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Diabetes Mellitus

Diabetes Mellitus (DM) is not a single disease entity, but rather a group of metabolic disorders sharing the common underlying features of hyperglycemia. Hyperglycemia in diabetes results from defects in insulin secretion, insulin action, or most commonly both.

Diabetes can affect almost every system in the body. In routine clinical practice, examination of the patient with diabetes is focused an examination of the
  1. Hands
  2. Eyes
  3. Feet 
  4. B.P.
  5. Insulin injection sites.

World wide more than 140 million people suffer from diabetes, making this one of the most common non communicable diseases the number of affected individuals with diabetes is expected to double by 2025. The countries with largest number of diabetics are India, China & USA.

Diagnosis:
Blood glucose values are normally maintained in a very narrow range usually 70 to 120mg/dl. The diagnosis of diabetes is established by noting elevation of blood glucose by any one of three criteria:
  1. A random glucose > 200mg/dl, with classical signs & symptoms’.
  2. A fasting glucose > 126 mg/dl on more than one occasion.
  3. An abnormal oral glucose tolerance test (OGTT), in which the glucose is > 200mg/dl 2 hours after a standard carbohydrate load.
Levels of blood glucose proceed along a continuum.
  1. Individuals with fasting glucoses less than 110mg/dl, or less than 140mg/dl     following an OGTT, are considered to be euglycemic.
  2. However, those with fasting glucoses greater than 110 but less than 126, or OGTT    values greater than 140 but less than 200, are considered to have impaired glucose tolerance (IGT).
Individuals with IGT have a significant risk of progressing to overt diabetes over time, with up to 5% to 10% advancing to DM per year.

Self assessment of Glycaemia Control

Earlier urine testing was used to assess blood glucose control since due to limitation especially in type-1 diabetes but also in type-2 diabetes is used very less. Self monitoring blood glucose (SMBG) devices are particularly very useful. It offer’s capillary blood glucose measurements using blood glucose test strip read with glucose meter. The principal advantage of home self monitoring of blood glucose is that information is available immediately & permits the patient to make appropriate adjustments in treatments on a day to day basis.

Symptoms of Hyperglycaemia:
  • Thirst, Dry Mouth
  • Polyuria
  • Nocturia
  • Tiredness, Fatique
  • Recent change in Weight
  • Blurring of Vision.
  • Prutitus, Vulvae, Balavitis (genital candidiasis)
  • Nausea, Headache
  • Hyperphagia, Predilection for sweet foods.
  • Mood change, irritability, difficulty in concentrating, apathy
Common symptoms of Hypoglycaemia:
  • Autonomic
    1. Sweating
    2. Hunger
    3. Trembling
    4. Anxiety
    5. Pounding Heart
  • Neuroglycopenic
    1. Confusion
    2. Inability to concentrate
    3. Drowsiness
    4. Incoordination
    5. Speech difficulty
  • Non Specific
    1. Nausea
    2. Tiredness
    3. Headache
Daily Energy Requirements
Circumstances Requirements
Healthy Adult Females Healthy Adults Males
At Rest 6.7 MJ (1600 kcal) 8.4 MJ (2000 kcal)
Light Work 8.4 MJ (2000  kcal) 11.3 MJ (2700 kcal)
Heavy Work 9.4 MJ (2250 kcal) 14.6 MJ (3500 kcal)


Quantifying Obesity with Body Mass Index ( Weight/Height2)
BMI (kg/m2) Classification* Risk of obesity comorbidity
18.5 – 24.9 Normal range Negligible
25.0 – 29.9 Overweight Mildly increased
> 30.0
30.0 – 34.9
35.0 – 39.9
> 40.0		 Obese
Class I
Class II
Class III
Moderate
Severe
Very Severe
* Classification of the World Health Organization (WHO) and international Obesity Task Force.