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In 2008 Eisenbarth GS polonsky KS have described the diabetes mellitus as the high glucose level which is accumulate in blood. This is a chronic condition that cannot be cured in life time. But it can be managed by balanced diet, physical activity & oral medications (1).
Under this topic we have to discuss about how to control the sugar level in blood at diabetes mellitus. But before it we have to know about what is diabetes mellitus & how to diagnosis the diabetes mellitus. It may be helpful to understand how glycemic controls in diabetes mellitus. And also we have to consider about why have we control the sugar level in blood. All of these objectives were discussed step by step through this analytical essay.
Diabetic mellitus is chronic disease which is associated with abnormally high levels of sugar (glucose) in the blood. The pancreatic Î² cells produce insulin to regulate the glucose level in the blood. Not produce or inadequate production of insulin causes diabetes. To study about diabetes first of all it is important to concern about normal process by which food is broken down & used by the body for energy. Many things occur during digestion of food (1).
After a meal glucose enters the bloodstream. Glucose is the main source which is released energy to day - today needs of the body (1).
Pancreatic Î² cells produce insulin. Glucose is acted on insulin & moves them from bloodstream into muscle, fat & liver cells where it can be used as energy releasing source (1).
person who suffer from diabetes have high level of blood sugar because their cells do not translate sugar into fat, liver & muscle cells to be stored for energy. This is because either (2);
Their pancreas does not produce enough insulin (2).
Their cells do not respond to insulin normally (2).
Both of above can happen in diabetes (2).
There are three types in diabetic mellitus. They are (1);
Type 1 diabetes (1)
Type 2 diabetes (1)
Gestational diabetes (1)
Symptoms of diabetic mellitus
Can be seen following symptoms in diabetic mellitus (3).
Blurry vision - High blood sugar may cause to construction of new vessels & damage old blood vessels in the retina at the back of the eye (3).
Excess thirst - Process of dehydration produces thirsty (3).
Fatigue - when cells don't get enough glucose because cells low sensitivity to insulin. It causes small amount of glucose into cells. So it can be caused to fatigue result (3).
Frequent urination (3).
Slow - healing cuts or infections (3).
Persistent itching of skin (3).
The symptoms are grew slowly the patients who are having type 2 diabetes. Some people who are having type 2 diabetes have no symptoms. But symptoms of type 1 diabetes develop rapidly within a short period (3).
Type 1 diabetic mellitus.
Type 1 diabetes is previously called as juvenile diabetes or insulin - dependent diabetes. It is a lifelong disease in which pancreas produce lack or no insulin. Insulin is a hormone which is necessary to allow glucose to enter cells to generate energy. Various factors may be contributed to type 1 diabetes such as genetics & exposure to certain viruses. Although type 1 diabetes usually appears in young age. It can be developed at any age. According to the active research, type 1 diabetes has no cure. But it can be managed with suitable treatment (4).
The precise cause of type 1 diabetes is not known. Most of people with type 1 diabetes, their body's own immune system (which is fights against harmful bacteria & viruses) mistakenly harms Î² cells in pancreas that produce insulin. When pancreatic Î² cells are destroyed pancreas produce lack or no insulin. Usually insulin allows glucose to enter cells to supply energy to muscle & tissues. Insulin secretes from pancreas, a gland just behind to stomach. If every procedure gets normal pancreas will secrete insulin into bloodstream after a meal (4).
Insulin reduced amount of sugar in the bloodstream. Then blood sugar level drop & regulate. So if there is no insulin glucose will accumulate in the bloodstream & blood glucose level goes up. So it can be caused life risking complications (4).
Type 1 diabetes can be occur following factors as well. They are (5);
A family history(5)
Low vitamin D levels(5)
Other dietary factors(5)
Type 1 diabetes symptoms can be seen within a short period. These symptoms can be occur at the first in the type 1 diabetes (5).
Feeling tingling in feet(5)
In type 1 diabetes these symptoms can be felt to other people (4).
Deep fast breathing(4)
Stomach pain (4)
Dry skin & mouth(4)
Nausea or vomiting(4)
People with type 1 diabetes who are taking more insulin they may be developed hypoglycemia. These symptoms may be seen in them when the blood sugar level falls more than below 70mg/dL (5).
Type 2 diabetes mellitus.
Type 2 diabetes is previously called as adult onset diabetes or non insulin - dependent diabetes. It is a chronic condition. It affects glucose metabolism in our body. In type 2 diabetes cells have lack of sensitive for insulin & there are inadequate amount of insulin to regulate normal blood glucose level. The type 2 diabetes is not ruled it can be fatal. In medicine there is not having treatment for type 2 diabetes but can be managed or prevent this condition by diet & exercise. It is not enough to type 2 diabetes you may be need medications or insulin therapy to manage this condition (6).
The reason why this condition happens is unknown. Although obesity & inactivity seem to be risk factors for type 2 diabetes. Type 2 diabetes is most general in society (6).
Pre - diabetes(3)
Typically patients who are having type 2 diabetes have no symptoms at first. Their symptoms develop gradually (6). (The symptoms mentioned earlier.)
This can be seen in pregnant women. The hormones which are produced in pregnancy can be blocked insulin from doing its work when this happen glucose level in blood increase in pregnant women (7).
Older than 25(7)
Too much amniotic fluid(7)
Usually no symptoms can be seen. The symptoms are mild & not fatal (7).
Complications of diabetes
Diabetes can be damaged several principal organs in body. They are (1);
So we must keep blood sugar level close to normal level most of time. It causes to spectacularly reduce risk of many complications. Ultimately diabetes complications can be lead to disabling or fatal (1).
Heart & blood vessel disease - Diabetes increase risk of various cardiovascular problems. They are (2);
Coronary artery disease with chest pain (angina) - This is referred as the macro vascular disease because it is damage to the large vessels (2).
Narrowing of arteries (atherosclerosis)(2)
Nerve damage (neuropathy) - High blood sugar can be injured the wall of capillaries that deliver nutrients to nerves, especially in lower limbs. It can result to stinging, numbness, burning pain that generally begins at tips of toes or fingers & slowly spread upwards. The nerve damage which is affected gastrointestinal tract can lead problems with nausea, vomiting, diarrhea or constipation (1).
Hearing impairments - Hearing loss more common in people with diabetes (2).
Osteoporosis - Diabetes may be caused to weaker than normal bone density, which increases risk of osteoporosis (1).
Eye damage - High glucose level in blood can lead to damage blood vessels in retina (diabetic retinopathy). It can lead to blindness. Diabetes develops risk of serious vision condition like cataracts & glaucoma. This is referred as the micro vascular disease because it is damaged to the small blood vessels (1).
Kidney damage - The tiny clusters of blood vessels that filter waste products from blood are contained in kidney. Diabetes can lead to damage this sensitive filtering system. So it can be lead to renal failure (2)
Foot damage - Nerve damage in foot or reduce blood supply may lead to increases risk of several foot complications (2).
Pregnancy complications - Diabetes may be dangerous for both maternal life & fetal life. When diabetes is not well controlled risk of miscarriage, stillbirth & birth defects are increased (1).
Skin & mouth conditions - Diabetes can be increased risk of bacterial & fungal infections & dental hygiene (2).
Tests & diagnosis
Glycated hemoglobin (A1C) test
The blood glucose level during past 2 or 3 months is shown by this blood test. In this test it is measuring the percentage of blood glucose attached to hemoglobin. Hemoglobin is the oxygen carrier protein which is in red blood cells. If there is high level of glucose in blood they will bind into hemoglobin (1).
Normal ÷ less than 5.7%(1)
Pre - diabetes ÷ 5.7% - 6.4%(1)
Diabetes ÷ 6.5% or higher(1)
In the present hemoglobin A1C test is not available because it can be incorrect certain conditions. In pregnant or rare form of hemoglobin doctor may be used following test to diagnose diabetes (1).
Random blood sugar test
A blood sample is taken at any time. Blood glucose values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L) (2).
Normal ÷ below 140mg/dL(2)
Pre - diabetes ÷ 140mg/dL (7.8mmol/L) - 199mg/dL (11.0mmol/L) (2)
Diabetes ÷ 200mg/L (11.1mmol/L) (2)
Fasting blood sugar test
A blood sample is taken after an overnight fast (1).
Normal ÷ below 100mg/dL (5.6mmol/L) (1)
Pre - diabetes ÷ 100mg/dL (5.6mmol/L - 6.9mmol/L) (1)
Diabetes ÷ 126mg/L or higher (1)
Oral glucose tolerance test
A blood sample is taken after an overnight fast & fasting blood sugar level is measured. Then you drink sugary liquid & sugar levels in blood are tested regularly for next hour (2).
Normal ÷ below 140mg/dL (7.8mmol/L) (2)
Pre - diabetes ÷ 140mg/dL - 199mg/dL (7.8mmol/L - 11.0mmol/L) (2)
Diabetes ÷ 200mg/dL(11.1mmol/L) or higher after 2 hours (2)
Glucose is checked in urine by this test. BENEDICT solution is used for this test. Urine is heated with BENEDICT solution. So if there is glucose in urine the sample was converted into brick red. If there is glucose, the person will have diabetes. However a urine test alone can't diagnose diabetes (1).
Every three months we must check following factors to reduce risk of diabetes
Check blood pressure (1)
Check skin & bones on feet & lower limbs (1)
Check to see if feet are becoming numb (1)
Examine back part of eye with special lighted instrument called an ophthalmoscope (1).
How glycaemic controls in diabetes mellitus?
Blood sugar monitoring, insulin & oral medications may play a major involvement in the glycaemic control in diabetic mellitus. Other treatment for diabetes is pancreas transplant. This is used for patients with diabetes which is hard to control. But it does not important what type of diabetes you have. These treatments can be used in any type of diabetes (8).
Healthy diet (8)
Maintaining healthy weight (8)
Keeping tabs on your blood sugar (8)
Glycaemic control in all types of diabetes
All forms of diabetes are managed by maintain healthy weight through balanced diet & exercise (8).
If you are not limited sweets & animal products you will be increased risk of having diabetes. So you have to need lots of fruits, vegetables & whole grains that are rich in nutrition & low fat & calories. Even sugary foods can get occasionally (8).
Your diet must be prepared as follows (8);
30% - fat (mostly monounsaturated fat & polyunsaturated fat) (8)
40% - 55% - carbohydrates (higher fiber, low glycaemic index) (8)
15% - protein (8)
The body weight is controlled by healthy diet. These dietary changes will lower blood sugar & lipid levels (8).
We must consider about followings as well as (8);
Choose more dark green & deep yellow vegetables such as carrots, peppers, cucumber & pumpkin (8).
Grains & beans
Add grains & beans for your diet because these foods are loaded with vitamins, minerals, fibers & healthy carbohydrates (8).
Select whole fruit more frequently than juice because they contain more fiber. They are orange, pineapple & mangoes (8).
Choose low fat or skim milk or yogurt (8).
Meat & fish
Eat fish & poultry more often (8).
Fat, alcohol & sweets
Usually you should reduce your intake of fatty foods, especially high in saturated fat like hamburgers, cheese, bacon & butter (8).
Sweets are high in fat & sugar. So the persons who are with diabetes are not necessary to taking sweets (8).
Alcohols are high in sugar. So the persons who are with diabetes are not necessary to taking alcohol (8).
Physical activity (exercise)
Everybody needs regular aerobic exercise & persons who are with diabetes have no exception. The glucose is required by cells where glucose is used as energy during exercise. So lowers the glucose level in blood. In exercise burns calories & muscle glycogen which lowers blood glucose level. It can be allow insulin to normally manage glucose level in blood (9).
Exercise also enhances sensitivity to insulin. This may be caused to lowers the blood glucose level at to the normal level. You can choose suitable activities that can be made you enjoy like walking, swimming, or cycling. Strive for at least 30 minutes per a day. It can be useful to lowers blood glucose level (9).
Glycemic control in type 1 diabetes
The sugar control of type 1 diabetes is long term commitment to (4);
Maintaining healthy weight(4)
Eating healthy diet(4)
Monitoring blood sugar(4)
The purpose is to keep your blood glucose as normal as possible to defer or prevent complications. The blood glucose level must be between 80mg/dL (4.4 mmol/L) - 120mg/dL (6.7mmol/L) at day time. But at bedtime the blood glucose level must be between 100mg/l (5.6mmol/L) - 140mg/dL (7.8mmol/L) (5).
Insulin & other medications
The patients who have type 1 diabetes need to use insulin therapy to survive (10).
Types of insulin (10)
Rapid acting insulin (10)
Long acting insulin(10)
Intermediate options (10)
Depending on your needs doctor may prescribe mixture of insulin types to use throughout day & night (10).
Inhaled insulin (Exubera) was used in past. But manufacturer makes ceased selling drug because too few people use it. This drug is accompanied with increased inhibit of lung cancer in people with history of smoking (10).
Insulin can't be taken orally to lowers blood glucose level because stomach enzymes interact with action of insulin. There are two types of taking insulin. They are (10);
Injection of insulin may be done using (10);
A fine syringe needle (10)
An insulin pen - Unit which resembles pen excluding cartridge been filled with insulin (10).
An insulin pump
Device about the size of mobile phone carried on outside of your body. One pipe links container of insulin to catheter that is introduced under skin of abdomen. There is also use wireless option made available in most regions. You carry pod filled with insulin in your body that small catheter that is introduced under skin. Insulin pod can be worn on your abdomen, lower back, lower limb or upper limb. The process of programming is done with wireless unit that interacts with pod (10).
Any pump you see, it is made to automatically distribute specific quantities of rapid - acting insulin. This constant dose of insulin is known as your basic rate, & it overrides what you have been using long - acting insulin. When you eat, you can program pump to much carbohydrates what you eat & it gives you what "bolus" doses of insulin called to cover your meals & your blood glucose to correct if it has increased. Some studies have found an insulin pump to be most effective in controlling blood glucose than injections (10).
An infusion of this drug before you eat may slowing down movement of food through your stomach to sharp increase in blood glucose that occurs after meals to slow (5).
High blood pressure medications
Although you do not have high blood pressure, your doctor can prescribe medication known by the name angiotensin - converting enzyme (ACE) inhibitors or angiotensin Ð¿ receptors blockers (ARBs) because such medications can make your kidneys healthy to help besides the lowering blood pressure. It is approved that persons with diabetes have blood pressure 130/80 mmHg (5).
Blood sugar monitoring
According to type of insulin therapy, you may need to check your blood glucose & make minimum of four times per day & possibly more. There are several types of insulin therapy. They are (4);
Single dose injections
Multiple dose injections
Often monitoring is only way to make sure that your blood glucose level in your target band. Make sure to wash your hands before testing your blood glucose for most precise measurement (5).
Experimental treatment for type 1 diabetes
You would no longer need insulin with successful pancreas transplantation. But pancreas transplantation cannot necessarily successful & proceeding brings with serious risks. You should be life time of strong immunosuppressant medications to stop rejecting of organs. These drugs can cause serious side effects, including high risk of infection & organ damage. Since side effects can be more hazardous than diabetes (11).
Islet cell transplantation
Scientists experimented to islet cell transplantation though which provides new insulin producing cells from donor pancreas. Even this labotary procedure has had problems in past. But new techniques & better medications to prevent inputs of islet cells could increase chances of further successes. Islet transplantation is even use of immunosuppressant drugs, & just as there has done. So their own be natural islet cells, the body destroys cells of transplanted islets frequently, and allowing insulin short lived (11).
Stem cell transplantation
Been to 2007 study in brazil, small number of individuals newly diagnosed with type 1 diabetes were capable to discontinue insulin after treatment with stem cells made from their own blood. One day stem cell plantation may be an additional treatment for type 1 diabetes (12).
Glycaemic control in type 2 diabetes
The sugar control of type 2 diabetes is long term commitment to (4);
Blood sugar monitoring(4)
Oral medications & insulin therapy(4)
Certain people who are suffering from type 2 diabetes may be managed their blood glucose level with diet & exercise alone. But most of people want drugs against diabetes & insulin therapy. Some studies show as early intervention with drugs even before Hemoglobin A1C is significantly increased, can be improved glycemic control with time. The decision concerning those drugs can best depend upon many factors, including your blood glucose levels & presence of any other health issues. Your physician may even be combined medications from different classes to help you manage your blood sugar in various ways (4).
Often, people who have newly diagnosed be prescribed metformin (Glucophage, Glumetza) drug against diabetes that reduces production of glucose in liver. Your physician will also advised life style changes, like losing weight & becoming more active (13).
Whenever metformin is not sufficient to regulate your blood sugar, other oral or injected medications are added to glycemic control in type 2 diabetes. Drugs reduce glucose level in different ways. Certain diabetes drugs stimulate pancreas to manufacture & release more insulin. They comprise glipizide (Glucotrol, Glucotrol XL) , glyburide (Diabeta, Glynase) & glimepiride (Amaryl). Some block action of enzymes that breakdown carbohydrates or create tissues more susceptible to insulin, such as Pioglitazone (Actos) (13).
If you do not use metformin, any other oral medications include sitagliptin (Januvia), saxagliptin (onglyza), repaglinide (prandin) & nateglinide (starlix), Exenatide (Byetta) & liraglutide (victoza) have been recently approved medications by injections (13).
Together you can choose which medications are suit you best depending on many factors, including costs & other aspects of your health. Rosiglitazone (Avandia) was accompanied with heart attacks & its use should be restricted by FDA. One recent study found that most expensive medications are not effective for prevent of heart attacks & strokes than drugs in people who are with both diabetes & heart diseases (13).
Glycaemic control in gestational diabetes
Goals of therapy are blood glucose level to maintain within normal limits during pregnancy & to ensure that fetal is healthy. In pregnancy sugar control is done by diet, exercise & insulin therapy (14).
Ayurvedic treatments for diabetes mellitus
There can be seen many herbs which are rendered in management of diabetes in ayurveda. Theses herbal therapies, when they are taken routinely with insulin injections in treatment of diabetes mellitus very effectively (15).
Some herbs that are belief to be comment of ayurveda for diabetes mellitus are (15);
This is general plant helpful in treatment of type 1 & type 2 diabetes. Gymnema stimulates cells of pancreas to produce more insulin (15).
This ancient spice lowers cholesterol, blood sugar level & triglycerides, in addition to increasing levels of good cholesterol in blood (15).
Herbs may be used for diabetes are (15);
Bitter melon (15)
saptrangi (salacia oblonga) (15)
vijaysaar (pterocarpus marsupium) (15)
Turmeric (curcuma longa) (15)
Regular active exercise is required & yoga to reduce stress is encouraged (15).
My special thanks are owed to DR. K. D. M. Kommalage, who is advised me in the preparation of this analytical essay.
I wish to thank my parents, my family members & my friends who have helped me to create this great creation. I am gratitude for them.
Finally I wish to express my debt to the staff of Department of physiology for their continued & unfailing help.