Diabetes mellitus- various aspects-Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā The diabetes which we speak generally in common language refers to diabetes mellitus
Symptoms of diabetes mellitus –
1 UsuallyĀ thereĀ mayĀ beĀ noĀ symptomsĀ atĀ all.. So instead of waiting for theĀ dayĀ toĀ comeĀ whenĀ the problemĀ comesĀ andĀ it isĀ necessary toĀ takeĀ treatmentĀ ,it isĀ alwaysĀ betterĀ toĀ getĀ done.Ā RandomĀ bloodĀ sugarĀ andĀ otherĀ investigationsĀ onceĀ youĀ cross theĀ age ofĀ 40 yrs. OtherĀ investigations include ECG, Blood pressure measurement from qualified experienced MD GeneralĀ Medicine doctor.
2 PatientĀ ofĀ diabetesĀ frequentlyĀ feelsĀ thirsty (polydipsia), so heĀ frequentlyĀ drinksĀ water. PeopleĀ workingĀ inĀ hisĀ office,any other profession startĀ commentingĀ onĀ him. InitialĀ comments mayĀ beĀ suchĀ thatĀ thisĀ individualĀ isĀ veryĀ hardĀ workingĀ ,soĀ heĀ feels thirstyĀ frequently. ButĀ asĀ weĀ knowĀ peopleĀ speakĀ something andĀ something elseĀ isĀ going onĀ inĀ theirĀ mind. ButĀ when theĀ problemĀ exceeds theĀ certainĀ limit the individual isĀ askedĀ toĀ consultĀ a doctor as the suspicion of diabetes mellitus arises in mind.
Ā 3 Polyphagia ā InĀ thisĀ theĀ dietĀ ofĀ theĀ individualĀ isĀ increased. UsuallyĀ we haveĀ ourĀ ownĀ judgementĀ ,butĀ whenĀ evenĀ withoutĀ doingĀ muchĀ workĀ weĀ feelĀ moreĀ hungryĀ thanĀ usualĀ thisĀ shouldĀ alert usĀ andĀ weĀ shouldĀ consultĀ aĀ qualified and experienced MD GeneralĀ MedicineĀ specialist doctorĀ .
TheĀ reasonĀ ofĀ polyphagiaĀ isĀ thatĀ inĀ Diabetes mellitus eitherĀ thereĀ isĀ lowĀ production ofĀ insulinĀ orĀ inabilityĀ of theĀ bodyĀ cellsĀ to utilizeĀ bloodĀ glucoseĀ asĀ theĀ cellsĀ becomeĀ resistantĀ toĀ insulin. InsulinĀ is necessaryĀ forĀ theĀ uptakeĀ of theĀ glucoseĀ by the bodyĀ cells. SoĀ inĀ both theĀ casesĀ theĀ uptakeĀ ofĀ glucoseĀ into theĀ cellsĀ isĀ decreasedĀ ,soĀ the individualĀ individualĀ feelsĀ muchĀ hungry.
4-Polyuria āAsĀ theĀ intakeĀ ofĀ waterĀ isĀ increased, dueĀ toĀ increasingĀ thirst, theĀ urine outputĀ naturallyĀ increases. SoĀ whenĀ allĀ theseĀ 3 things areĀ increasedĀ itĀ shouldĀ alarmĀ theĀ concernedĀ individual. WheneverĀ such anĀ individualĀ consultsĀ an MD General MedicineĀ doctorĀ initiallyĀ onlyĀ RandomĀ blood sugar isĀ advised. IfĀ itĀ turnsĀ highĀ thenĀ onlyĀ fastingĀ blood sugarĀ andĀ Post prandial (PP) blood sugar isĀ advised to rule out diabetes mellitus.
Such individualĀ shouldĀ seekĀ adviceĀ from anĀ experienced and qualified MD General Medicine doctor as earlyĀ diagnosis and treatmentĀ preventsĀ furtherĀ complications.
5 InĀ a normalĀ individualĀ wheneverĀ aĀ woundĀ occursĀ ,afterĀ someĀ daysĀ a scab formationĀ followedĀ byĀ skinĀ formation isĀ there, but inĀ caseĀ ofĀ diabetesĀ patient theĀ woundĀ remainsĀ rawĀ forĀ quiteĀ longĀ periods of time, howeverĀ highĀ antibiotics areĀ takenĀ andĀ howeverĀ wellĀ dressingsĀ areĀ given -theseĀ thingsĀ goĀ inĀ favourĀ ofĀ diabetes mellitus, butĀ treatment isĀ notĀ startedĀ unlessĀ blood sugar level crossesĀ 200 mg/dl.
6 FatigueāĀ An individual of diabetesĀ easilyĀ getsĀ exhausted. HeĀ findsĀ itĀ difficult toĀ doĀ too muchĀ hardĀ work.
7-BlurrringĀ ofĀ vision WhenĀ a personĀ hasĀ blurringĀ ofĀ visionĀ alongĀ withĀ ophthalmicĀ check up, testingĀ randomĀ blood sugarĀ alsoĀ becomes essential.
8 Giddiness -All theĀ above mentioned symptomsĀ mayĀ not beĀ there ,butĀ evenĀ ifĀ giddinessĀ isĀ there aloneĀ orĀ combinedĀ alongĀ with any of theseĀ aboveĀ mentionedĀ symptoms randomĀ blood sugar, ECG, blood pressureĀ evaluation, andĀ neurologistĀ consultationĀ isĀ required.Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Types of diabetes mellitus –
Following are theĀ different types of diabetes mellitus –
1-Type 1 diabetes.-ItĀ isĀ alsoĀ calledĀ juvenile diabetes.
TreatmentĀ canĀ helpĀ inĀ thisĀ caseĀ butĀ itĀ cannot be cured. ItĀ is aĀ chronicĀ conditionĀ in which the pancreasĀ produceĀ littleĀ or noĀ insulin. ItĀ is aĀ kind ofĀ autoimmuneĀ disorderĀ inĀ whichĀ autoantibodiesĀ developĀ whichĀ destroy theĀ betaĀ cellsĀ of islets of Langerhans thatĀ produceĀ insulin. ThisĀ occursĀ atĀ aĀ veryĀ earlyĀ ageĀ andĀ insulinĀ hasĀ to beĀ administeredĀ toĀ suchĀ patients.
2-Type 2 diabetes.- InĀ thisĀ thereĀ isĀ impairmentĀ inĀ theĀ wayĀ whichĀ ourĀ body regulatesĀ andĀ usesĀ glucose asĀ aĀ fuel.
For detailsĀ ofĀ symptoms of diabetes pl click on the link given below
The symptoms of diabetes mellitus givenĀ in the linkĀ mentioned aboveĀ areĀ only the general symptoms of diabetes, butĀ diabetes has effects on various body systems like nervous system, gastrointestinal system, skin wounds and infections, blood vessels, vision ,kidney -the description for which is given in the links mentioned below –
AllĀ theĀ following effectsĀ discussedĀ inĀ articlesĀ ofĀ theĀ aboveĀ links areĀ partĀ ofĀ symptoms of diabetes mellitus
AsĀ they are veryĀ lengthy ,theyĀ areĀ inĀ formĀ ofĀ seperate blogs -as-
EffectsĀ of diabetes onĀ gastrointestinal systemĀ
EffectsĀ ofĀ diabetesĀ onĀ nervousĀ systemĀ
EffectsĀ ofĀ diabetesĀ of skin
EffectsĀ ofĀ diabetesĀ onĀ wounds and infectionsĀ
EffectsĀ ofĀ diabetesĀ onĀ blood vessels
3-Gestational diabetes.It isĀ alsoĀ called as diabetes mellitus inĀ pregnancy.
In thisĀ the placentaĀ producesĀ certainĀ hormonesĀ thatĀ blockĀ theĀ effects of insulin. InĀ such pregnant womenĀ theĀ pancreasĀ does not produce enough insulin. AfterĀ delivery andĀ in later part of life there is possibilityĀ thatĀ such women canĀ developĀ TypeĀ -2 diabetesĀ mellitus.
There may be no symptoms at all, but asĀ routinely ANCĀ check up is doneĀ inĀ thatĀ theĀ diagnosisĀ ofĀ gestational diabetes comes ahead.
4-Maturity onset diabetes of the young (MODY)
Maturity-onset diabetes of the young (MODY) is a group of several conditions characterized by abnormally high blood sugar levels. These forms of diabetes typically begin before theĀ individual reaches theĀ ageĀ of 30, although they can occurĀ at later ageĀ in life.
5-Neonatal diabetes-
What Is Neonatal Diabetes? Neonatal diabetes mellitus is a rare form of diabetes that occursĀ inĀ individuals within the age ofĀ first 6 months of life. HumansĀ need insulin to help theĀ various cells ofĀ theĀ bodyĀ to produceĀ energy. Infants with this condition do not produce enough insulin, asĀ aĀ result of which the blood glucose levels increase.
6-Wolfram Syndrome.
7-Alstrƶm Syndrome.
8-Latent Autoimmune diabetes in Adults (LADA)
Wolfram Syndrome.
6-Wolfram syndrome is a genetically inherited condition that is typically associated with childhood-onset insulin-dependent diabetes mellitus and progressive optic atrophy. In addition, many individualsĀ with Wolfram syndrome also develop diabetes insipidus and sensorineural hearing loss.
What are the four most common features of Wolfram syndrome?
Wolfram Syndrome is a rare genetic disorder which is also known as DIDMOAD syndrome after its four most common features (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness).
7-Alstrƶm Syndrome.
Alstrƶm syndrome is characterized by a progressive loss of vision and hearing, a form of heart disease that enlarges and weakens the heart muscle (dilated cardiomyopathy ), obesity, type 2 diabetes (the most common form of diabetes), and short stature.
Alstrƶm syndrome is a rare condition that affects variousĀ body systems. Many of the clinical features of this condition begin in infancy or early childhood, butĀ some appear later in life.
8-Latent Autoimmune diabetes in Adults (LADA)-
Latent autoimmune diabetes mellitus in adults (LADA) is a slow-progressing form of autoimmune diabetes. Like the autoimmune disease type 1 diabetes, LADA occurs because your pancreas stops producing adequate insulin, mostly due to the autoantibodiedĀ which slowly damage theĀ BetaĀ cellĀ ofĀ islets of Langerhans whichĀ produce insulin . But itĀ isĀ notĀ asĀ severeĀ asĀ type 1 diabetes as theseĀ affectedĀ individuals oftenĀ do notĀ requireĀ insulin for several months up to years after beingĀ diagnosed.
InvestigationsĀ in diabetes mellitus-Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā
Random blood sugar
IfĀ randomĀ blood sugarĀ isĀ atĀ higher levelsĀ thenĀ Ā Fasting andĀ postĀ prandialĀ blood sugar levelsĀ need to beĀ done.
InĀ cases ofĀ chronicĀ diabetes mellitusĀ Hb 1 ACĀ need to beĀ done, which isĀ described inĀ detailĀ belowĀ inĀ thisĀ article.
AsĀ diabetes isĀ usuallyĀ associatedĀ withĀ hypertension andĀ elevatedĀ levelsĀ ofĀ serumĀ cholesterol, it isĀ necessary to do –
Lipid profile
Assessment ofĀ blood pressureĀ fromĀ physican (MD-GeneralĀ Medicine)
HbA1c-
HbA1cĀ is the average period of bloodĀ sugar levels inĀ yourĀ bloodĀ over aĀ period ofĀ 2-3 months .YouĀ mustĀ have ā heardĀ aboutĀ mean medianĀ andĀ mode. These areĀ measures ofĀ centralĀ tendency. IfĀ there areĀ 25Ā peopleĀ travellingĀ through aĀ bus andĀ we want toĀ findĀ theirĀ averageĀ height, thenĀ whatĀ we doĀ isĀ thatĀ weĀ addĀ upĀ theirĀ heightsĀ and divideĀ byĀ 25 ,thisĀ gives usĀ anĀ idea of theirĀ averageĀ height.
SimilarlyĀ HbA1cĀ isĀ theĀ averageĀ level ofĀ bloodĀ sugarĀ over aĀ period ofĀ 2-3 months.
It isĀ necessaryĀ inĀ thoseĀ individuals with diabetes mellitus who haveĀ fluctuatingĀ levels ofĀ bloodĀ sugar, thoseĀ who areĀ at theĀ risk of developingĀ typeĀ 2 diabetes.
NormalĀ level ofĀ HbA1cĀ in a diabeticĀ individualĀ isĀ aboutĀ 48mmol/molecular andĀ ideallyĀ itĀ should beĀ belowĀ 42 mmol/mol .
Explanation -In aĀ diabeticĀ individual theĀ levelĀ ofĀ bloodĀ sugarĀ isĀ highĀ asĀ theĀ bodyĀ cellsĀ are not able toĀ utilizeĀ theĀ glucoseĀ in blood dueĀ toĀ inabilityĀ ofĀ glucoseĀ toĀ getĀ transportedĀ into theĀ bodyĀ cells. Haemoglobin is aĀ moleculeĀ in theĀ RBCs((RedĀ bloodĀ corpuscles)Ā that isĀ necessaryĀ forĀ transportĀ ofĀ oxygen. TheĀ excess ofĀ glucoseĀ combinesĀ withĀ haemoglobinĀ toĀ formĀ glycatedĀ Haemoglobin.
SoĀ moreĀ theĀ levelsĀ ofĀ glycatedĀ haemoglobinĀ more isĀ theĀ hb 1 ac levels in case of diabetes mellitus.
NormalĀ levels ofĀ Hb1 ACĀ areĀ belowĀ 5.7 percent. InĀ pre-diabetes itĀ isĀ betweenĀ 5.7 percentĀ toĀ 6.4 percent. InĀ diabetesĀ itĀ isĀ moreĀ thanĀ 6.5 percent.
FactorsĀ affectingĀ theĀ levelsĀ ofĀ Hb1ac.
1 -Anaemia -In anaemiaĀ theĀ HaemoglobinĀ percentageĀ isĀ veryĀ lowĀ soĀ Ā glycosylatedĀ Hb is alsoĀ lowĀ andĀ soĀ leadsĀ toĀ falseĀ lowĀ levels.
2- InĀ liverĀ andĀ kidney diseaseĀ falseĀ valuesĀ areĀ obtained .
3-WhenĀ VitaminĀ C andĀ VitaminĀ E areĀ givenĀ then theĀ valuesĀ ofĀ He 1 ACĀ obtainedĀ areĀ misleading
4- WhenĀ theĀ cholesterolĀ levelĀ isĀ highĀ inĀ untreatedĀ casesĀ theĀ valuesĀ ofĀ GB 1 AC areĀ notĀ correct.
InĀ allĀ theseĀ situations wheneverĀ youĀ consultĀ yourĀ qualifiedĀ andĀ experiencedĀ MD MedicineĀ doctor for diabetes mellitus youĀ haveĀ toĀ letĀ himĀ knowĀ allĀ theseĀ details, asĀ it isĀ quiteĀ possibleĀ thatĀ beingĀ busyĀ inĀ heavyĀ OPD, heĀ mayĀ notĀ getĀ timeĀ toĀ askĀ youĀ allĀ theseĀ things. SoĀ awarenessĀ isĀ quiteĀ important. IfĀ weĀ knowĀ certainĀ thingsĀ weĀ areĀ definitelyĀ benefitted.
HowĀ frequentlyĀ thisĀ testĀ ofĀ Hb 1 ac should be done. -An individualĀ withĀ diabetesĀ shouldĀ doĀ thisĀ test atĀ leastĀ onceĀ inĀ 3 monthsĀ period. IfĀ satisfactoryĀ blood sugarĀ levels areĀ maintainedĀ thenĀ thisĀ testĀ canĀ beĀ doneĀ lessĀ frequently .AĀ minimumĀ twoĀ timesĀ perĀ yearĀ should be doneĀ inĀ diabeticĀ individuals.
DietĀ requiredĀ byĀ diabetes mellitus individualsĀ isĀ bitĀ differentĀ fromĀ non diabetics. BelowĀ hereĀ weĀ mentionĀ theĀ detailsĀ ofĀ dietĀ requiredĀ by a person who hasĀ diabetesĀ mellitus –
Diabetic diet -Part -1
An individualĀ withĀ diabetesĀ shouldĀ avoidĀ eatingĀ processedĀ Ā foods, deserts, outside snacks. HomemadeĀ foodĀ shouldĀ beĀ preferred.
FoodsĀ withĀ highĀ caloricĀ value, tooĀ muchĀ sweets, ghee, friedĀ foodsĀ should beĀ avoided..
DietĀ richĀ inĀ fruits, vegetablesĀ ,andĀ proteinsĀ isĀ helpfulĀ inĀ diabeticĀ individuals.
SugaryĀ andĀ starchyĀ carbohydratesĀ inĀ highĀ amounts canĀ increaseĀ theĀ bloodĀ sugarĀ levels. TheyĀ should beĀ givenĀ inĀ theĀ rightĀ amountĀ asĀ perĀ theĀ instructions ofĀ balancedĀ diet. ForĀ thisĀ adviceĀ should beĀ takenĀ fromĀ dietician.
It depends on what type ofĀ occupation the individualĀ isĀ doingĀ ,theĀ level ofĀ hardĀ physicalĀ workĀ inĀ it -fromĀ thisĀ the dieticianĀ willĀ decideĀ theĀ type ofĀ carbohydrate inĀ dietĀ andĀ theĀ amount ofĀ carbohydrate inĀ diet for patients of diabetes mellitus.
ItĀ alsoĀ depends on the factĀ that whatĀ medicationĀ isĀ going on to theĀ diabetes patient whetherĀ it isĀ insulin orĀ oralĀ hypoglycemic agent andĀ theĀ dosageĀ ofĀ these.
Ā RegardsĀ dietĀ consultation should be done from yourĀ dieticianĀ andĀ MD GeneralĀ MedicineĀ doctor only.
Following areĀ the guidelines ā
Fruits and vegetablesĀ should beĀ takenĀ inĀ diet.
Lean proteinĀ should beĀ included inĀ diet.
GreenĀ leafy vegetables areĀ richĀ inĀ mineralsĀ vitamins, nutrients.
TheyĀ do not haveĀ muchĀ great impact onĀ bloodĀ sugarĀ levels of diabetes mellitus patients. Green leafyĀ vegetablesĀ likeĀ spinach andĀ kaleĀ are rich inĀ potassium, calcium ,vitaminĀ A .Proteins andĀ fiber areĀ alsoĀ presentĀ inĀ it.
GreenĀ leafyĀ vegetablesĀ haveĀ antioxidantsĀ andĀ starchĀ digestingĀ enzymesĀ whichĀ areĀ ofĀ advantage toĀ diabeticĀ individuals.
List ofĀ greenĀ leafyĀ vegetablesĀ thatĀ should beĀ takenĀ byĀ diabeticĀ individualsĀ areĀ ā
Spinach
Kale
Cabbage
Broccoli
CollardĀ greens
Bok choy
FoodsĀ should beĀ suchĀ thatĀ sugarĀ should not beĀ addedĀ intoĀ it.
JuiceĀ should beĀ madeĀ fromĀ kaleĀ andĀ givenĀ to diabetes mellitusĀ patients -itĀ helpsĀ toĀ reduceĀ blood sugarĀ levels. ItĀ doesnātĀ helpĀ toĀ lowerĀ Blood pressureĀ inĀ individualsĀ withĀ highĀ levelsĀ ofĀ bloodĀ pressureĀ butĀ itĀ helpsĀ toĀ lowerĀ bloodĀ pressureĀ inĀ individualsĀ withĀ subclinical hypertension.
Ā 300 ml ofĀ kaleĀ juiceĀ shouldĀ beĀ drunkĀ byĀ theseĀ individualsĀ perĀ dayĀ forĀ aĀ duration ofĀ 6 weeks.
Ā IfĀ youĀ areĀ doingĀ thisĀ youĀ need toĀ informĀ yourĀ regularĀ MD MedicineĀ doctorĀ so thatĀ whatever youĀ doĀ isĀ withĀ hisĀ permission.
AllĀ thisĀ list ofĀ vegetablesĀ shouldĀ beĀ takenĀ inĀ salads, sideĀ dishĀ ,soups, dinners. A source ofĀ leanĀ proteinĀ likeĀ chickenĀ should beĀ combined withĀ it.
WholeĀ grainsĀ areĀ preferableĀ inĀ comparison toĀ refinedĀ grainsĀ asĀ they containĀ moreĀ nutrientsĀ andĀ moreĀ fiber material.
MoreĀ amountĀ ofĀ fiber willĀ increase theĀ timeĀ requiredĀ forĀ digestiveĀ process .ThisĀ willĀ reduce theĀ rate ofĀ absorption ofĀ nutrientsĀ andĀ inĀ thisĀ wayĀ itĀ willĀ helpĀ toĀ stabilizeĀ theĀ bloodĀ sugarĀ levels of diabetes mellitus patients.
ExamplesĀ ofĀ wholeĀ grainsĀ are-
Whole grainĀ bread
BrownĀ rice
Buckwheat
Quinoa
Rye,
Bulgur
Millet
Decision regarding ArtificialĀ sweeteners availableĀ in theĀ marketĀ shouldĀ beĀ takenĀ only afterĀ consultation with your MD GeneralĀ MedicineĀ doctor asĀ someĀ ofĀ these artificial sweetenersĀ areĀ attributedĀ toĀ be carcinogenic.
IfĀ youĀ areĀ aĀ diabetes mellitus patient on oral hypoglycemic andĀ youĀ haveĀ got operatedĀ inĀ someĀ hospitalĀ forĀ someĀ surgery, before doingĀ surgeryĀ youĀ shouldĀ informĀ theĀ concernedĀ operatingĀ surgeonĀ aboutĀ theĀ ongoingĀ medications.
Ā ImmediatelyĀ afterĀ post -operative periodĀ thereĀ isĀ aĀ periodĀ ofĀ 6 hrs.Ā NBM. InĀ thisĀ periodĀ patientĀ isĀ notĀ allowedĀ toĀ eatĀ orĀ drink anything. IvĀ fluidsĀ areĀ allowed inĀ this period. EvenĀ afterĀ thisĀ periodĀ andĀ theĀ nextĀ dayĀ theĀ appetiteĀ of theĀ patientĀ isĀ veryĀ low andĀ so eitherĀ oral hypoglycemicĀ drugsĀ should not be taken asĀ perĀ the consultationĀ ofĀ your operatingĀ surgeon andĀ your regularĀ MD GeneralĀ MedicineĀ doctor.
DangerousĀ hypoglycemia canĀ resultĀ asĀ already theĀ foodĀ intakeĀ isĀ lowĀ ,soĀ bloodĀ sugar isĀ low, on theĀ topĀ ofĀ thatĀ ifĀ oralĀ hypoglycemic agents areĀ takenĀ thenĀ theĀ bloodĀ sugarĀ canĀ dropĀ toĀ tooĀ muchĀ lowĀ levels andĀ itĀ canĀ causeĀ fainting .
ToĀ someĀ extentĀ hyperglycemiaĀ isĀ ok, butĀ hypoglycemiaĀ isĀ tooĀ muchĀ dangerous in patients of diabetes mellitus.
Diabetic diet -Part -2
Fatty fishĀ containĀ omegaĀ -3 FattyĀ acids.These are also known asĀ EPA andĀ DHA.
IfĀ dietĀ containsĀ monounsaturatedĀ andĀ polyunsaturatedĀ fattyĀ acidsĀ thenĀ itĀ can achieveĀ better diabetic control .AlsoĀ if theĀ diabetic individualĀ hasĀ elevatedĀ lipid profileĀ then controlĀ can beĀ achievedĀ overĀ itĀ also. FishĀ thatĀ haveĀ goodĀ level of monounsaturated and polyunsaturated fatty acidsĀ are
Salmon
Herring
Trout .
PrawnsĀ shouldĀ beĀ avoidedĀ byĀ diabeticĀ individualsĀ andĀ thoseĀ withĀ elevated levels lipidĀ profile .
Baked roastedĀ grilledĀ fishĀ should beĀ consumed.
FriedĀ fishĀ should beĀ avoided asĀ itĀ willĀ causeĀ intake ofĀ oilĀ inĀ dietĀ andĀ weĀ alwaysĀ try toĀ avoidĀ oilĀ inĀ diabeticĀ individualsĀ andĀ inĀ individualsĀ withĀ elevatedĀ Ā lipid profile .
BeansĀ are good forĀ diabetes mellitus individuals asĀ theyĀ haveĀ a lowerĀ sideĀ glycaemicĀ index.Ā TheyĀ haveĀ highĀ content ofĀ protein andĀ lowĀ content ofĀ carbohydrateĀ soĀ theyĀ helpĀ inĀ betterĀ regulationĀ ofĀ bloodĀ sugarĀ asĀ comparedĀ to theĀ starchyĀ foods.They alsoĀ containĀ iron, potassiumĀ andĀ magnesium.
Also appetiteĀ of theĀ individualĀ isĀ satisfied. So itĀ canĀ helpĀ inĀ weightĀ loss, control ofĀ blood pressureĀ andĀ cholesterolĀ levels.
AvoidĀ takingĀ beans fromĀ outsideĀ whichĀ areĀ cannedĀ ,soĀ salted
MakeĀ themĀ at home toĀ avoidĀ this.
Walnuts -These areĀ alsoĀ richĀ inĀ omegaĀ 3 fattyĀ acids .Theses areĀ good forĀ heart andĀ as diabetes mellitusĀ patientsĀ haveĀ tendencyĀ toĀ developĀ heartĀ disease, soĀ thoseĀ should beĀ utilizedĀ byĀ diabeticĀ individuals.
OmegaĀ -3 fattyĀ acidsĀ canĀ achieveĀ betterĀ diabeticĀ controlĀ andĀ alsoĀ controlĀ overĀ elevatedĀ lipidĀ profile. WalnutsĀ alsoĀ containĀ Magnesium, VitaminĀ B 6,iron ,proteins .
Citrus fruitsĀ containĀ bioflavonoidĀ antioxidantsĀ -naringin andĀ hesperidin andĀ these are responsible forĀ theĀ antidiabetic effectsĀ ofĀ oranges.
CitrusĀ foodsĀ alsoĀ containĀ mineralsĀ likeĀ potassiumĀ ,folateĀ andĀ VitaminĀ C
Berries -There isĀ lot ofĀ oxidativeĀ stressĀ inĀ patientsĀ ofĀ diabetes mellitus. BerriesĀ helpĀ toĀ decreaseĀ it asĀ theyĀ containĀ lot ofĀ antioxidants .OxidativeĀ stressĀ isĀ a conditionĀ thatĀ occursĀ whenĀ thereĀ isĀ imbalanceĀ betweenĀ freeĀ radicalsĀ andĀ antioxidantsĀ inĀ our body.
BerriesĀ thatĀ should beĀ consumedĀ areĀ blueberries
blackberries
StrawberriesĀ 
raspberries
BesidesĀ beingĀ helpfulĀ inĀ diabetes theyĀ alsoĀ containĀ fibre, mineralsĀ like potassium ,manganese, Vitamin K, vitamin C.
As dueĀ toĀ busyĀ scheduleĀ weĀ mayĀ forget toĀ consumeĀ themĀ weĀ shouldĀ makeĀ aĀ practiceĀ toĀ includeĀ itĀ inĀ outĀ breakfast.
SweetĀ potatoes areĀ beneficialĀ forĀ patientsĀ withĀ diabetes mellitusĀ asĀ theyĀ release bloodĀ sugarĀ slowly andĀ besidesĀ theyĀ alsoĀ provideĀ us vitaminĀ A, vitaminĀ C, fibre ,potassium .
Probiotic Yogurt -These reduceĀ inflammation andĀ oxidativeĀ stress .IfĀ aĀ patientĀ ofĀ diabetesĀ hasĀ elevatedĀ bloodĀ cholesterolĀ levelsĀ thenĀ thisĀ pro biotic yogurtĀ willĀ helpĀ toĀ decreaseĀ it. ItĀ hasĀ beenĀ foundĀ thatĀ diabetesĀ ,elevatedĀ cholesterolĀ andĀ hypertensionĀ areĀ associatedĀ withĀ each other. Pro bioticĀ yogurtĀ containsĀ culturesĀ ofĀ Lactobacillus ofĀ Bifidobacterium.If aĀ diabetic patientĀ isĀ purchasingĀ pro bioticĀ yogurtĀ fromĀ the marketĀ thenĀ heĀ shouldĀ make itĀ sureĀ thatĀ itĀ doesnātĀ containĀ anyĀ addedĀ sugar.
Chia seeds -These containĀ highĀ levelsĀ ofĀ antioxidantsĀ andĀ omega3 fattyĀ acidsĀ are thusĀ reduce theĀ oxidativeĀ stressĀ inĀ diabetes mellitus patient.People do notĀ likeĀ to consumeĀ itĀ directlyĀ soĀ theyĀ shouldĀ beĀ addedĀ toĀ saladsĀ andĀ desserts.
Treatment of diabetes mellitus-
Treatment of diabetes is with a few different medications. Some are taken orally , while others are available as injections.
Type 1 diabetes mellitus
Insulin is the main treatment for type 1 diabetes. It replaces the hormone your body isnāt able to produce.
Various types of insulin are commonly used by people with type 1 diabetes. They differ in how quickly they start to work and how long their effects last:
Rapid-acting insulin: starts to work within 15 minutes and its effects last for 2 to 4 hours
Short-acting insulin: starts to work within 30 minutes and lasts 3 to 6 hours
Intermediate-acting insulin: starts to work within 2 to 4 hours and lasts 12 to 18 hours
Long-acting insulin: starts to work 2 hours after injection and lasts up to 24 hours
Ultra-long acting insulin: starts to work 6 hours after injection and lasts 36 hours or more
Premixed insulin: starts working within 5 to 60 minutes and lasts 10 to 16 hours
Type 2 diabetes mellitus
Diet and exercise can help some people manage type 2 diabetes. If lifestyle changes arenāt enough to lower your blood sugar, youāll need to take medication.
These drugs lower your blood sugar in a variety of ways:
Drugs- Mechanisms ofĀ action -Examples-
alpha-glucosidase inhibitors slow your bodyās breakdown of sugars and starchy foods
acarbose (Precose) and miglitol
biguanides reduce the amount of glucose your liver makes.
alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia)
glucagon-like peptide stimulate your pancreas to produce more insulin; slow stomach emptying
semaglutide (Ozempic), dulaglutide (Trulicity), exenatide (Byetta), and liraglutide (Victoza)
meglitinides stimulateĀ pancreas of diabetes mellitus patient to release more insulin .
nateglinide and repaglinide
SGLT2 inhibitors release more glucose into the urine
canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance)
sulfonylureasstimulate your pancreas to release more insulin
glyburide (Glynase), glipizide (Glucotrol), and glimepiride (Amaryl)
thiazolidinedione help insulin work better.
You may need to take more than one of these medications. Some people with type 2 diabetes also take insulin.
Insulin-
What is Insulin ?
Insulin is a hormone that is secreted by the beta cells of the pancreas. It helps to regulate blood sugar levels and it has been found to effectively treat diabetes mellitus. InsulinĀ isĀ a hormone. ItĀ isĀ mainlyĀ producedĀ in theĀ bodyĀ by theĀ isletsĀ ofĀ Langerhans.
IsletsĀ ofĀ LangerhansĀ areĀ aĀ group ofĀ cellsĀ inĀ theĀ pancreas -theyĀ produceĀ insulin. They notĀ onlyĀ doĀ theĀ production ofĀ insulinĀ butĀ alsoĀ decideĀ howĀ muchĀ amountĀ should beĀ produced. TheĀ amountĀ producedĀ dependsĀ on theĀ bloodĀ glucoseĀ levels. IfĀ theĀ amountĀ ofĀ bloodĀ glucose isĀ increased thenĀ theĀ amount ofĀ insulinĀ producedĀ isĀ alsoĀ increased.
PancreasĀ isĀ endocrineĀ gland. ItĀ secretesĀ insulinĀ directlyĀ intoĀ blood. ThisĀ isĀ inĀ contrastĀ toĀ otherĀ glandsĀ thatĀ areĀ exocrine-like salivaryĀ glandsĀ whichĀ haveĀ ducts.
AsĀ endocrineĀ glandsĀ do not haveĀ ducts theirĀ secretionĀ isĀ directlyĀ added toĀ blood.Insulin needs to be administered externally to some diabetes mellitus patients.
IntroductionĀ toĀ hormones ā
HormonesĀ areĀ chemo messengers thatĀ influenceĀ theĀ targetĀ organsĀ orĀ cells. HormonesĀ doĀ theĀ work ofĀ givingĀ specificĀ instructionsĀ toĀ cellsĀ due toĀ whichĀ theĀ bodyĀ cellsĀ canĀ actĀ in a specificĀ way. SimilarlyĀ insulinĀ helpsĀ toĀ transferĀ glucoseĀ fromĀ bloodĀ intoĀ cells andĀ soĀ theĀ cellsĀ getĀ energy .Thus itĀ helpsĀ the cells to utilize glucose.
Indirectly insulinĀ isĀ requiredĀ byĀ humansĀ toĀ remainĀ alive. IfĀ theĀ levels ofĀ insulin are less (Insulin dependentĀ diabetesĀ mellitus. )/IDDM orĀ ifĀ theĀ cellsĀ areĀ lessĀ responsiveĀ toĀ insulin (Non -insulinĀ dependent diabetesĀ mellitus ) thenĀ theĀ levels of glucose in bloodĀ willĀ increase.
Ā InĀ IDDMĀ there isĀ malfunctioningĀ of systemĀ due toĀ whichĀ theĀ immuneĀ systemĀ attacks theĀ isletsĀ ofĀ LangerhansĀ so thatĀ insulinĀ productionĀ isĀ affectedĀ andĀ itĀ becomesĀ necessary toĀ administerĀ insulinĀ toĀ theĀ individual .
Ā .
Insulin isĀ givenĀ toĀ thoseĀ diabetes patientsĀ whoĀ doĀ notĀ respondĀ toĀ oralĀ hypoglycemicĀ agents .
TheĀ type ofĀ insulinĀ thatĀ shouldĀ beĀ givenĀ toĀ diabetes mellitus patientĀ byĀ MD MedicineĀ doctorĀ is decidedĀ by theĀ followingĀ factors ā
TheĀ timeĀ ofĀ onset ofĀ actionĀ afterĀ insulinĀ isĀ given
TheĀ timeĀ required toĀ achieveĀ theĀ peakĀ effectĀ ofĀ action
TheĀ duration till whenĀ theĀ action ofĀ insulinĀ willĀ persist(the timeĀ intervalĀ tillĀ whenĀ theĀ hypoglycemicĀ actionĀ ofĀ insulinĀ willĀ last)
TheĀ routeĀ ofĀ administrationĀ ofĀ insulin
Ā Subcutaneous
Ā Intravenous
Ā Nasal spray
TheĀ most commonĀ route forĀ administeringĀ insulinĀ which isĀ preferredĀ allĀ overĀ theĀ worldĀ isĀ byĀ subcutaneousĀ method. ThisĀ isĀ easyĀ method. PatientĀ canĀ do itĀ himselfĀ andĀ thereĀ isĀ no needĀ every timeĀ toĀ visitĀ doctor āsĀ clinic.
Rapid actingĀ insulin -ThisĀ typeĀ ofĀ insulinĀ isĀ absorbedĀ veryĀ fastĀ intoĀ bloodĀ from theĀ subcutaneousĀ fat. SoĀ itĀ isĀ theĀ insulinĀ ofĀ choiceĀ ifĀ weĀ haveĀ toĀ correctĀ hyperglycemiaĀ inĀ aĀ veryĀ shortĀ duration.The type of insulin to be given to diabetes mellitus patient is decided by physician- MD General Medicine doctor
InĀ thisĀ typeĀ weĀ haveĀ rapidĀ actingĀ insulinĀ analogs. This takesĀ onĀ averageĀ 5-15 minutesĀ toĀ haveĀ effect. It lastsĀ forĀ durationĀ ofĀ 4 hrs.
RegularĀ humanĀ insulin -ForĀ thisĀ theĀ timeĀ ofĀ onsetĀ ofĀ actionĀ isĀ 30 minutesĀ toĀ oneĀ hr. TheĀ durationĀ ofĀ actionĀ isĀ 8 hrs.
IntermediateĀ actingĀ insulin. -In thisĀ type theĀ timeĀ forĀ onset of actionĀ isĀ slowĀ butĀ itāsĀ effects lastĀ for aĀ longerĀ time. SoĀ itāllĀ isĀ alwaysĀ in aĀ betterĀ positionĀ toĀ control theĀ bloodĀ sugar of diabetes mellitus patients overnightĀ orĀ inĀ betweenĀ meals.
ExamplesĀ ofĀ intermediateĀ actingĀ insulin are-
NPH humanĀ insulin -ForĀ thisĀ onsetĀ ofĀ actionĀ is 1-2 hrs. andĀ theĀ peakĀ levelĀ isĀ achievedĀ inĀ 4-6 hrs. In someĀ Case durationĀ ofĀ actionĀ isĀ 12 hrs.
PremixedĀ insulin-This isĀ a mixture of rapidĀ acting insulin andĀ intermediateĀ acting insulin.
LongĀ actingĀ insulin -This isĀ slowĀ reachĀ bloodĀ stream .ItĀ hasĀ aĀ stabilizingĀ effectĀ onĀ bloodĀ sugarĀ andĀ itĀ lastsĀ through outĀ theĀ day. TimeĀ ofĀ onsetĀ ofĀ actionĀ ofĀ insulinĀ is 1.5-2 hrs. .
ForĀ actualĀ treatmentĀ aĀ diabeticĀ patient shouldĀ consultĀ a qualified and experienced MD General MedicineĀ doctor. OurĀ websiteĀ doesnāt mention theĀ doseĀ ofĀ medicinesĀ asĀ it hasĀ beenĀ foundĀ thatĀ some peopleĀ makeĀ diagnosisĀ andĀ treatment justĀ byĀ goingĀ toĀ googleĀ andĀ catastrophicĀ consequencesĀ result. SoĀ theĀ treatment for diabetes mellitus should beĀ takenĀ onlyĀ after takingĀ consultationĀ withĀ qualified andĀ experiencedĀ MD MedicineĀ doctor.
Side effects of insulin therapy –
In typeĀ 1 diabetesĀ mellitus followingĀ sideĀ effectsĀ areĀ seenĀ dueĀ toĀ insulinĀ therapy ā
WeightĀ gain -InitiallyĀ beforeĀ insulinĀ therapyĀ cellsĀ areĀ notĀ ableĀ toĀ utilizeĀ glucoseĀ asĀ thereĀ isĀ difficultyĀ inĀ transferĀ ofĀ glucoseĀ into theĀ cells.
WhenĀ insulinĀ isĀ startedĀ itĀ helpsĀ inĀ theĀ transfer of glucoseĀ through theĀ cellĀ membraneĀ from theĀ bloodĀ into theĀ cells. SoĀ now cellsĀ canĀ utilizeĀ glucose. OurĀ bodyĀ hasĀ mechanismĀ whichĀ helpsĀ toĀ transferĀ glucoseĀ intoĀ fatsĀ andĀ glucoseĀ intoĀ proteins. InsulinĀ alsoĀ helpsĀ inĀ theĀ breakdown ofĀ proteins and fats.
Due toĀ allĀ these mechanisms theĀ bodyĀ weight increases in case of diabetes mellitus patients.
Hypoglycemia -IfĀ moreĀ thanĀ theĀ requiredĀ doseĀ ofĀ insulinĀ isĀ given, or ifĀ insulinĀ isĀ givenĀ at theĀ wrongĀ time thenĀ theĀ bloodĀ glucoseĀ levelsĀ fallĀ belowĀ theĀ normalĀ rangeĀ ,brainĀ doesĀ notĀ get sufficientĀ supply ofĀ glucoseĀ andĀ theĀ personĀ faints. FollowingĀ are theĀ effectsĀ seenĀ inĀ hypoglycemia-
Dizziness
TroubleĀ inĀ speaking
Fatigue
TheĀ individualĀ canĀ becomeĀ unconscious
Confusion
TheĀ skinĀ becomesĀ pale
Sweating
Seizures
TwitchingĀ ofĀ muscles
FatĀ necrosis -As the individualĀ takesĀ subcutaneousĀ insulinĀ itĀ isĀ actuallyĀ deliveredĀ intoĀ theĀ subcutaneousĀ fatĀ andĀ thereĀ isĀ aĀ possibilityĀ thatĀ a painfulĀ lumpĀ canĀ form inĀ theĀ subcutaneousĀ plane.
SoĀ aĀ personĀ withĀ diabetes mellitus shouldĀ alwaysĀ keepĀ packetsĀ ofĀ sugarĀ orĀ chocolateĀ withĀ him andĀ theseĀ shouldĀ beĀ consumedĀ asĀ early as possible. FamilyĀ membersĀ mustĀ beĀ aware ofĀ allĀ theseĀ things asĀ hypoglycemiaĀ isĀ alwaysĀ muchĀ moreĀ dangerousĀ thanĀ hyperglycemia.
IfĀ thisĀ hypoglycemia(falling ofĀ bloodĀ glucoseĀ belowĀ theĀ normalĀ range ) occursĀ Ā in aĀ hospitalĀ thenĀ itĀ isĀ muchĀ moreĀ safe conditionĀ asĀ immediatelyĀ ivĀ glucoseĀ can beĀ givenĀ by theĀ hospitalĀ staffĀ andĀ situationĀ can beĀ broughtĀ underĀ control.
SweatingĀ andĀ palpitationsĀ can occur toĀ theĀ patientĀ duringĀ hypoglycemia.
Rash orĀ swelling -ThisĀ canĀ occurĀ at theĀ siteĀ ofĀ injection.
Anxiety and depression -TheseĀ thingsĀ canĀ occurĀ inĀ aĀ patient of diabetes mellitus takingĀ insulinĀ asĀ heĀ startsĀ thinkingĀ thatĀ somethingĀ hasĀ happened toĀ him, heĀ isĀ definitelyĀ dependentĀ onĀ injectionsĀ andĀ thingsĀ haveĀ notĀ remainedĀ theĀ sameĀ asĀ before. InĀ thisĀ caseĀ theĀ familyĀ membersĀ shouldĀ boostĀ theĀ moraleĀ ofĀ this patient.
Complications dueĀ toĀ insulin therapy ā
HeartĀ attack (Myocardial infarction)
Stroke
OphthalmicĀ problems
ComplicationsĀ related toĀ kidney.
