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Diabetes mellitus

Diabetes mellitus- various aspects-                                                                                                                                                          The diabetes which we speak generally in common language refers to diabetes mellitus
Symptoms of diabetes mellitus –
1 Usually  there  may  be  no  symptoms  at  all.. So instead of waiting for the  day  to  come  when  the problem  comes  and  it is  necessary to  take  treatment  ,it is  always  better  to  get  done.  Random  blood  sugar  and  other  investigations  once  you  cross the  age of  40 yrs. Other  investigations include ECG, Blood pressure measurement from qualified experienced MD General  Medicine doctor.
2 Patient  of  diabetes  frequently  feels  thirsty (polydipsia), so he  frequently  drinks  water. People  working  in  his  office,any other profession start  commenting  on  him. Initial  comments may  be  such  that  this  individual  is  very  hard  working  ,so  he  feels thirsty  frequently. But  as  we  know  people  speak  something and  something else  is  going on  in  their  mind. But  when the  problem  exceeds the  certain  limit the individual is  asked  to  consult  a doctor as the suspicion of diabetes mellitus arises in mind.
 3 Polyphagia – In  this  the  diet  of  the  individual  is  increased. Usually  we have  our  own  judgement  ,but  when  even  without  doing  much  work  we  feel  more  hungry  than  usual  this  should  alert us  and  we  should  consult  a  qualified and experienced MD General  Medicine  specialist doctor  .
The  reason  of  polyphagia  is  that  in  Diabetes mellitus either  there  is  low  production of  insulin  or  inability  of the  body  cells  to utilize  blood  glucose  as  the  cells  become  resistant  to  insulin. Insulin  is necessary  for  the  uptake  of the  glucose  by the body  cells. So  in  both the  cases  the  uptake  of  glucose  into the  cells  is  decreased  ,so  the individual  individual  feels  much  hungry.
4-Polyuria –As  the  intake  of  water  is  increased, due  to  increasing  thirst, the  urine output  naturally  increases. So  when  all  these  3 things are  increased  it  should  alarm  the  concerned  individual. Whenever  such an  individual  consults  an MD General Medicine  doctor  initially  only  Random  blood sugar is  advised. If  it  turns  high  then  only  fasting  blood sugar  and  Post prandial (PP) blood sugar is  advised to rule out diabetes mellitus.
Such individual  should  seek  advice  from an  experienced and qualified MD General Medicine doctor as early  diagnosis and treatment  prevents  further  complications.
5 In  a normal  individual  whenever  a  wound  occurs  ,after  some  days  a scab formation  followed  by  skin  formation is  there, but in  case  of  diabetes  patient the  wound  remains  raw  for  quite  long  periods of time, however  high  antibiotics are  taken  and  however  well  dressings  are  given -these  things  go  in  favour  of  diabetes mellitus, but  treatment is  not  started  unless  blood sugar level crosses  200 mg/dl.
6 Fatigue–  An individual of diabetes  easily  gets  exhausted. He  finds  it  difficult to  do  too much  hard  work.
7-Blurrring  of  vision When  a person  has  blurring  of  vision  along  with  ophthalmic  check up, testing  random  blood sugar  also  becomes essential.
8 Giddiness -All the  above mentioned symptoms  may  not be  there ,but  even  if  giddiness  is  there alone  or  combined  along  with any of these  above  mentioned  symptoms random  blood sugar, ECG, blood pressure  evaluation, and  neurologist  consultation  is  required.                                                                                                                                                                                                                                                                     Types of diabetes mellitus –
Following are the  different types of diabetes mellitus –
1-Type 1 diabetes.-It  is  also  called  juvenile diabetes.
Treatment  can  help  in  this  case  but  it  cannot be cured. It  is a  chronic  condition  in which the pancreas  produce  little  or no  insulin. It  is a  kind of  autoimmune  disorder  in  which  autoantibodies  develop  which  destroy the  beta  cells  of islets of Langerhans that  produce  insulin. This  occurs  at  a  very  early  age  and  insulin  has  to be  administered  to  such  patients.
2-Type 2 diabetes.- In  this  there  is  impairment  in  the  way  which  our  body regulates  and  uses  glucose as  a  fuel.
For details  of  symptoms of diabetes pl click on the link given below
The symptoms of diabetes mellitus given  in the link  mentioned above  are  only the general symptoms of diabetes, but  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 –
All  the  following effects  discussed  in  articles  of  the  above  links are  part  of  symptoms of diabetes mellitus
As  they are very  lengthy ,they  are  in  form  of  seperate blogs -as-
Effects  of diabetes on  gastrointestinal system 
Effects  of  diabetes  on  nervous  system 
Effects  of  diabetes  of skin
Effects  of  diabetes  on  wounds and infections 
Effects  of  diabetes  on  blood vessels
3-Gestational diabetes.It is  also  called as diabetes mellitus in  pregnancy.
In this  the placenta  produces  certain  hormones  that  block  the  effects of insulin. In  such pregnant women  the  pancreas  does not produce enough insulin. After  delivery and  in later part of life there is possibility  that  such women can  develop  Type  -2 diabetes  mellitus.
There may be no symptoms at all, but as  routinely ANC  check up is done  in  that  the  diagnosis  of  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 the  individual reaches the  age  of 30, although they can occur  at later age  in life.
5-Neonatal diabetes-
What Is Neonatal Diabetes? Neonatal diabetes mellitus is a rare form of diabetes that occurs  in  individuals within the age of  first 6 months of life. Humans  need insulin to help the  various cells of  the  body  to produce  energy. Infants with this condition do not produce enough insulin, as  a  result of which the blood glucose levels increase.
6-Wolfram Syndrome.
7-Alström 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 individuals  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-Alström Syndrome.
Alström 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.
Alström syndrome is a rare condition that affects various  body systems. Many of the clinical features of this condition begin in infancy or early childhood, but  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 autoantibodied  which slowly damage the  Beta  cell  of  islets of Langerhans which  produce insulin . But it  is  not  as  severe  as  type 1 diabetes as these  affected  individuals often  do not  require  insulin for several months up to years after being  diagnosed.
Investigations  in diabetes mellitus-                                                                                                                                                                                                                 
Random blood sugar
If  random  blood sugar  is  at  higher levels  then   Fasting and  post  prandial  blood sugar levels  need to be  done.
In  cases of  chronic  diabetes mellitus  Hb 1 AC  need to be  done, which is  described in  detail  below  in  this  article.
As  diabetes is  usually  associated  with  hypertension and  elevated  levels  of  serum  cholesterol, it is  necessary to do –
Lipid profile
Assessment of  blood pressure  from  physican (MD-General  Medicine)
HbA1c  is the average period of blood  sugar levels in  your  blood  over a  period of  2-3 months .You  must  have ‘ heard  about  mean median  and  mode. These are  measures of  central  tendency. If  there are  25  people  travelling  through a  bus and  we want to  find  their  average  height, then  what  we do  is  that  we  add  up  their  heights  and divide  by  25 ,this  gives us  an  idea of their  average  height.
Similarly  HbA1c  is  the  average  level of  blood  sugar  over a  period of  2-3 months.
It is  necessary  in  those  individuals with diabetes mellitus who have  fluctuating  levels of  blood  sugar, those  who are  at the  risk of developing  type  2 diabetes.
Normal  level of  HbA1c  in a diabetic  individual  is  about  48mmol/molecular and  ideally  it  should be  below  42 mmol/mol .
Explanation -In a  diabetic  individual the  level  of  blood  sugar  is  high  as  the  body  cells  are not able to  utilize  the  glucose  in blood due  to  inability  of  glucose  to  get  transported  into the  body  cells. Haemoglobin is a  molecule  in the  RBCs((Red  blood  corpuscles)  that is  necessary  for  transport  of  oxygen. The  excess of  glucose  combines  with  haemoglobin  to  form  glycated  Haemoglobin.
So  more  the  levels  of  glycated  haemoglobin  more is  the  hb 1 ac levels in case of diabetes mellitus.
Normal  levels of  Hb1 AC  are  below  5.7 percent. In  pre-diabetes it  is  between  5.7 percent  to  6.4 percent. In  diabetes  it  is  more  than  6.5 percent.
Factors  affecting  the  levels  of  Hb1ac.
1 -Anaemia -In anaemia  the  Haemoglobin  percentage  is  very  low  so   glycosylated  Hb is also  low  and  so  leads  to  false  low  levels.
2- In  liver  and  kidney disease  false  values  are  obtained .
3-When  Vitamin  C and  Vitamin  E are  given  then the  values  of  He 1 AC  obtained  are  misleading
4- When  the  cholesterol  level  is  high  in  untreated  cases  the  values  of  GB 1 AC are  not  correct.
In  all  these  situations whenever  you  consult  your  qualified  and  experienced  MD Medicine  doctor for diabetes mellitus you  have  to  let  him  know  all  these  details, as  it is  quite  possible  that  being  busy  in  heavy  OPD, he  may  not  get  time  to  ask  you  all  these  things. So  awareness  is  quite  important. If  we  know  certain  things  we  are  definitely  benefitted.
How  frequently  this  test  of  Hb 1 ac should be done. -An individual  with  diabetes  should  do  this  test at  least  once  in  3 months  period. If  satisfactory  blood sugar  levels are  maintained  then  this  test  can  be  done  less  frequently .A  minimum  two  times  per  year  should be done  in  diabetic  individuals.
Diet  required  by  diabetes mellitus individuals  is  bit  different  from  non diabetics. Below  here  we  mention  the  details  of  diet  required  by a person who has  diabetes  mellitus –
Diabetic diet -Part -1
An individual  with  diabetes  should  avoid  eating  processed   foods, deserts, outside snacks. Homemade  food  should  be  preferred.
Foods  with  high  caloric  value, too  much  sweets, ghee, fried  foods  should be  avoided..
Diet  rich  in  fruits, vegetables  ,and  proteins  is  helpful  in  diabetic  individuals.
Sugary  and  starchy  carbohydrates  in  high  amounts can  increase  the  blood  sugar  levels. They  should be  given  in  the  right  amount  as  per  the  instructions of  balanced  diet. For  this  advice  should be  taken  from  dietician.
It depends on what type of  occupation the individual  is  doing  ,the  level of  hard  physical  work  in  it -from  this  the dietician  will  decide  the  type of  carbohydrate in  diet  and  the  amount of  carbohydrate in  diet for patients of diabetes mellitus.
It  also  depends on the fact  that what  medication  is  going on to the  diabetes patient whether  it is  insulin or  oral  hypoglycemic agent and  the  dosage  of  these.
 Regards  diet  consultation should be done from your  dietician  and  MD General  Medicine  doctor only.
Following are  the guidelines –
Fruits and vegetables  should be  taken  in  diet.
Lean protein  should be  included in  diet.
Green  leafy vegetables are  rich  in  minerals  vitamins, nutrients.
They  do not have  much  great impact on  blood  sugar  levels of diabetes mellitus patients. Green leafy  vegetables  like  spinach and  kale  are rich in  potassium, calcium ,vitamin  A .Proteins and  fiber are  also  present  in  it.
Green  leafy  vegetables  have  antioxidants  and  starch  digesting  enzymes  which  are  of  advantage to  diabetic  individuals.
List of  green  leafy  vegetables  that  should be  taken  by  diabetic  individuals  are  –
Collard  greens
Bok choy
Foods  should be  such  that  sugar  should not be  added  into  it.
Juice  should be  made  from  kale  and  given  to diabetes mellitus  patients -it  helps  to  reduce  blood sugar  levels. It  doesn’t  help  to  lower  Blood pressure  in  individuals  with  high  levels  of  blood  pressure  but  it  helps  to  lower  blood  pressure  in  individuals  with  subclinical hypertension.
 300 ml of  kale  juice  should  be  drunk  by  these  individuals  per  day  for  a  duration of  6 weeks.
 If  you  are  doing  this  you  need to  inform  your  regular  MD Medicine  doctor  so that  whatever you  do  is  with  his  permission.
All  this  list of  vegetables  should  be  taken  in  salads, side  dish  ,soups, dinners. A source of  lean  protein  like  chicken  should be  combined with  it.
Whole  grains  are  preferable  in  comparison to  refined  grains  as  they contain  more  nutrients  and  more  fiber material.
More  amount  of  fiber will  increase the  time  required  for  digestive  process .This  will  reduce the  rate of  absorption of  nutrients  and  in  this  way  it  will  help  to  stabilize  the  blood  sugar  levels of diabetes mellitus patients.
Examples  of  whole  grains  are-
Whole grain  bread
Brown  rice
Decision regarding Artificial  sweeteners available  in the  market  should  be  taken  only after  consultation with your MD General  Medicine  doctor as  some  of  these artificial sweeteners  are  attributed  to  be carcinogenic.
If  you  are  a  diabetes mellitus patient on oral hypoglycemic and  you  have  got operated  in  some  hospital  for  some  surgery, before doing  surgery  you  should  inform  the  concerned  operating  surgeon  about  the  ongoing  medications.
 Immediately  after  post -operative period  there  is  a  period  of  6 hrs.  NBM. In  this  period  patient  is  not  allowed  to  eat  or  drink anything. Iv  fluids  are  allowed in  this period. Even  after  this  period  and  the  next  day  the  appetite  of the  patient  is  very  low and  so either  oral hypoglycemic  drugs  should not be taken as  per  the consultation  of  your operating  surgeon and  your regular  MD General  Medicine  doctor.
Dangerous  hypoglycemia can  result  as  already the  food  intake  is  low  ,so  blood  sugar is  low, on the  top  of  that  if  oral  hypoglycemic agents are  taken  then  the  blood  sugar  can  drop  to  too  much  low  levels and  it  can  cause  fainting .
To  some  extent  hyperglycemia  is  ok, but  hypoglycemia  is  too  much  dangerous in patients of diabetes mellitus.
Diabetic diet -Part -2
Fatty fish  contain  omega  -3 Fatty  acids.These are also known as  EPA and  DHA.
If  diet  contains  monounsaturated  and  polyunsaturated  fatty  acids  then  it  can achieve  better diabetic control .Also  if the  diabetic individual  has  elevated  lipid profile  then control  can be  achieved  over  it  also. Fish  that  have  good  level of monounsaturated and polyunsaturated fatty acids  are
Trout .
Prawns  should  be  avoided  by  diabetic  individuals  and  those  with  elevated levels lipid  profile .
Baked roasted  grilled  fish  should be  consumed.
Fried  fish  should be  avoided as  it  will  cause  intake of  oil  in  diet  and  we  always  try to  avoid  oil  in  diabetic  individuals  and  in  individuals  with  elevated   lipid profile .
Beans  are good for  diabetes mellitus individuals as  they  have  a lower  side  glycaemic  index.  They  have  high  content of  protein and  low  content of  carbohydrate  so  they  help  in  better  regulation  of  blood  sugar  as  compared  to the  starchy  foods.They also  contain  iron, potassium  and  magnesium.
Also appetite  of the  individual  is  satisfied. So it  can  help  in  weight  loss, control of  blood pressure  and  cholesterol  levels.
Avoid  taking  beans from  outside  which  are  canned  ,so  salted
Make  them  at home to  avoid  this.
Walnuts -These are  also  rich  in  omega  3 fatty  acids .Theses are  good for  heart and  as diabetes mellitus  patients  have  tendency  to  develop  heart  disease, so  those  should be  utilized  by  diabetic  individuals.
Omega  -3 fatty  acids  can  achieve  better  diabetic  control  and  also  control  over  elevated  lipid  profile. Walnuts  also  contain  Magnesium, Vitamin  B 6,iron ,proteins .
Citrus fruits  contain  bioflavonoid  antioxidants  -naringin and  hesperidin and  these are responsible for  the  antidiabetic effects  of  oranges.
Citrus  foods  also  contain  minerals  like  potassium  ,folate  and  Vitamin  C
Berries -There is  lot of  oxidative  stress  in  patients  of  diabetes mellitus. Berries  help  to  decrease  it as  they  contain  lot of  antioxidants .Oxidative  stress  is  a condition  that  occurs  when  there  is  imbalance  between  free  radicals  and  antioxidants  in  our body.
Berries  that  should be  consumed  are  blueberries
Strawberries 🍓
Besides  being  helpful  in  diabetes they  also  contain  fibre, minerals  like potassium ,manganese, Vitamin K, vitamin C.
As due  to  busy  schedule  we  may  forget to  consume  them  we  should  make  a  practice  to  include  it  in  out  breakfast.
Sweet  potatoes are  beneficial  for  patients  with  diabetes mellitus  as  they  release blood  sugar  slowly and  besides  they  also  provide  us vitamin  A, vitamin  C, fibre ,potassium .
Probiotic Yogurt -These reduce  inflammation and  oxidative  stress .If  a  patient  of  diabetes  has  elevated  blood  cholesterol  levels  then  this  pro biotic yogurt  will  help  to  decrease  it. It  has  been  found  that  diabetes  ,elevated  cholesterol  and  hypertension  are  associated  with  each other. Pro biotic  yogurt  contains  cultures  of  Lactobacillus of  Bifidobacterium.If a  diabetic patient  is  purchasing  pro biotic  yogurt  from  the market  then  he  should  make it  sure  that  it  doesn’t  contain  any  added  sugar.
Chia seeds -These contain  high  levels  of  antioxidants  and  omega3 fatty  acids  are thus  reduce the  oxidative  stress  in  diabetes mellitus patient.People do not  like  to consume  it  directly  so  they  should  be  added  to  salads  and  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 isn’t 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 aren’t enough to lower your blood sugar, you’ll need to take medication.
These drugs lower your blood sugar in a variety of ways:
Drugs- Mechanisms of  action -Examples-
alpha-glucosidase inhibitors slow your body’s 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 stimulate  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.
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. Insulin  is  a hormone. It  is  mainly  produced  in the  body  by the  islets  of  Langerhans.
Islets  of  Langerhans  are  a  group of  cells  in  the  pancreas -they  produce  insulin. They not  only  do  the  production of  insulin  but  also  decide  how  much  amount  should be  produced. The  amount  produced  depends  on the  blood  glucose  levels. If  the  amount  of  blood  glucose is  increased then  the  amount of  insulin  produced  is  also  increased.
Pancreas  is  endocrine  gland. It  secretes  insulin  directly  into  blood. This  is  in  contrast  to  other  glands  that  are  exocrine-like salivary  glands  which  have  ducts.
As  endocrine  glands  do not have  ducts their  secretion  is  directly  added to  blood.Insulin needs to be administered externally to some diabetes mellitus patients.
Introduction  to  hormones –
Hormones  are  chemo messengers that  influence  the  target  organs  or  cells. Hormones  do  the  work of  giving  specific  instructions  to  cells  due to  which  the  body  cells  can  act  in a specific  way. Similarly  insulin  helps  to  transfer  glucose  from  blood  into  cells and  so  the  cells  get  energy .Thus it  helps  the cells to utilize glucose.
Indirectly insulin  is  required  by  humans  to  remain  alive. If  the  levels of  insulin are less (Insulin dependent  diabetes  mellitus. )/IDDM or  if  the  cells  are  less  responsive  to  insulin (Non -insulin  dependent diabetes  mellitus ) then  the  levels of glucose in blood  will  increase.
 In  IDDM  there is  malfunctioning  of system  due to  which  the  immune  system  attacks the  islets  of  Langerhans  so that  insulin  production  is  affected  and  it  becomes  necessary to  administer  insulin  to  the  individual .
Insulin is  given  to  those  diabetes patients  who  do  not  respond  to  oral  hypoglycemic  agents .
The  type of  insulin  that  should  be  given  to  diabetes mellitus patient  by  MD Medicine  doctor  is decided  by the  following  factors –
The  time  of  onset of  action  after  insulin  is  given
The  time  required to  achieve  the  peak  effect  of  action
The  duration till when  the  action of  insulin  will  persist(the time  interval  till  when  the  hypoglycemic  action  of  insulin  will  last)
The  route  of  administration  of  insulin
 Nasal spray
The  most common  route for  administering  insulin  which is  preferred  all  over  the  world  is  by  subcutaneous  method. This  is  easy  method. Patient  can  do it  himself  and  there  is  no need  every time  to  visit  doctor ‘s  clinic.
Rapid acting  insulin -This  type  of  insulin  is  absorbed  very  fast  into  blood  from the  subcutaneous  fat. So  it  is  the  insulin  of  choice  if  we  have  to  correct  hyperglycemia  in  a  very  short  duration.The type of insulin to be given to diabetes mellitus patient is decided by physician- MD General Medicine doctor
In  this  type  we  have  rapid  acting  insulin  analogs. This takes  on  average  5-15 minutes  to  have  effect. It lasts  for  duration  of  4 hrs.
Regular  human  insulin -For  this  the  time  of  onset  of  action  is  30 minutes  to  one  hr. The  duration  of  action  is  8 hrs.
Intermediate  acting  insulin. -In this  type the  time  for  onset of action  is  slow  but  it’s  effects last  for a  longer  time. So  it’ll  is  always  in a  better  position  to  control the  blood  sugar of diabetes mellitus patients overnight  or  in  between  meals.
Examples  of  intermediate  acting  insulin are-
NPH human  insulin -For  this  onset  of  action  is 1-2 hrs. and  the  peak  level  is  achieved  in  4-6 hrs. In some  Case duration  of  action  is  12 hrs.
Premixed  insulin-This is  a mixture of rapid  acting insulin and  intermediate  acting insulin.
Long  acting  insulin -This is  slow  reach  blood  stream .It  has  a  stabilizing  effect  on  blood  sugar  and  it  lasts  through out  the  day. Time  of  onset  of  action  of  insulin  is 1.5-2 hrs. .
For  actual  treatment  a  diabetic  patient should  consult  a qualified and experienced MD General Medicine  doctor. Our  website  doesn’t mention the  dose  of  medicines  as  it has  been  found  that  some people  make  diagnosis  and  treatment just  by  going  to  google  and  catastrophic  consequences  result. So  the  treatment for diabetes mellitus should be  taken  only  after taking  consultation  with  qualified and  experienced  MD Medicine  doctor.
Side effects of insulin therapy –
In type  1 diabetes  mellitus following  side  effects  are  seen  due  to  insulin  therapy –
Weight  gain -Initially  before  insulin  therapy  cells  are  not  able  to  utilize  glucose  as  there  is  difficulty  in  transfer  of  glucose  into the  cells.
When  insulin  is  started  it  helps  in  the  transfer of glucose  through the  cell  membrane  from the  blood  into the  cells. So  now cells  can  utilize  glucose. Our  body  has  mechanism  which  helps  to  transfer  glucose  into  fats  and  glucose  into  proteins. Insulin  also  helps  in  the  breakdown of  proteins and fats.
Due to  all  these mechanisms the  body  weight increases in case of diabetes mellitus patients.
Hypoglycemia -If  more  than  the  required  dose  of  insulin  is  given, or if  insulin  is  given  at the  wrong  time then  the  blood  glucose  levels  fall  below  the  normal  range  ,brain  does  not  get sufficient  supply of  glucose  and  the  person  faints. Following  are the  effects  seen  in  hypoglycemia-
Trouble  in  speaking
The  individual  can  become  unconscious
The  skin  becomes  pale
Twitching  of  muscles
Fat  necrosis -As the individual  takes  subcutaneous  insulin  it  is  actually  delivered  into  the  subcutaneous  fat  and  there  is  a  possibility  that  a painful  lump  can  form in  the  subcutaneous  plane.
So  a  person  with  diabetes mellitus should  always  keep  packets  of  sugar  or  chocolate  with  him and  these  should  be  consumed  as  early as possible. Family  members  must  be  aware of  all  these  things as  hypoglycemia  is  always  much  more  dangerous  than  hyperglycemia.
If  this  hypoglycemia(falling of  blood  glucose  below  the  normal  range ) occurs   in a  hospital  then  it  is  much  more  safe condition  as  immediately  iv  glucose  can be  given  by the  hospital  staff  and  situation  can be  brought  under  control.
Sweating  and  palpitations  can occur to  the  patient  during  hypoglycemia.
Rash or  swelling -This  can  occur  at the  site  of  injection.
Anxiety and depression -These  things  can  occur  in  a  patient of diabetes mellitus taking  insulin  as  he  starts  thinking  that  something  has  happened to  him, he  is  definitely  dependent  on  injections  and  things  have  not  remained  the  same  as  before. In  this  case  the  family  members  should  boost  the  morale  of  this patient.
Complications due  to  insulin therapy –
Heart  attack (Myocardial infarction)
Ophthalmic  problems
Complications  related to  kidney.

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