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Diabetes mellitus is a heterogeneous disease; the human's body failure to produce insulin. The insulin hormone is important in absorption of glucose in the blood. Insulin deficiency increases the amount of glucose in the blood which results in hyperglycemia. Diabetes associated with carbohydrate metabolism disorder.
Diabetes mellitus classified into three main categories
Diabetes mellitus type one (insulin -dependent diabetes) which is associated with impaired of autoimmunity. The human's body spontaneously produce the antibodies and these antibodies react to the pancreatic beta cell. Following this attack from antibodies, the beta cells are destroyed therefore no insulin is produced. This type of diabetes is most common among the young and children.
Diabetes mellitus type two (non-insulin dependent), is most common type in developed countries. Disease is associated to deficiency or impaired the cells to produce insulin, or abnormality the function of insulin, this known as insulin resistance
Gestational diabetes, the blood glucose is increased and is often related with pregnant women. The hormone changes during the pregnancy, this causes the cells to become unresponsive towards insulin.
The national health and nutrition examination survey (NHANES) recently declare that the diabetes type two about 12.9% common among the age of 20 years old and over and also more than 40% of the adult affected by hyperglycaemic disease. Type2 diabetes is most epidemic in the world and it is associated with life style modification because of obesity, increase weight and reduced the physical activity.
Diabetes basis on vascular complication can be classified into two categorise microvascular this is causes damaging the kidney, retina and nerves system. The macrovascular this is causes disease in the coronary artery, cerebrovascular and peripheral arterial circulation.
Glucose is a monosaccharide and is most significant sugar of carbohydrate, and it is important for generate of energy as like ATP. The mean of normal of glucose in body is 72 mg/dL, the blood glucose is out of the normal value therefore indicating the clinical condition. The blood stream carries the glucose and transporting from intestine and the liver to all cells of the body. Other type of diabetes called monogenic diabetes; it is inherited diabetes occurs due to alteration in an autosomal dominant gene lead to failed to insulin synthesis.
The diabetes mellitus causes chronic disease and impaired a variety of organs is including kidneys, eyes and nervous system, and with some characteristic sign and symptom (polyuria, polydipsia and polyphgia). In some cases the sign and symptom of diabetes may be helpful for diagnosis the disease.
Diagnosis and management of diabetes
There are several different ways for diagnosis of diabetes mellitus including fasting plasma glucose (FPG) test, oral glucose tolerance test (OGTT), random plasma glucose test, Glycated Haemoglobin (HbA1c), fasting lipid profile with cholesterol HDL and LDL, analysis of urine including (ketone, glucose, and protein), serum creatinine, urine microalbumin, and thyroid function test.
Fasting glucose test (FGT) is used to measure the level of glucose in the blood elevated of FGT is the basic identify of diabetes. The blood sample must be taken from the patient has not been eating for at least eight hours. The level of FGT should be lower than 100mg/dL. The level of FGT for a person with pre diabetes must be 100-125% mg/dL, if the blood plasma over 126%, that is shows the patient has diabetes.
The random blood glucose test (RBG) is a laboratory test used to detection the concentration of glucose plasma, the test can be carried out at any time (the patient can eat and drink before the test). also its casual blood glucose test. If the test revel the level of glucose sugar elevated to over 200mg/dL, that is mean the patient has the diabetes. And the patient needs further diagnosis.
Analysis and detection of diabetes is established completely by the elevated the level of glucose in the plasma (hyperglycemia). In 1997 the criteria for the diagnosis of diabetes were improved and change to better to recognise who is at high risk of nephropathy and retinopathy. The purposes of the criteria involve the sign and symptom of diabetes and casual for example during the meal time the concentration of plasma glucose is 200mg/dL and fasting plasma glucose 126mg/dL. And during an oral glucose tolerance test (OGTT) a few hours intake glucose 200mg/dl. Measuring the glucose must be performed in the qualified laboratory test to establish the detection and identify the diabetes and to shows the serious condition of the patient with diabetes. Glycated Haemoglobin (HbA1c) is a laboratory test used for detection and identifies the level concentration of plasma glucose for long term; this method has been used for first time in the last three decades. HbA1c is a form of non-enzymatic glycocylation reaction
Glycated haemoglobin (GHb) must be detected every three month in patient with diabetes. The GHb production relied on mean blood glucose concentration. GHb measures the amount of glycosylated hemoglobin (hemoglobin that is chemically associated with glucose) in the blood. The concentration of GHb must be maintain at lower than 7%, and the management must be make a new valuation if GHb concentration is higher than 8%, the GHb detected by National Glycohemoglobin Standardization Program (NGSP) certified method.
Self -monitoring of blood glucose (SMBG) is this test must performed for all type of diabetes which are associated with insulin. The test must carried out at least three times per day for patient diabetes type one. But SMBG test is not recommended for patient with diabetes type two. This test based on the individual clinical need.
More than 23% of patient with diabetes are suffered from the chronic kidney disease (CKD), it is prevalence condition. About 19 million people and more than 50 million in all over the country in the world have been affected diabetes frequently related to CKD, and nearly 50% of patients who has treatment with dialysis therapy, diabetes is the main reason of impaired the kidney. Understanding the effect of this combination of detection is important because increased the risk of death from the cardiovascular disease but the patient without been using the combination therapy there risk is lower. Also the cardiovascular disease is more common in the patient with microalbuminuria than the patients without albuminuria. Detection of CKD is important to make a perfect clinical therapy for the patient.
Dipstick test used for detection of the albumin in the urine excretion for diagnosis of diabetic nephropathy, this test is a usual qualitative test for albuminuria but do not identify small elevated of albumin in the urine, Detection small amount of albumin using the microalbuminuria, such as secretion of 20-200 micro gram of albumin per mint.
American diabetes association (ADA) recommends the dipstick test used for measuring the albumin in the urine for patient with diabetes. ADA recommended the measuring the protein in the urine protein secretion is more than 200 microgram per mint and over 300 microgram per mint of ceratinin), this useful to find out the serious of proteinuria, its development in treatment of identify the affects therapy. The complications of diabetes effects on the renal impairment depending on the age of individual, the older patient are more effective than young. Microalbuminuria test is used for diagnosis of nephropathy in old patient with diabetes.
Also fructosamine and aberrant haemoglobin tests (A1C) are used as monitoring to regulate the level of plasma glucose.but the A1C test is more acceptable in the world. Both tests are recommended by the ADA. But the fructosamine test is more useful, because is more reliable than A1C test.
Fructosamines produced from the blood protein is call glycated serum protein (GSP). That is useful for detection the level of plasma glucose for diagnosis the diabetes. GSP is coplex component, which is revel the concentration of blood glucose for past at least 3 weeks use for control and management of insulin treatment for patient with diabetes.
Hyper lipidaedimia is a condition increase amount of fat such as lipid and cholesterol in the blood circulation and react with protein produce hyperlipoproteinemia. Hyperlipidemia is common in the patient with diabetes. Diabetic patient with coronary heart diseases are more susceptible of developing hyperlidimia in comparison to non diabetic individuals.
If diabetes not be treated could causes a serious complication as like as hypoglycemia is more prevalence in case of type one of diabetes, elevated the keto-acidosis because of insulin deficiency. Non acidotic diabetes is call hyperosmolar. Dawn phenomenons increase the level of blood glucose in the morning without hypoglycaemic in night and infection, several of factors to make susceptible the patient with diabetes to raised a cute infection.
Treatment and management of diabetes mellitus
Diabetes is broadly divided into categories, which requires treatment specific for each type. Type 1 is caused by lack of insulin therefore the treatment provided to such individuals should be tailor made i.e. appropriate diet, physical activities and most importantly multiple injections of exogenous insulin with monitoring of plasma glucose levels.
In contrast, type 2 diabetes is mainly associated with obesity, thus control of diet, excellent physical exercise, testing of plasma glucose is important. However, some individuals do show the necessity of oral medication or insulin, therefore the management of this is vital in sustaining their life.