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Diabetes Mellitus: Types, Causes, Signs, Symptoms, Diagnosis, Treatment, General Care and Home remedies of Diabetes Mellitus

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia with or without glycosuria resulting from an absolute or conditional deficiency of insulin. Diabetes mellitus, colloquially also called ``the sugar illness'', is a disorder of the body's metabolism . Nearly all our food gets broken up into small chemicals by the digestive juices. One of those is the sugar molecule glucose which diffuses into the body's bloodstream. There it is available for the cells which are able to gain energy  from it. The glucose molecules themselves are not able to pass a cell membrane. Diabetes is a disease in which the body doesn't produce or properly use insulin. Insulin is a hormone produced in the pancreas, an organ near the stomach. Insulin is needed to turn sugar and other food into energy. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should, or both. This causes sugars to build up too high in your blood. Above the age of 60 years 16.5% of urban and 5.3% of rural population show diabetes mellitus.

Types of Diabetes Mellitus

•  Insulin- dependent diabetes mellitus ( IDDM or type I )

•  Non- Insulin dependent diabetes mellitus ( NIIDM or type II )

•  Gestational Diabetes ( Type III )

Insulin- dependent diabetes mellitus ( IDDM or type I ) normally affects children  or adolescents only, although it can appear at any age. The body's own immune system  is responsible for IDDM, because it starts to destroy the beta cells  which are part of the pancreas and produce the insulin. Today it is unknown why the immune system kills the beta cells, but it is believed that both genetic factors  and virus infections  are responsible for it. Up to ten per cent of all diabetes diseases are of type I. Some of the first symptoms  are increased needs of sleep, constant hunger and thirst, a bleary vision and a loss of weight. Insulin dependent diabetes mellitus (IDDM) may start at any age, but vast majority start below the age of 20 years.

IDDM is a heterogenous disorder in which several factors may playa role. These are the HLA system, viral infections and autoimmune processes. IDDM tends to be a familial disorder and there is a 25-fold increase in the risk amongst the siblings than the general population. Its inheritance is strongly related to the HLA loci on chromosome 6. It is seen that HLA B8, B15, B6, B21' BW3, DR3 and DR4 are associated with a higher risk of diabetes mellitus. On the other hand, a negative association has also been noted with HLA B7. In Asian Indians and Japanese, IDDM appears to be associated more with HLA BW21 and BW54 than with B8. Among identical twins only 50% show concordance for IDDM as against 100% for NIDDM.

Non- Insulin dependent diabetes mellitus ( NIIDM or type II ) normally affects adults at an age of above 40. The body loses its ability to use its own insulin  even though the pancreas  still produces it. Over ninety per cent of all diabetes patients have NIDDM. The symptoms  are similar to type I, but about 85 per cent are overweight. Genetic factors playa major role in this condition. Though the exact pattern is not known, it has been variously described as autosomal dominant, autosomal recessive or polygenic. A genetic predisposition running through families is evident. Identical twins invariably develop NIDDM when exposed to the same environmental factors. Environmental factors which precipitate the onset of diabetes are obesity, physical inactivity, repeated pregnancies, infections, physical or psychological stress and diabetogenic drugs. Birth of babies with weight above 4kg is a strong pointer to the subsequent development of diabetes in the mother. Obese subjects show a relative resistance to the action of insulin due to a reduction in the number of insulin receptors on the target cells. This defect is reversible on reducing weight.

Gestational Diabetes ( Type III ) appears in about 2-5% of all pregnancies. It is temporary and fully treatable, but if untreated it may cause problems with the pregnancy, including macrosomia (high birth weight) of the child. It requires careful medical supervision during the pregnancy., but those women will have a higher chance to get NIDDM.

Causes of diabetes Mellitus

Since insulin is the principal hormone that regulates uptake of glucose into cells (primarily muscle and fat cells) from the blood, deficiency of insulin or its action plays a central role in all forms of diabetes.

Insulin:- This is the hormone produced by the beta cells of the islets of Langerhans and is composed of two polypeptide chains A anJ B linked together by two disulphide bonds. The precursor of insulin is pro insulin (big insulin) from which C-peptide is broken off to form insulin with a mol wt 5807 d. C-peptide is secreted in equimolar quantities with insulin from beta cells. The C-peptide levels can indirectly reflect IRI levels. Serum C-peptide levels can indicate functioning beta cell reserves. The nornlal values of C-peptide levels are highly variable. Insulin is stored in the granules of the beta cells to be discharged into the interstitial fluid, under appropriate stimulus. Though proinsulin cross­reacts with insulin antibodies, it has none of the metabolic effects of insulin.

Main stimulus for formation and release of insulin is hyperglycemia caused by ingestion of carbohydrates. Other stimuli include rise in amino acids produced by protein digestion, growth hormone, glucagon, gastrin, pancreozymin, secretin, several of the other gut hormones, especially gastric inhibitory polypeptide (GIP) and neurohormones such as encephalins and endorphins. Insulin secreted by beta cells enter portal circulation and 50-60% is trapped by the liver. The remaining portion enters the circulation. This can be estimated as IRI. Insulin reaches its target cells through blood. Levels of circulating insulin vary during the different periods of the day. It is lowest during fasting.

Immuno reactive insulin (IRI) level ranges from 2-20 micro International unit/ml. in fasting normal subjects.

On the target cell insulin binds to specific surface receptors and then initiates further biochemical events within the cell. The insulin receptors are large molecular weight proteins (500,000 D) which help the entry of insulin into the cell and start off metabolic processes through the activation of a kinase. The metabolic actions are together known as 'post receptor effect'. Sensitivity to insulin depends on the number of unbound receptors. The number of receptors vary inversely with the levels of circulating insulin. The sensitivity of the receptors to insulin has a major role to play in the production of diabetes mellitus. The genetic locus for insulin is chromosome 11 and that for the receptors chromosome 19. Alteration of the cell membrane by insulin favors the entry of glucose, potassium, and aminoacids into muscles, liver, and fat cells. In the liver insuJin retards gluconeogenesis. Excess glucose entering the skeletal muscles is converted into glycogen. Insulin helps to build up adipose tissue by aiding the conversion of glucose into fat and blocks the escape of fatty acids from fat cells. In conjunction with growth hormone insulin enhances the incorporation of aminoacids into peptides in the liver and skeletal tissues.

Sign of Diabetes Mellitus

Diabetes can sometimes feel like a viral illness, with fatigue, weakness and loss of appetite. Sugar is your body's main fuel, and when it doesn't reach your cells you may feel tired and weak.
Weight gain or loss:- Because your body is trying to compensate for lost fluids and sugar, you may eat more than usual and gain weight. But the opposite also can occur. You may eat more than normal, but still lose weight because your muscle tissues don't get enough glucose to generate growth and energy. This is especially true if you have type 1 diabetes, in which very little sugar gets into your cells. In fact, most people with type 1 diabetes are at or below their normal weight.
Blurred vision:- High levels of blood sugar pull fluid out of the tissues in your body including the lenses of your eyes. This affects your ability to focus. Once your diabetes is treated and your blood sugar levels drop, your vision should improve. Over a period of years, however, diabetes can also cause new blood vessels to form in your retina ? the back part of your eye ? as well as damage old vessels. For most people this causes only mild vision problems. But for others, the effects may be much more serious. In some cases, diabetes can lead to blindness.
Slow-healing sores or frequent infections:- Diabetes affects your body's ability to heal and fight infection. Bladder and vaginal infections can be a particular problem for women.
Nerve damage (neuropathy):- Excess sugar in your blood can damage the small blood vessels to your nerves, leading to a number of symptoms. The most common are tingling and loss of sensation in your hands and especially your feet. You may also experience burning pain in your legs, feet, arms and hands. In addition, more than half the men age 50 and older with diabetes may experience some degree of sexual dysfunction from damage to the nerves that help produce an erection.
Red, swollen, tender gums:- Diabetes increases the risk of infection in your gums and in the bones that hold your teeth in place. As a result, your gums may pull away from your teeth, your teeth may become loose, or you may develop sores or pockets of pus in your gums. This is especially true if you have a gum infection before the onset of diabetes.

Symptoms of Diabetes Mellitus

Often diabetes goes undiagnosed because many of its symptoms (often misspelled as "symtoms") seem so harmless.  Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

Some diabetes symptoms include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

Diagnosis of Diabetes Mellitus

In the past, the common approach to diabetes screening was a preliminary, semi quantitative test for glucose in a urine sample, followed by an oral glucosse tolerance test or those found to have glycosuria. The underlying assumption is that early detection and effective control of hyperglycemia in asymptomatic diabetics reduces morbidity.

•  Urine Examination: Urine test for glucose, 2 hours after a meal is commonly used in medical practice for detecting cases of diabetes. All those with glycosuria are considered diabetic unless otherwise proved by a standard oral glucose tolerance test. Most studies now confirm that although glucose is found in urine in the most severe cases of diabetes, it often absent in milder forms of the disease and such cases are likely to be missed by the urine test. This is know as lack of sensitivity. To be more precise, the sensitivity of the test caries between 10-50 %. The lack of sensitivity means that many diabetics would have been misused if this had been tha only test. That is , the test yields too many false negatives. Further glycosuria may be fing in perfect normal people, this give rise to false positives. Since the specificity of the test is over 90%, the yield of false positives is not very high.

•  Blood sugar testing :- because of the inadequancies of urine examination standard oral glucose test remains the corner stone of diagnosis of diabetes. Mass screening programmes have used glucose measurement of fasting, post prandial or random blood samples is considered unsatisfactory for epidemiological use, at the most, it can give only a crude estimate of the frequency of diabetes in a population.

Treatment of Diabetes Mellitus

When diabetes is detected, a doctor may prescribe changes in eating habits, weight control and exercise programs, and even drugs to keep it in check. It's critical for people with diabetes to have regular checkups. Work closely with your healthcare provider to manage diabetes and control any other risk factors. The best range for you depends on your age and the type of diabetes you have. For younger adults who don't have complications of diabetes, a typical target range might be 80 to 120 mg/dL before meals, and below 180 mg/dL after eating. Older adults who have complications from their disease may have a fasting target goal of 100 to 140 mg/dL and below 200 mg/dL after meals. That's because blood sugar that falls too low in older adults can be more dangerous than in younger people. Controlling your blood sugar is essential to feeling healthy and avoiding long-term complications of diabetes. Some people are able to control their blood sugar with diet and exercise alone. Others may need to use insulin or other medications in addition to lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program.Pancreas or islet cell transplantation may be an option for people whose kidneys are failing or who aren't responding to other treatments.

Keep in mind that the amount of sugar in your blood is constantly changing. Self-monitoring helps you learn what makes your blood sugar levels rise and fall, so you can make adjustments in your treatment.

General home care in Diabetes Mellitus

• Food:- Food raises your blood sugar level ? it's highest one to two hours after a meal. What and how much you eat, and the time of day, also affect your blood sugar level.
• Exercise and physical activity:- In general, the more active you are, the lower your blood sugar. Physical activity causes sugar to be transported to your cells, where it's used for energy, thereby lowering the levels in your blood. Aerobic exercises such as brisk walking, jogging or biking are especially good. But gardening, housework and even just being on your feet all day also can lower your blood sugar.
• Medications:- Insulin and oral diabetes medications deliberately work to lower your blood sugar. But medications you take for other conditions may affect glucose levels. Corticosteroids, in particular, may raise blood sugar levels. Medications such as thiazides, used to control high blood pressure, and niacin, used for high cholesterol, also may increase blood sugar. If you need to take certain high blood pressure medications, your doctor will likely make changes in your diabetes treatment.
• Illness:- The physical stress of a cold or other illness causes your body to produce hormones that raise your blood sugar level. The additional sugar helps promote healing. But if you have diabetes, this can be a problem. In addition, a fever increases your metabolism and how quickly sugar is utilized, which can alter the amount of insulin you need. For these reasons, be sure to monitor your glucose levels frequently when you're sick.
• Alcohol:- Even a small amount of alcohol ? about 2 ounces ? can cause your sugar levels to fall too low. But sometimes alcohol can cause sugar levels to rise. If you choose to drink, do so only in moderation. And monitor your blood sugar before and after consuming alcohol to see how it affects you. Also, keep in mind that alcohol counts as carbohydrate calories in your diet.
• Fluctuations in hormone levels:- The female hormone estrogen typically makes cells more responsive to insulin, and progesterone makes cells more resistant. Although these two hormones fluctuate throughout the menstrual cycle, the majority of women don't notice a corresponding change in blood sugar levels. Those who do are more likely to experience changes in blood sugar during the third week of their menstrual cycle, when estrogen and progesterone levels are highest.

Home remedies of Diabetes Mellitus

1. The best remedy for this disease is the bitter gourd, better known as karela. Eat this vegetable as often as you can or have at least one tablespoon of karela juice daily to reduce blood sugar levels in your blood and urine.
2. Indian gooseberry, with its high vitamin C content, is considered valuable in diabetes. A tablespoon of its juice, mixed with a cup of bitter gourd juice, taken daily for two months, will stimulate the islets of Langerhans, that is, the isolated group of cells that secrete the hormone insulin in the pancreas. This mixture reduces the blood sugar in diabetes.
3. Take ten tulsi leaves, ten neem leaves and ten belpatras with a glass of water early morning on an empty stomach. It will work wonders in keeping your sugar levels under control.
4. Grapefruit is a splendid food in the diet of a diabetic patient. If grapefruits were eaten more liberally, there would be much less diabetes. If you have sugar, use three grapefruits three times a day. If you do not have sugar, but a tendency towards it and want to prevent it, use three a day.
5. Eat 10 fresh fully grown curry leaves every morning for three months. It prevent diabetes due to heredity factors. It also cures diabetes due to obesity.
6. The tender leaves of the mango tree are considered useful in diabetes. An infusion is prepared by soaking 15 gm of fresh leaves in 250 ml of water overnight, and squeezing them well in the water in the moming. This filtrate should be taken every morning to control early diabetes. As an alternative, the leaves should be dried in the shade, powdered and preserved for use when necessary. Half a teaspoon of this powder should be taken twice a day.
7. Besides bitter gourd, certain other vegetables have been found useful in diabetes. These include string beans, cucumber, onion, and garlic. Tea made of the pods of string beans is valuable in diabetes.