Diabetes mellitus

DM is characterized by hyperglycaemi due to absolute or relative insulin deficiency.there are two subtype.
a)type 1 -severe insulin deficiency due to autoimmune destruction of the pancreatic islets
b).type 2:commonly affectes people who are obese and insulin -resistant,although impaired beta cell function of pancrease.

The differece between type 1 and type 2 are:
Type 1:'
Usually age of onset is les than 20,body weight normal or low,plasma insuline low or absent,plasma glucagon high ,can be suppressed ,plasma insulin increase,insulin sensitivity is normal,ketonuria is present,no family history of diabetes and death is rapid without insulin therapy.For type 1 DM ,oral drugs cannot be used.Only insulin injection can be given.

Type 2:
Age of onset usuualy 40 above,obese,plasma glucagon high and resistant to supprression,plasma insulin mormal or high,plasma glucose high,ketonuria is absent ,family has a history of DM .for this type weight loss and oral hypoglycemic agent is  sufficient.

Lab investigation that can be done are:
-Urine test for glucose and ketones
-blood glucose level:fasting -3.6 to.6.1 if more than 7.8  is DM
                                        :Random plasma glucose -7 to 11,more than 11 is DM
                                         Ater meal-should be less than within 11.1 if more thanh 13,its  DM.

Clinical features of Diabetes are:
-frequent urination(polyuria)
-excessive hunger and thrist
-rapid weight loss
-weakness or fatigue
-tachycardia(heart rate more than 100)
-dehydration
-hypotension
-hypoithermia(feeling cold)
-confusion
-drowsiness
-hyperventilation(sweating )
-muscle wasting

Complication of diabetes:
Impaired vision
Renal failure
Sensory loss
Postural hypotension
Foot ulceration
Sometimes itching of the genetalia(pruritus vulvae in women or balanitis in men can occur due to candida yeast infection(trush).This occur due to high sweetness of urine which favour fungal infection.
Sometimes the breath may have sweet smell of ketones.skin infection with boils  and abscess are common
Acanthosis nigricans(soft velvety ,brown skin) is a sign of hyperinsulinism and frequently seen in axillae(armpit) and groins of patients with insulin -resistant type 2 diabetes.
Look for xanthomata (a soft nodules like_) which indicates hyperlipidaemia.
Examine insulin injection site for evidence of lipohyperttophy(which may cause unpredictable insulin release).

Treatment for Diabetes:
Type 1 and gestation DM (which occur during pregnancy  can only be treated with insulin injection.insulin is toxic to baby.so it should not be given to pregnant mother.
Type 2:
-glibenclamide
-glipizide
-glimepiride
-tolbutamide
-chloropropamide (those drugs is not suitable for obese people cause it can increase weight and cholestrol level.
Incase of obese people-metformin
For person have increase glucose level after meal-repaglinide and nateglinide can be use.
Others
-pioglitazone
-rosiglitazone
-acarbose
-miglitol
-sitagliptin
-vildagliptin can be given.

Normal walking can also stimulate insulin secretion,so people with diabetes can go for a walk after meal .