Diabetes is now regarded as a heterogeneous group of diseases characterized by a state of chronic hyperglycemia leading to a number of complications. e.g cardiovascular,renal,neurological,ocular and other such as intercurrent infections.The underlying cause of diabetes is the decreased production or action of insulin hormone which is secreted by the beta cells of islet of Langerhans in the pancreas.Classification:
The WHO classifies the diabetes in the following categories:
i)Insulin dependent diabetes mellitus(IDDM type 1)
ii)Non-insulin dependent diabetes mellitus(NIDDM type 2)
iii)Malnutrition related diabetes mellitus(MRDM)
iv)Other types(Secondary to pancreatic disease,hormonal imbalance,drug-induced,or genetic disorder)
2.Impaired glucose tolerence(IGT)
3.Gastrointestinal diabetes mellitus(GDM)
IDDM is the most severe form of disease.
Two main types of the disease have long been recognized clinically:
1.The juvenile onset type:Usually developsduring the first 40 years of life in patients of normal or less than normal weight.Since administration of insulin is required for the patients of juvenile type diabetes,it is also called insulin dependent diabetes.2.The adult or maturity onset type:
Usually develops in middle aged or elderly persons who are generally obese.The disease can be controlled by dietary control alone or by oral hypoglycemic drugs.
Causes of Diabetes Mellitus:
Insulin deficiency is the underlying cause of the diabetes which may be due to diseases of the pancreas,defective formation of the insulin,destruction of beta cells in the pancreas,defective formation of the insulin,destruction of beta cells in the pancreas,due to viral infections,decreased sensitivity of insulin,genetic defects or autoimmunity etc.In diabetes glucose utilization is decreased which leads to hyperglycemia(increased blood sugar level) and glycosuria(sugar in urine).Prevention and Care of Diabetes:
Prevention of diabetes can be done under there headings i.e. primary,secondary and tertiary prevention.
Two strategies of primary prevention namely population strategy and high risk strategy,have been suggested.
Prevention of IDDM is not possible presently.However prevention of NIDDM is possible.THe preventive measures include maintenance of normal body weight,by diet control and exercise.The diet should be restricted in sugar and it should be rich in protein and fibres.High risk strategy:
There is no special strategy for IDDM. In patients of NIDDM it can be achieved by changing sudentary life style,correction of over eating and controlling of the body weight.SECONDARY PREVENTION:
It includes adequate treatment to maintain blood glucose level close to normal level.Treatment is done by control of diet control and insulin.Proper management prevents the complications.Self care is very important.Patient should take his care according to medical advice.He should be able to do his urine sugar and blood sugar examination.TERTIARY PREVENTION:
Diabetes is a disease which produces many complications such as blindness,kidney failure,coronary thrombosis and gangrene of the lower limbs.The objective of the tertiary level is to organise specialized clinics called Diabetetic Clinics and Units for the diagnosis and treatment of the disease.