Identifying patients with DM: A Short Review

What is diabetes mellitus?

Diabetes mellitus has come from ‘greek’ terminology. Word diabetes meaning to pass or flow excess urine and mellitus means sweet. So Diabetes mellitus is a disease characterised by a state of chronic hyperglycaemia resulting from a diversity of etiologies, environmental, metabolic and genetic, acting jointly.

Diabetes mellitus is not a single disease entity but rather a group of metabolic disorders sharing the common underlying feature of hyperglycemia.

Underlying cause is defective production or action of insulin, a hormone that controls glucose, fat and amino acid metabolism. Chronic hyperglycaemia whatever might be the cause leads to a number of complications like cardiovascular, renal, neurological, ocular and others such as recurrent infections.

CLASSIFICATION

1. insulin-dependent diabetes mellitus-type-1 DM

2. Non- insulin dependent diabetes mellitus, NIDDM

3. Malnutrition related diabetes mellitus-MRDM

4. Impaired glucose tolerance-IGT/IFG

5. Gestational diabetes mellitus-GDM

KEY FACTS AND CHEKPOINTS

1. Above 25 years prevalence is 7.5%.

2. IGT is 10.6%

3. About 30% of them will develop diabetes in next 10 years

4. Diabetes can exist for years before detection and complication is evident.

5. Type-2 diabetes is not a mild disease. About 1/3rd surviving 15 years will need insulin to control blood glucose.

6. Complications occur in both types of diabetes.

7. Asymptomatic people for high risk should be screened for diabetes.

8. There are several causes of secondary DM.

SECONDARY CAUSES

A. Endocrine: 1. Cushing’s syndrome, 2. Acromegaly, 3. Pheochromocytoma, 4. Poly-cystic ovary syndrome.

B. Pancreatic Disease: Haemochromatosis, 2. Chronic pancreatitis.

C. Drug induced: 1.High dose oestrogen, 2. Thiazide diuretics, 3. Corticosteroids.

D. Medical stress- like stroke, MI.

E. Surgical stress like RTA, Burns.

F. Gestational diabetes mellitus.

CLINICAL FEATURES

There may be no symptoms, POLYURIA, POLYDIPSIA, LOSS OF WEIGHT IN TYPE-1, TIREDNESS AND FATIGUE, More tendency for INFECTIONS LIKE SKIN AND GENITALS.

OTHER SYMPTOMS

VULVOVAGINITIS, PRURITIS VULVAE, BALANITIS, NOCTURNAL ENURESIS, BLURRED VISION, VISUAL CHANGES.

SYMPTOMS OF COMPLICATIONS

SKIN INFECTION, POLYNEUROPATHY- NUMBNESS, PAIN AND TINGLING, IMPOTENCE, ARTERIAL DISEASE- IHD, PERIPHERAL VASCULAR DISEASE.

COMPLICATIONS OF DM

1. GENERAL-HYPOGLYCEMIA, HYPERGLYCEMIA, KETOACIDOSIS and DYSLIPIDIMIA.

2. BRAIN- CVA

3. EYES-CATARACT, RETINOPATHY, GLAUCOMA, 3rd AND 6th NERVE PALSY

4. BP-HTN, POSTURAL HYPOTENSION.

5. HEART-IHD, ARRYTHMIAS, VAGAL NEUROPATHY

6. RENAL-NEPHROPATHY, UTI

7. GI TRACT-DIARRHOEA, GASTROPARESIS

8. GENITOURINARY-ATONIC BLADDER, IMPOTENCE

9. FEET-DFS, GANGRENE, ULCERS

10. LIMBS-NEUROPATHY, PAIN, VASCULAR DISEASE

SCREENING METHODS

1. NON DIABETIC-FBS<6MMOL, RBS<7.8 MMOL

2. IFG-FBS-6.1 to 6.9 MMOL

3. IGT- 2 hours PP -7.9 to 10.9 MMOL

4. DIABETIC-FBS>7 MMOL or RBS>11 MMOL

5. GDM-FBS>5.5 MMOL, 2 hours PP 8 or more

6. GTT- FBS-6.1 to 6.9 MMOL, RBS-7 to 11 MMOL

REVIEW OF DM PATIENTS

HISTORY

1. Smoking and alcohol use.

2. S/S of hypoglycemia or hyperglycemia

3. S/S relating to eye or feet and circulation

4. Other symptoms

EXAMINATION

1. Height, weight and BMI

2. BP-Standing and lying

3. Examination of heart

4. Carotid and peripheral pulses

5. Eyes-Cataract, visual acuity, fundal photography

6. Peripheral sensation and reflexes.

7. Skin examination

8. Foot examination with foot wear

9. Examination of injection sites

10. Urine- glucose, proteins and ketones

C. Biochemistry- FBC,U and E and Lipids.