Diabetology

Diabetes Mellitus is a metabolic disorder involving blood sugar levels. The blood sugar level has to be maintained in a normal range to prevent morbidity and mortality in these patients. A good control of blood sugar levels will help them to have a normal span of life.

DM is a disorder of metabolism and inappropriate hyperglycemia due to either deficiency of insulin secretion or a combination of insulin resistance and inadequate secretion. There are two types of diabetic mellitus.

• TYPE1: This is due to islet beta cell destruction by an autoimmune process. This occurs at any age but most commonly children and young adults. As the insulin secretion is totally absent these patients have to necessarily be on insulin lifetime. This accounts for 10% to 15% of all diabetes.
• TYPE2: In these patients, though insulin is secreted, either it is insufficient or does not work due to insulin resistance. This type can be seen in people from the age of 20-25yrs to any age.

The main symptoms of diabetes mellitus are frequent urination, excessive thirst, increased appetite and loss of weight. When the complications develop the patient can have burning sensation in feet, benumbed feeling on the feet, visual disturbance, chest pain, difficulty in breathing difficulty or weakness of one half of the body, swelling of the legs, vomiting.

Normal fasting blood sugar is 70-110mg/dl, postprandial 80-140mg/dl, random blood sugar 80-130mg/dl HBA1C: 6.5 to 7% if the blood sugar levels are more than above said 11 am is in more than one sitting, a diagnosis of DM is confirmed.

To start with lifestyle management is very important. Every patient should have moderate exercise of 30-40 minutes daily.

Carbohydrates in the diet have to be brought to be minimum total diet intake has to be decided according to the body weight. Diet charts can be given accordingly to body weight.

Different groups of drugs like secretagogues stimulate insulin secretions. Biguanides, Thiazolidinedione which breaks insulin resistance. DPP4 inhibitor and SGLT4 inhibitor can be used. In these patients when the OHAs fail they have to be put on insulin either huminsulin or analogues.