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Diabetes mellitus is a metabolic condition characterized by a decrease or lack of insulin production resulting in improper glucose metabolism. Insulin produced by the pancreas is decreased or ineffective. Blood sugar is the majority body fuel and when it cannot be used it build up in the blood causing hyperglycemia and the body cells must rely on fat as fuel so the patient loses weight. People who are diabetic sometimes become ill because there is too much or too little sugar in their blood. In the United States, the prevalence of prediabetes is increasing. About one-third of people at the age of 20 and older have prediabetes, they are not aware of it because most people do not have symptoms. Though the level of glucose in prediabetes are not as high as in full-blown diabetes

Types of diabetes

Diabetes types divided into different forms. They have much in common with each other but differ in the cause and urgency of treatment necessary. Type 1 diabetes is an insulin-dependent diabetes the patient is usually thin, the age of onset most commonly under 30 years. In general, type 1 diabetes occurs in those who are generally younger, so children and teenagers are more likely to have type 1 diabetes and those in middle age type 2 diabetes. It is also true that those with type 1 diabetes are generally of normal weight while overweight is common in those with type 2 diabetes. It is certain that overweight is a risk for type 2 diabetes and not for type 1 diabetes. Type 1 diabetes has a rapid onset and symptoms can be quite severe. Prompt medication intervention is almost always necessary. Type 2 diabetes is quite strongly genetic being found in families from one generation to the next and in brothers and sisters as they get to middle age and also related to lifestyle factors such as low level of physical activity and weight gain. Type 2 diabetes is non-insulin dependent diabetes the age of onset most commonly above 30 years and the patients usually obese. Unlike type 1 diabetes, it can have a very slow insidious onset and the diagnosis may be missed for many months or even be found by chance on routine medical testing for other conditions.

Causes of diabetes

Hormonal disorders; diabetes itself results from a hormonal imbalance because it results from an imbalance of insulin which eventually leads to an inability to control blood sugar levels.

Acromegaly is another hormonal condition that can lead to diabetes. It is a condition in which the body pituitary gland produces too much growth hormone.

Pancreatitis. If this is severe and a large area is involved the pancreas can be destroyed due to inflammation and scaring and this can lead to diabetes.

Diabetes caused by medications or chemical: certain medication and chemical can cause diabetes. Common examples include pentamidine, nicotinic acid, and glucocorticoids.

Risk factors that may lead to diabetes

It is clearly understood that your lifestyle and certain health conditions can increase your risk of getting diabetes.

Family history: your chance of developing either type 1 or type 2 diabetes increase if someone from your family has diabetes disease there is a high chance that you may also develop diabetes. Weight; being overweight or obese in one of the most common risk factors for type 2 diabetes.

 Inactivity; the less active you are the greater your risk of type 2 diabetes. Being physically active may also help to reduce the chance of developing diabetes and also help in reducing your body weight, it will make body cells more sensitive to insulin, increase blood flow and improves circulation.

Age as you grow older especially after the age of 45 you are at the risk of getting type 2 diabetes. Part of the reason is that as people grow older they tend to become less physically active and they gradually lose muscle mass and gain weight.

Signs and symptoms of diabetes

Excessive thirst; this occurs because you become dehydrated due to water loss.

More frequent urination; the kidneys must work extra hard to get rid of the excess sugar that has built up in the bloodstream. The excess sugar must be flushed out along with water so this leads to more urination that is frequent.

Unexpected weight loss; this occurs because this occurs because your body can no longer make use of sugar in the blood.

Increased hunger; you may be more hungry than usual, even though your activity level has not changed. This because your body cannot make use of the sugar in your food and you are losing its valuable calories as it is elimination in the urine.

Unusual tiredness; because you are losing so much sugar in your urine you are losing out on important calories that provide your body with energy.

Blurred vision; when excess sugar builds up in the blood it can also build up in the lens of the eyes. This pulls extra water into the lens too and causes the lens to change shape. This leads to blurry vision.  Some other less frequent symptoms include:

Dry skin and mouth, nausea and vomiting, slow healing sores, repeated vaginal infection in women, yeast infections in women and men, itchy skin and numbness and tingling in the feet.

Thirst, polydipsia, and polyuria: severe thirst, including day and night. A few often elderly ignore their thirst for fear of increased urination. This can cause dehydration and may precipitate hospital admission.

Pruritus: pruritus vulvae are a common presenting feature caused by candida infection. Generalized pruritus is not a feature of diabetes only. There are many other minor causes as well.

Diagnosing or assessing a person with diabetes

When making the diagnosis of diabetes doctor evaluate a person’s risk factors for the disease, such as overweight, obesity age activity level, family history, and associated medical conditions. They also use laboratory test to confirm a diagnosis of diabetes. Healthcare provider can also diagnose diabetes by measuring the amount of glucose in your blood using a simple blood test. There are four main tests:

A1C test: this test is also called hemoglobin A1C, HbA1C, glycated hemoglobin. The A1C test measures your average blood glucose over three months. It is a picture of your blood glucose over time.

Fasting plasma glucose test. A fasting plasma glucose test can be used to diagnose diabetes. It is also a simple blood test, and it measures your blood glucose as a snapshot at that moment. A reading of 126mg/dL or above means you have diabetes. Prediabetes can be diagnosed with fasting plasma glucose of 100 – 125 mg/dL.

Random plasma glucose test; A random plasma test is another test to diagnose diabetes. Just like it sounds, it can be done randomly as a snapshot of your blood glucose.

Management of Diabetic emergency

If a diabetic person is conscious in an emergency situation and he or she can safely swallow fluids or food give the victims sweat food or drink and should be in liquid forms if possible give him or her sugar preferably in a liquid form. Any diabetic patient on glucose lowering treatment who behaves oddly in any way is hypoglycemic until proved otherwise. The feature of hypoglycemia includes confusion, seating, shaking blurred vision aggression coma, and fits.

If patients capable of swallowing: glucose is absorbed most rapidly in liquid. Give 10g glucose. Treat hypoglycemia as soon as it is suspected. Check finger-prick glucose if possible give oral glucose immediately.

In patients who cannot, or will not swallow safely

Conscious patients who refuse to swallow:  Firm encouragement to eat. Glucogel is best in this situation as it is difficult to spit out.

Violent patients keep back to avoid personal injury and try to contain the patient in a safe area.  Inject glucagon into whatever muscle bulk can be accessed safely.

Unconscious patients, unsafe swallow and uncooperative

Profound hypoglycemia is rare.it is most often seen in patients who have taken insulin overdoses, alcohol, or sulphonylureas or in renal failure. Risk of respiratory or cardiac arrest of the patients, protect the airway, give oxygen if convulsing or hypoxic, safeguard patients from injury. Give IV glucose repeat once if not recovered within 15 minutes. Monitor Glasgow coma, heart rate blood pressure, and respiration oxygen saturation. Feed patient if safe, or infuse glucose slowly rate depends on the medical situation.

Treatment for diabetes

Self-monitoring of blood glucose is very important. For type 1 diabetes, it is better to monitor sugar level at least three times a day.  Food planning with dietary control is very important in controlling diabetes. Exercise is very crucial for a person with diabetes because it will help to control blood glucose in the body, help keep body weight down and also help to keep blood pressure down.

Monitor and Management of hyperglycemia this happens when there is no insulin in the blood or not enough insulin in blood or insulin in the blood is not working properly hence high blood sugar level. Revise the food diary and treat hyperglycemia immediately to prevent associated complication.

Mange hypoglycemia it is sometimes called insulin reaction. It is when your blood glucose is too low. The fastest way to manage this is to eat firm of sugar.

History of polyuria, polydipsia, weight lost weakness, fatigue and frequent infection. Physical examination of the complication of hyperglycemia such as neuropathy, nephropathy, and retinopathy 

Complication of diabetes

Hypertension is an extremely common comorbid condition in diabetes., including stroke, coronary artery disease, and peripheral vascular disease, retinopathy, and possibly neuropathy.

Heart disease: death from heart disease and risk for stroke is three times higher for diabetes.

High blood pressures 75 percent of diabetics have high blood pressure.

Kidney disease diabetes is the leading cause of kidney failure.

Infertility; patient with type 1 diabetes complication might have certain risk factors that would end up to their partial infertility.

Reference:

Matthews, D. (2008). Diabetes. Oxford: OUP Oxford. Retrieved from http://search.ebscohost.com.asa.idm.oclc.org/login.aspx

Hillson, R. (2008). Diabetes Care : A Practical Manual. Oxford: OUP Oxford. Retrieved from http://search.ebscohost.com.asa.idm.oclc.org/login.aspx

Fox, C., Sönsken, P., & Kilvert, A. (2008). Type 1 Diabetes : Answers at Your Fingertips (Vol. 6th ed. Charles Fox, Anne Kilvert). London: Class Health. Retrieved from http://search.ebscohost.com.asa.idm.oclc.org/login.aspx

Cowap, N. (2015). Diabetes. Dulles, Virginia: Mercury Learning & Information. Retrieved from http://search.ebscohost.com.asa.idm.oclc.org/login.aspx