DIABETES MELLITUS
By
Dr. Sabry Ahmed Salem
Prof. of community medicine
Environ mental health &
occupational medicine
Classification of diabetes mellitus:
It can be classified, according to the level
of blood glucose, into:
I-Clinical diabetes: cases show symptoms and
signs and clearly elevated blood glucose,
which may be:
A-Primary:
1- Type I or Insulin dependent diabetes mellitus
(IDDM).
2- Type II or Non-Insulin dependent diabetes
mellitus (NIDDM).
B-Other specific types:
1. Pancreatic diseases (Pancreatitis, neoplastic
disease, pancreatectomy, cystic fibrosis).
2. Excess endogenous production of hormonal
antagonists to insulin:
e.g. Growth Hormone (Acromegaly),
Glucocorticoids (Cushing Syndrome), Thyroid
Hormones (hyper thyroidism), Catecholamines
(phaeochramocytoma) and human placental
lactogen (pregnancy).
1. Medications:
corticosteroids and thiazide diuretics.
2. Associated with genetic syndrome:
e.g. Diabetes insipidus, Down’s syndrome and
Turner’s syndrome.
C-Gestational.
II- Abnormal glucose tolerance:
The cases show mild hyperglycemia, which is
not so high to be diagnosed as diabetes. It may be
called a symptomatic, chemical, potential, latent,
borderline or subclinical diabetes.
Epidemiology:
Diabetes mellitus is worldwide in distribution and
the incidence of both types of primary diabetes i.e
IDDM and NIDDM, is increasing. However the
prevalence of both types varies in different part of the
world and this probably due to differences in genetic
and environmental factors. The great majority of cases
seen worldwide have primary diabetes and in Europe
and North America the ratio of type 2: type 1 is
approximately 7:3, in Egypt may be around 4:1.
I- IDDM:
It is more common is young age than that
among old age, with usually sudden onset and
severe insulin deficiency and more prone to
ketosis. It may be fatal with negligence of
insulin therapy as it is insulin dependent.
II-NIDDM:
• It is more common among middle or old age
groups of population (any age may be affected).
• Insulin deficiency is not sense and cases are
prone to ketosis.
• Trauma and infections might be predisposing
factors for developing ketosis.
• This type not dependent on insulin therapy.
• Obesity is an important risk factor among this type.
• Diet control and hypoglycemic drugs usually
control the cases. Insulin is given in some cases.
Aetiology:
A-Type 1, IDDM:
1-Genetics:
2- Viruses:
3-Diet:
4- Stress:
5-Immunological factors:
II- Type II NIDDM:
Causes:
1- Genetics:
2- lifestyle:
a- Overeating:
b- Malnutrition in utero:
C- pregnancy:
High-risk factors for NIDDM:
1- Familial tendency due to:
• Inheritance.
• Exposure of the family members to the same
risk factors e.g. diet, obesity and stress.
2- Herd tendency:
Exposure of numbers of an ethnic group to
common social and environmental factors.
3- Personal factors:
i. Obesity:
ii. the risk is directly associated with extent and
duration of obesity.
iii.Child bearing period:
Affects insulin utilization.
c- Diabetogenic drugs:
Corticosteriods and oral contraceptive.
* Factors associated with in creased mortality
and morbidity in diabetic patients:
1. Duration of diabetes.
2. Early age at onset of disease.
3. Raised blood pressure.
4. Proteinuria.
5. Obesity.
6- Hyperlipidaemia.
7- High glycated hemoglobin.
Complications of diabetes:
I-Acute complications:
1- Hypoglycemia:
2- Counter-regulatory responses:
3- Diabetic ketoacidosis:
4- Non-ketotic hyperosmolar diabetic coma:
5- lactic acidosis.
II- long-term complications:
1. Diabetic retinopathy.
2- Diabetic neuropathy.
3. Diabetic foot.
4- Diabetic nephropathy.
Prevention of diabetes:
Preventive measures are mainly based on
the high-risk factors:
1- Nutrition education:
To avoid excess carbohydrate and fats which
leads to obesity, through:
i. Adequate feeding for children and avoiding
over weight.
ii. Avoid cow’s milk during infancy and encourage
breast feed.
iii.Regular checking of weight, to screen and
management of over weight and early obesity.
2- Prevention and control of viral infections:
To prevent the viral infections that may be
complicated with pancriatitis, through:
• Specific immunization and seroprophylaxis
when needed, (MR vaccine during child hood) to
prevent mumps and rubella infection.
• Environmental sanitation.
3- Avoid the diabetogenic drugs abuse:
These preparation must be used under
medical super vision.
4- Premarital examination and counseling:
For
early case
diabetics:
finding
and
guidance
of
The public must be aware of the risk of
inherited susceptibility, when both parents are
diabetic.
Control of diabetes:
1- Epidemiological studies
Objectives:
i. To determine the prevalence and
epidemiological features of the disease.
ii. To study the high risk factors associated with
the disease and the high-risk groups.
iii. To evaluate the control measures.
II- Case finding program:
To detect the cases of hyperglycemia through:
i. Health appraisal: during providing medical service.
ii. Comprehensive medical examination.
iii. Screening tests
d- Survey studies.
III-Management and treatment of cases.
IV- Health education:
a- The public for,
- Utilization of health services.
- Adequate nutrition.
- Healthy lifestyle
- Normal weight avoid stress
- Exercise.
- Knowledge about the disease and the
associated risk factors.
b- The borderline cases and high risk
groups for:
•
Weight control.
•
Uses diabetogenic drugs under medical supervision.
•
Early detection of hyperglycemia through regular
checking blood glucose level.
•
Manifestations of hyperglycemia.
c- The cases for:
•
Strictly follow up the scheme of treatment and diet.
•
Signs and symptoms of complicated disease.
•
Seek medical care regularly.