Classification of diabetes mellitus
Diabetes mellitus is a medical condition of a metabolic disorder resulting from a frank lack of, or diminished, effectiveness of endogenous insulin and is (diabetes mellitus) characterized by increase or rise in blood sugar or plasma glucose. A diabetic patient at first time does not know that they have diabetes as the condition does not show any symptoms as that time of onset.
As time goes on the diabetic patient will start showing some diabetes symptoms that will first bring him or her to the diabetic clinic. Such of the symptoms include but not limited to ketoacidosis, unwell, increased breathing rate, and smell of ketones on breath, weight loss, frequent urination (polyuria), fatigue, tiredness, and dehydration, increased thirst (polydipsia), which are the most common among the symptoms of diabetes.
On classification, diabetes is classified in two major types of diabetes: type 1 diabetes and type 2 diabetes. While other sub types may exist like gestational diabetes which is associated with pregnancy and most likely disappears after the pregnancy.
Type 1 – Insulin-dependent Diabetes Mellitus, IDDM: This is usually juvenile in onset but may occur at any age, and it is characterized by frank insulin deficiency. Patients suffering from type I diabetes regularly needs insulin injection through insulin pumps and other comfortable insulin devices. Patients suffering from type 1 diabetes, IDDM, are more prone to suffer weight loss and ketoacidosis. Type 1 diabetes is usually associated other immune diseases like HLA DR3 & DR4 and positive islet cell antibodies around the time of diagnosis. Type 1 diabetes, which is insulin dependent (IDDM) can as well be co-controlled using the right and appropriate diabetes diet as well as regular physical exercise upon the doctor’s attention.
Type II – Non-insulin-dependent Diabetes Mellitus, NIDDM: This type of diabetes sets in during the matured age- maturity onset of diabetes mellitus. It sets in older age group, often obese. NIDDM may eventually need insulin, but this does not mean that IDDM has developed. Insulin is likely to be needed in non-insulin diabetes mellitus, NIDDM, in those diabetic patients who may have ketonuria and with glucose level that is greater than 25mmol/L.
Other conditions of non-insulin dependent diabetes that may warrant the use of insulin include sudden onset of the diabetes, rapid weight loss and dehydration or loss of water/or body fluid. If the diabetic ketoacidosis persists, then IDDM exists largely due to impaired insulin secretion and/or insulin resistance.
Causes of secondary diabetes include most of the following:
1. Drugs- such as steroid drugs and thiazides drugs
2. Pancreatic disease such as pancreatitis, surgery in which over 90% of the pancreas is removed, haemochromatosis, cystic fibrosis, and pancreatic cancer
3. Endocrine conditions like acromegaly, Cushing’s disease, phaechromocytoma, thyrotoxicosis)
4. Others include acanthosis nigricans, congenital lipodystrophy with insulin receptor antibodies, and glycogen storage diseases.
Diabetes Diagnosis: According to the World Health Organization (WHO) criteria adopted by United Kingdom in June 2000. Fasting venous blood sample for glucose, and if the blood glucose level is above or equal to 7mmol/L; a glucose level of 6-7mmol/L implies impaired fasting glucose. If the patient has no diabetes symptoms, diabetes diagnosis should not be based on a single glucose value.
If there is any doubt about the diabetic status of the patient, the 2-hour value in an oral glucose tolerance test, OGTT should be used. The method for performing the 2-hour oral glucose tolerance test (OGTT) follows: the patient should fast overnight and in the morning should be given 75g of glucose dissolved in 300mL of water and given to drink. Then the venous blood sample collected 2 hours after drinking the glucose solution, and then tested for venous sample glucose level. Note that urine tests for glycosuria and random blood glucose tests are unreliable ( but if >11.1mmol/L and symptoms are present, this confirms diabetes mellitus, DM)
In some conditions, blood glucose or blood sugar may rise significantly. Such conditions in which this may occur include acute infection, trauma, or circulatory or other stress which may be transitory, are all conditions in which a patient may be seen presenting with severe hyperglycemia. When this happens, formal diabetes diagnosis should be delayed, but management should be followed promptly.
With reference to HbA1c values, if it is above 7%, diabetes mellitus is likely and risk of microvascular diabetic complications is higher.
The diabetes management base line borders on weight loss and exercise, manage hyperglycemia, with diabetes diet, drugs or insulin. Vitamin E improves insulin sensitivity, reducing insulin insensitivity and (Vitamin E) serves as powerful anti oxidant delaying damaging oxidation by removing free radicals of metabolism.
Diabetic patients need motivation and proper diabetes education in order to enable them cope with the new metabolic condition. Diabetes has been shown to be controlled, and managed, and even some diabetes treatment regimens are becoming widely accepted. Most of these diabetes treating course are mostly based on natural diabetes diet/diabetic diets that have the potency to regenerate new islet cells of the pancreas thereby increasing insulin secretion and insulin sensitivity.
