DIABETES MELLITUS
Name and magnitude of the problem:
Diabetes Mellitus. This metabolic disease which is manifests with hyperglycemia comprising mainly of 2 types, type 1 DM and type 2 DM. The former is characterized by a distinct autoimmune process which leads to an absolute deficiency of insulin whereas the latter and the more common type 2 DM is characterized by a predominant initial insulin resistance and a strong hereditary component. At the turn of the new millennium the prevalence of DM was estimated to be 0.19% in people <20 years old and 8.6% in people >20 years old. In individuals >65 years the prevalence of DM was 20.1%. More alarmingly the incidence seems to be increasing for both types of DM.
How one contracts the illness:
Exact cause of DM is unknown, but most likely a combination of genetic predisposition, viral infection, lifestyle, nutrition and diet, obesity, autoimmune disorders, and exposure to toxic agents have a role to play in different magnitudes in different types of DM.
Signs and symptoms:
The most characteristic symptoms are polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased eating) and rapid weight loss. Some may present with generalized weakness, fatigue, dehydration, non-healing wounds, increased susceptibility to infections or even with acute complications such as ketoacidosis. A large population also presents with chronic complications of long standing DM of which they were not aware of previously. These complications include visual problems, renal impairment, neuropathies, adverse cardiac events etc …
How it is diagnosed:
Symptomatic patient (ie: symptoms such as polyuria, polydipsia, and weight loss) associated with random plasma glucose >11.1mmol/L (200 mg/dL) can be diagnosed as DM. Fasting plasma glucose (FPG) > 7.0 mmol/L (126 mg/dL) also warrants the diagnosis of DM.
There is also a current concept of pre diabetes which includes impaired fasting glucose (IFG) and impaired glucose tolerance both are associated with risk of progression to DM as well as increased cardiovascular adverse outcomes.
Impaired fasting glucose (IFG) is defined as plasma glucose (FPG) >5.6 mmol/L (100 mg/dL) but <7.0 mmol/L (126 mg/dL). Impaired glucose tolerance is defined as plasma glucose levels between 7.8 and 11.1 mmol/L (140 and 200 mg/dL) 2 h after a 75-g oral glucose load.
How it is treated:
The main two modalities of treatment are orally taken medication and insulin injection. Along with these its imperative that a diabetic diet and a regular exercise regimen be followed.
Important considerations:
Since one of the main complications of uncontrolled diabetes is cardiovascular adverse effects its important that other risk factors such as hypertension, dyslipidemias etc be optimally managed.
What can you do?
The most important first step is early detection and control and thus as soon as symptoms consistent with DM are noted medical attention should be sought. Also adherence to the exercise program, diabetic diet as well as medications is extremely important especially given the fact that this is a long standing chronic disease.
