1
Course Code.
: ZOL_5104
Course Teacher. : Mam Amber Gul
Student ID.
: BBOF18E020
Program.
: BS Botany (S. S)
Regular/S. S.
: Self _support
Course Name.
: Principles of animal
physiology
Submission Date. :20 April 2020
Student Name.
:Aneeqa Ali
Session.
:2018 _2022
Semester.
:4th
Main campus
University Of Sargodha
ASSIGNMENT COVER SHEET:
Title of the Assignment: Diabetes mellitus
Word count : 3156
Marks awarded by teacher:
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Diabetesmellitus :
Diabetes mellitus : (often called sugar diabetes or simply diabetes)
Definition:
Diabetes is a condition that occurs when the body can't use glucose (a
type of sugar) normally. Glucose is the main source of energy for the body's cells.
“It is a group of metabolic diseases in which there are high blood sugar levels
over a prolonged period.”
This high blood sugar produces the symptoms of frequent urination,
increased thirst and increased hunger.
Complications:
Untreated, diabetes causes many complications
Acute complications:
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Acute complications include

diabetic ketoacidosis (body start using only fat as fuel)

non ketotic hyper osmolar coma. (if low blood sugar left untreated)
Long-term complications:
Serious long-term complications include

heart disease,.

Stroke.

kidney failure.

foot ulcers.

damage to the eyes.

The long-term complications relate to damage to blood vessels.

Diabetes doubles the risk of cardiovascular disease.
The primary microvascular complications of diabetes include

Damage to the kidneys, and nerves.
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
Damage to the eyes (diabetic retinopathy,) is caused by damage to the
blood vessels in the retina of the eye, and can result in gradual vision loss
and potentially blindness.

Damage to the kidneys (diabetic Nephropathy) , can lead to tissue
scarring, urine protein loss, and eventually chronic kidney disease,
sometimes requiring dialysis or kidney transplant Damage to the nerves of
the body, (symptoms can include numbness, tingling, pain, and altered
pain sensation, which can lead to damage to the skin.

Proximal diabetic neuropathy causes painful muscle wasting and
weakness.
Hormone:
The levels of glucose in the blood are controlled by a hormone called
insulin. Insulin is made by the pancreas.
Diabetes is due to either the pancreas not producing enough insulin, or the
cells of the body not responding properly to the insulin produced.
Types of diabetes mellitus:
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There are three types of diabetes mellitus which are as follow:

Type 1 diabetes mellitus

Type 2 diabetes mellitus

Gestational diabetes.
1) Type 1 DM:
This type is also referred to as “insulin dependent diabetes mellitus”(IDDM)
or “juvenile diabetes. It result from body failure to produce insulin.
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1 DM is characterized by loss of the insulin producing cells (beta cells) of the
islets of Langerhans in the pancreas, which leads to the insulin deficiency .It can
be further divided into immune mediated or idiopathic. In type 1 diabetes is
majority immune mediated. In which T-Cell mediated anti immune attacks that
result in the loss of beta cell. Type 1 diabetes occurs mostly in adult and children
and termed as juvenile diabetes.
Type 1 diabetes can occur at any age. It is mostly diagnosed in children,
adolescents, or young adults.
The pancreas is below and behind the stomach. Insulin is needed to move
blood sugar (glucose) into cells. Glucose is stored and later used for energy with
in the cells. Beta cells produce little or no insulin, with type 1 diabetes
Glucose builds up in the bloodstream instead of going into the cells without
having enough insulin. This buildup of glucose in the blood is called
hyperglycemia. The body is unable to use the glucose for energy. That results in
the symptoms of type 1 diabetes.
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The exact cause of type 1 diabetes is unknown. Most likely, it is
an autoimmune disorder. This is a condition that occurs when the immune system
mistakenly attacks and it destroys the healthy body tissues of the body. With type
1 diabetes, an infection or another trigger causes the body to mistakenly attack the
cells in the pancreas that make insulin. The tendency to develop autoimmune
diseases, including type 1 diabetes, it can be inherited from your parents.
“Brittle diabetes” often called as unstable diabetes or “labile diabetes”. (a
term that is used to define dramatic and recurrent swings in glucose level) it has
no biologic basis hence it is not used.
It is unpredictable hyperglycemia frequently with ketosis and sometimes
with serious hypoglycemia.
Type 2 diabetes mellitus:
Type 2 DM is characterized by insulin resistance and may b combined
with reduced insulin secretion. The body tissue do not accurately response to
insulin believed to involve the insulin receptor. Its specific defects are unknown.
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Cases due to its known defects are classified separately . It is the most common
type.
At early stage predominant abnormality is reduced insulin sensitivity.
Hyperglycemia can be reversed by medications to improve insulin sensitivity and
reduce glucose production by liver.
The symptoms of type 2 diabetes can be so mild that they are not noticed by
anyone. About 8 million people who have it don't know it. Its symptoms include.

Being very thirsty

Peeing a lot

Blurry vision

Being cranky

Tingling or numbness in your hands or feet

Fatigue/feeling worn out

Wounds that don't heal

Yeast infections that keep coming back
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
Hunger

Weight loss without trying

Getting more infections
Dark rashes around your neck or armpits. that are often a sign of insulin
resistance
Your pancreas makes a hormone called insulin. It support your cells to turn
the glucose, (a type of sugar) from the food you eat into the energy that we need
to do work . Patients with type 2 diabetes make insulin, but their cells don't use it
as well as they should.
At first, your pancreas makes more insulin in order to try to get glucose into
your cells. But eventually, it can't keep up, and the glucose builds up in your
blood instead.
Usually, a combination of things that causes type 2 diabetes. They might
include:

Genes. Scientists have found different bits of DNA that affect the working
of your body to make insulin.

Extra weight . Being overweight or obese can cause insulin resistance,
especially if you carry your extra pounds around your middle.

Metabolic syndrome . People with insulin resistance often have a group
of conditions including high blood sugar, extra fat around your waist, high
blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver . When the blood sugar is low, your
liver makes and sends out glucose. After you eat, your blood sugar goes
up, and your liver will usually slow down and store its glucose for later.
But some people's livers don't. They keep cranking out sugar.

Bad communication between cells. Sometimes, cells send the wrong
signals or don't pick up messages correctly that is its working got
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disturbed. When these problems affect the working of your cell and use
insulin or glucose, chain reaction results in the cause of diabetes.

Broken beta cells. If the cells that make insulin send out the wrong
amount of insulin at the wrong time, your blood sugar gets thrown off.
High blood sugar may results in the damage of these cells, too.
Comparison between type 1 diabetes mellitus and type 2 diabetes mellitus:
There are two main types of diabetes: type 1 and type 2. Both types of
diabetes are chronic diseases that affect the way your body regulates blood sugar,
or glucose. Glucose is the fuel that feeds your body’s cells, but to enter your cells
it needs a key. Insulin is that key.
People with type 1 diabetes don’t produce insulin. You can think of it as
not having a key.
People with type 2 diabetes don’t respond to insulin as well as they should
and later in the disease often don’t make enough insulin. You can think of this as
having a broken key.
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Gestational diabetes :( GDM)
It resembles to type 2 diabetes in many aspects involving combination of
inadequate insulin secretion and responsiveness. It occurs about 2-10% of all
pregnancies and may improve or disappear after delivery. It is fully treatable but
requires careful medical supervision throughout pregnancy management may
include changes in diet, blood glucose monitoring and in some cases insulin may
be required
If it left untreated it can damage the health of fetus and mother. Risk to
baby include macrosomia (high birth weight), cardiac and central nervous system
anomalies and skeleton muscle malformations. Increased fetal insulin production
inhibits fetal surfactant production and cause respiratory distress syndrome. In
critical cases prenatal death may occur. Labor induction may be indicated with the
decreased placental function.
Gestational diabetes usually happens in the second half of pregnancy. Your
doctor will check for it between weeks 24 and 28 or earlier if you're at high risk.
Your doctor will give you a glucose challenge or glucose screening test.
You’ll drink something sweet to raise your blood sugar. An hour later, you’ll take a
blood test to see how your body handled all that sugar. If the results show that your
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blood sugar is higher than a certain level, usually around 200 milligrams per deciliter
(mg/dL), you’ll have to do an oral glucose tolerance test. This means checking your
blood sugar after going without food and having a 3-hour glucose test.
If you’re at high risk but your test results are normal, your doctor might test
you again later in your pregnancy to make sure you still don’t have it.
Your doctor will ask you to:

Check your blood sugar levels 4 or more times a day

Check your urine for ketones, chemicals that mean that your diabetes isn’t
under control

Take a healthy diet

Make regular exercise a habit
Signs and symptoms:
The symptoms of untreated diabetes are

Weight loss

Frequent urination (polyuria)

Increased thirst(polydipsia)

Increased hunger (polyphagia)
Symptoms may develop rapid in type 1 diabetes many other symptoms and
signs can mark the onset of diabetes, while they are not specific to the disease. In
addition to above mentioned symptoms it may include
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
Blurry vision

Headache

Fatigue

Slow healing of cuts

Itchy skin
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
Prolonged high blood glucose level may result in glucose absorption in
lens of the eye(i.e. changes in its shape or vision changes)

Numbers of skin rashes (diabetic dermatomes)
Diabetic emergencies:
People usually with type 1 diabetes may also experience (diabetic
ketoacedosis) a type of metabolic problems characterized by

Nausea

Vomiting

Abdominal pain

The smell of acetone during breathing

In several cases decreased level of consciousness
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A rare possibility of hyperosmolar nonketotic state occurs in patients having
type 2 diabetes and is mainly the result of dehydration.
Diagnosis/blood glucose level:
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia
and is diagnosed by the following:

Fasting plasma glucose level ≥7.0mmol/l (126mg/dl)

Plasma glucose≥11.1mmol/l (200mg/dl) two hours after a 75g oral glucose
load as in a glucose tolerance test

Symptoms of hyperglycemia and casual plasma glucose ≥11.1mmol/l
(200mg/dl)
Note:
High glucose level (hyperglycemia)
Low glucose level (hypoglycemia)
Normal glucose level(euglycemia)
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Diabetes test:
Blood sugar test:
It is a process that measures the amount of sugar or glucose in your blood.
In order to diagnose diabetes doctors suggest diabetes test. People suffering
from diabetes manage their condition by using this test.
It provides instant following result.

How your diabetes medications and treatment is working

If your blood glucose level high or low

If your overall treatment goals are manageable

your routine or diet needs to change or not
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Checking of your blood sugar levels can be easily done at home or at doctor’s
clinic. Doctors may order it as a part of routine checkup. They may also be
looking to see if you are suffering from diabetes or prediabetes( a condition where
your blood sugar level are higher than normal).
Types of blood sugar test:
There are two ways of blood sugar test

People who manage or monitor their diabetes prick their finger using a
glucometer for their daily test

Other method is to draw blood and taking samples. These samples are
used to screen for diabetes.
Your doctor will order a fasting blood sugar test (FBS). This test is used to
measure your blood sugar level.
An oral glucose tolerance test. This means checking your blood sugar after
going without food and having a 3-hour glucose test.
A glycosylated hemoglobin (hemoglobin A1C) test. This test reflect your
blood sugar level over the previous 90 days. This result show that if you have
diabetes or prediabetes and monitor how your diabetes is controlled.
When and how you have to test diabetes it depends on the type of diabetes
you have and your treatment method.
Risks and side effects of blood sugar tests:
Blood sugar test has low to no risks and side effects. You may feel
swelling, soreness and bruising at the puncture site. Especially if the blood is
drawn from the vein. This should go away or cured with in 1 day
Greater risk for diabetes:
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Risk for getting diabetes increase if any of following factors exist:

If you are obese (overweight)

You do not take regular exercise

If you have high blood pressure

You are 45 years old or older

You have history of insulin resistance

You have history of strokes or hyper tension

You have diabetes in your family history

You have history of gestational diabetes.
Medications:
Diabetes medications and insulin therapy

Metformin (first medication prescribed for type 2 diabetes)

Sulfonylurease(this can help your body to produce more insulin)
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
Meglitinides( also help body to secrete more insulin duration of their
effect is shorter)

Thiazolidinedione’s(make body tissues more sensitive to insulin)

DPP-4 inhibitors(help to reduce blood sugar level)

SGLT-2 inhibitors(they prevent kidneys from reabsorbing sugar into
blood)

Insulin therapy (hypoglycemia is its possible side effect)

Bariatric surgery(if your body mass index is greater than 35 you may be a
candidate for weight loss surgery)
Prevention:
Preventive measures of type 2 DM:
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
Work out regularly:
Performing physical activity on a regular basis help to prevent diabetes .
Exercise increases the insulin sensitivity of your cells. when we exercise, less
insulin is required to keep your blood sugar levels under control.

Cut sugar from your diet:
Eating sugary foods and refined carbs can put at-risk of developing diabetes.
Our body rapidly breaks these foods down into small sugar molecules, which are
absorbed into bloodstream.

Drink water and avoid beverages:
Water is the most natural beverage you can drink. Sticking with water most of
the time helps you avoid beverages that are high in sugar, preservatives and other
questionable ingredients.

Lose weight:
Although not everyone who develops type 2 diabetes is overweight or obese,
the majority are those with prediabetes tend to carry excess weight in their
midsection and around abdominal organs like the liver. This is known as visceral
fat.

Follow very low carb diet:
Following a ketogenic or very-low-carb diet can help you avoid diabetes.
Although there are a number of ways of eating that promote weight loss, verylow-carb diets have strong evidence behind them.
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
Watch portion sizes:
Whether or not you decide to follow a low-carb diet, it's important to avoid
large portions of food to reduce the risk of diabetes, especially if you are
overweight. Eating too much food at one time has been shown to cause higher
blood sugar and insulin levels in people at risk of diabetes

Avoid sedentary behavior:
It's important to avoid being sedentary if you want to prevent diabetes. If you
get no or very little physical activity, and you sit during most of your day, then
you lead a sedentary lifestyle.

Eat high fiber diet:
Getting plenty of fiber is beneficial for gut health and weight management.
Studies in obese, elderly and prediabetic individuals have shown that it helps keep
blood sugar and insulin levels low
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
Optimize vitamin D level:
Vitamin D is important for blood sugar control. Indeed, studies have found
that people who don't get enough vitamin D, or whose blood levels are too low,
have a greater risk of all types of diabetes

Take natural herbs:
There are a few herbs that may help increase insulin sensitivity and reduce the
risk of diabetes progression.
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Curcumin
Curcumin is a component of the bright gold spice turmeric, it is one of the
main ingredients in curries.
Bebeerines
Berberine is found in several herbs and it has been used in traditional
Chinese medicine for thousands of years.
There is no known preventive measure for the type 1 DM
Management:

Manage glucose level:
Diabetes mellitus is a chronic disease. There is no known cure for it. It only be
controlled in very specific conditions. It’s management concentrates on keeping
the blood glucose level near to normal level as possible in doing this it is
prevented from dropping to low level of blood glucose because this may cause
hypoglycemia.

Obtaining knowledge about diabetes:
Learning about this disease and actively participating in its treatment is good
for people having diabetes. As a result of which the complications of diabetes are
far less common and less severe in people who have well managed there blood
glucose level. Attention us also paid to other health problems which accelerates
the effects of diabetes. Which include smoking, elevated cholesterol levels,
obesity, high blood pressure, and lack of physical exercise.

Use of foot wear :
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Specialized footwear are available and mostly used to reduce the risks of
ulceration specially in at risk of diabetic feet(in those persons feet suffering from
diabetes).
Conclusion:
Life style and home remedies:
Consider these following tips for careful management in order to reduce the
risk of serious or life threatening complications:

Commit to managing your diabetes. Make healthy eating and physical
activity a part of your daily routine.

Schedule a yearly physical exam and regular eye check up.

Keep your vaccination up to date.

Take care of your teeth.
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
Pay attention to your feet.

Keep your blood pressure and cholesterol under control.

Ask your doctor to help you in quitting smoking

If you drink alcohol, do so responsibly.
References:

"Diabetes Blue Circle Symbol". International Diabetes Federation.
17March2006.

"About diabetes". World Health Organization. Retrieved 4 April 2014

^ abcdefghij"Diabetes Fact sheet N°312". WHO. October 2013Retrieved
25March 2014.

Kitabchi, AE; Umpierrez, GE; Miles, JM; Fisher, JN (Jul 2009).
"Hyperglycemic
Care32(7):
crises in adult patients with diabetes.". Diabetes
1335–43.doi:10.2337/dc09-9032.
PMC2699725.
PMID19564476.

^ abcdefShoback, edited by David G. Gardner, Dolores (2011).
Greenspan's basis & clinical endocrinology(9th ed.). New York: McGrawHill Medical. pp.Chapter 17.ISBN0-07-162243-8.

https://www.healthline.com/health/blood-sugar-tests

Blood
glucose
testing.
(n.d.). http://www.diabetes.org/living-with-
diabetes/treatment-and-care/blood-glucose-control/

Blood sugar tests. (n.d.). http://my.clevelandclinic.org/heart/diagnosticstesting/laboratory-tests/blood-sugar-tests.aspx
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
Checking your blood glucose. (2018). http://www.diabetes.org/livingwith-diabetes/treatment-and-care/blood-glucose-control/checking-yourblood-glucose.html

Mayo Clinic Staff. (2018). Blood sugar testing: Why, when and
how. http://www.mayoclinic.com/health/blood-sugar/DA00007

https://www.mayoclinic.org/diseases-conditions/type-2diabetes/diagnosis-treatment/drc-20351199