2 DIABETES MELLITUS

Patients are often asymptomatic and may be diagnosed secondary to unrelated blood testing.

• Lethargy, polyuria, nocturia, and polydipsia can be present. Significant weight loss is less common; more often, patients are overweight or obese.

Diagnosis

Criteria for diagnosis of DM include any one of the following:

1. A1C of 6.5% or more
2. Fasting (no caloric intake for at least 8 hours) plasma glucose of 126 mg/dL (7.0 mmol/L) or more
3. Two-hour plasma glucose of 200 mg/dL (11.1 mmol/L) or more during an oral glucose tolerance test (OGTT) using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water
4. Random plasma glucose concentration of 200 mg/dL (11.1 mmol/L) or more with classic symptoms of hyperglycemia or hyperglycemic crisis. In the absence of unequivocal hyperglycemia, criteria 1 through 3 should be confirmed by repeat testing.

• Normal fasting plasma glucose (FPG) is less than 100 mg/dL (5.6 mmol/L).
• Impaired fasting glucose (IFG) is FPG 100 to 125 mg/dL (5.6–6.9 mmol/L).
• Impaired glucose tolerance (IGT) is diagnosed when the 2-hour post load sample of OGTT is 140 to 199 mg per dL (7.8–11.0 mmol/L).
• Pregnant women should undergo risk assessment for GDM at first prenatal visit and have glucose testing if at high risk (eg, positive family history, personal history of GDM, marked obesity, or member of a high-risk ethnic group).

Treatment: Goals of Treatment

Ameliorate symptoms, reduce risk of microvascular and macrovascular complications, reduce mortality, and improve quality of life.

NONPHARMACOLOGIC THERAPY

• Medical nutrition therapy is recommended for all patients. For type 1 DM, the focus is on physiologically regulating insulin administration with a balanced diet to achieve and maintain healthy body weight. The meal plan should be moderate in carbohydrates and low in saturated fat, with a focus on balanced meals. Patients with type 2 DM often require caloric restriction to promote weight loss.
• Aerobic exercise can improve insulin sensitivity and glycemic control and may reduce cardiovascular risk factors, contribute to weight loss or maintenance, and improve well-being.

Pharmacological therapy: Tab Glucophage (metformin) 500/750/850mg PO BD after meal

If blood sugar is not controlled then consider dual therapy

Tab Sitamet (Sitagliptin+metformin) 50/850-50/1000mg PO BD after breakfast, lunch or dinner

If blood sugar still not controlled the triple therpay

Tab Piozer plus(pioglitazone+metformin+)15/50015-15/85015mg 1tab PO BD with meals

Tab Diabeta(Gibenclamide) 5-15mg PO OD before breakfast

If still not controlled or there is complication of neuropathy then go for insulin

Dose of insulin is 0.5-0.7 unit/kg/day adjust according to response.