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Diabetes - Introduction to Diabetes

In This Article
Diabetes is a chronic state of hyperglycaemia caused by a lack of or diminished effectiveness of endogenous insulin. Over time it can cause specific tissue damage, particularly to the retina, kidney, nerves and arteries.
The term diabetes mellitus literally means ‘passage of a large amount of sweet urine’
 
In the past the definitions IDDM and NIDDM were used for type 1 and type 2 diabetes respectively. However, this is not necessarily true in descriptive terms, as not all type 1 sufferers require insulin, and not all type 2 sufferers do not require insulin (many in the later stages of the disease do).
More than 90% of diabetic patients have type 2 diabetes. Less than 10% have type 1.
 

Epidemiology

  • Diabetes affects 2% of the British population, i.e. over 1 million people, and takes up 5-10% of the health budget.
  • The prevalence is increasing rapidly in Western World
  • More than 90% of diabetic patients have type 2 diabetes; less than 10% have type 1.
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Rare Causes

  • Pancreatectomy – in cases where greater than 90% of the pancreas has been removed
  • Drug induced – steroids and thiazides
  • Others – e.g. congential condition that may cause insulin receptor antibodies, glycogen storage diseases
  • Endocrine – such as Cushing’s, hyperthyroidism

                                                 

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Clinical presentation

Acute presentation – typically in those with type 1 diabetes, but not always
  • Polyuria
  • Thirst
  • Weight loss
  • Ketonuria which may progress to ketoacidosis
 
Subacute presentation – in type 2 diabetes, same as above but also with the following:
  • Lack of energy
  • Blurred vision

Such cases may also present with complications such as...

  • Staphylococcal skin infections
  • Retinopathy
  • Polyneuropathy
  • Erectile dysfunction
  • Arterial disease
  • Inflammation of genitals  – due to Candida infection
 
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Diagnosis

  • Fasting glucose > 7 mmol/L and a glucose tolerance test
  • OR random glucose > 11mmol/L (usually on 2 separate occasions)
 
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Management

Type 1 diabetes:
  • Insulin and dietary modification
Type 2 diabetes:
  • Lifestyle modification (>>+ metformin >>+ further drugs>> + insulin)
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Basic principles of monitoring

  • Weight – can have significant impact on insulin sensitivity
  • Blood glucose – self-monitoring for those taking insulin
  • Urine glucose –is an alternative for those who do not want blood glucose methods, but it is imprecise
  • Haemoglobin A1c (HbA1c) – for long term management/risk assessment; should keep the value <7% to minimise complications
  • Maintaining other parameters within ideal range in order to minimise risk of complications, including blood pressure (<130/80 mmHg), total cholesterol (<4.5 mmol/L), LDL (<2.6), HDL (>1.1) and triglycerides (<1.7)
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Comparison of type I and type II diabetes

  Type I Type II
Age at onset Mostly <30 Mostly >30 – however due to the rise in obesity this age i