Diabetes Mellitus ~ DIABETES MELLITUS

Origin of diabetes mellitus…

Diabetes mellitus actually comes from the Greek word "diabainein" which means "to pass through," and the Latin word "mellitus" meaning "sweetened with honey." Previously, an Egyptian papyrus and Greek Physician Aretaeus have mention a rare disease with several symptoms such as loss of weight, urinate frequently and constant thirst but then it seems to be a mystery during the Middle Ages.

However, the first person that has made clearance about diabetes mellitus is Avicenna, the famous Arabian physician by describing on more detail about the complication and the progression of the disease.

What is diabetes mellitus?

Diabetes mellitus is a condition where the glucose level in the blood higher than the normal values. This occurs due to inability of the body to produce or/and use the insulin that help lowers the glucose in the blood. Nowadays diabetes in Malaysia has become a growing problem as The Health Ministry recently comes out with a statistic that around 2.6 million of Malaysian people has suffer from diabetic and it make up one in five people have diabetes in Malaysia. A prediction on diabetic that it will be 7^th leading causes of death in Malaysia in 2030.

Type 1Diabetes Mellitus (1DDM)

Previously type 1 Diabetes Mellitus is known as Insulin-dependent Diabetes Mellitus (IDDM) or juvenile-onset. Basically, insulin injection is required for patient with T1DM. It is a subtype of diabetes mellitus where the body cannot produce insulin needed to control the blood glucose level. It mostly affects children and young adult.

Type 2 Diabetes Mellitus (NIDDM)

Type 2 Diabetes Mellitus is known as non-insulin dependent Diabetes Mellitus (NIDDM) or adult-onset diabetes. Basically, this kind of diabetes mellitus can be controlled by diet and hypoglycemic agents without injections of insulin. It is another subtypes of the diabetes mellitus where the body cannot produce enough insulin or the insulin cannot work efficiently. It usually gives effects on the adult and accounts for about 90% of people with diabetes.

Gestational Diabetes Mellitus (GDM)

GDM occurs when there is high glucose in blood during pregnancy where the body has less ability to produce enough insulin to meet extra needs of pregnancy. The onset of the GDM is on second (14 to 28 weeks of pregnancy) and third (29 weeks until delivery) trimester of pregnancy. GDM affects about one to two percent of all pregnancy women.

Criteria for Diagnosis

The American Diabetic Association (ADA) had deal out diagnostic criteria for diabetic mellitus in 1997 with follow-up in 2003 and 2010. There are four types of tests can be used for diagnosis of diabetes mellitus:

1) Casual plasma glucose concentration

– Casual referred to the blood is taken at any time of day without regarding the last meal times.

2) Fasting plasma glucose (FPG)

– Fasting is defined as no caloric intake for 8 hours but water consumption is allowed.

3) Oral glucose tolerance test (OGTT)

– Drink a glucose load containing the equivalent a 75 g of anhydrous glucose dissolved in 100 ml of water. The glucose level is compared before and 2 hours after glucose load intake.

4) A1C test also called the heamoglobin A1c, HbA1c, or glycohemoglobin test.

– Blood glucose level is measured by the amount of glycosylated heamoglobin (HbA1c) in blood.

Table 1: The criteria of blood glucose level diagnosis with DM (WH0, 2006)

In 2011, WHO had recommended an addition of new criterion in diagnosis of diabetes mellitus which is A1c test. The result of HbA1c test reported in percentage form. The higher the percentage, the higher the blood glucose levels in an individual. The criteria show in a table below.

Table 2: The percentage reference for HbA1c test.

Table 3: provides the blood test levels for diagnosis of normal, prediabetes (also called Impaired Fasting Glucose (IFG)), and diabetes.

Source: Adapted from American Diabetes Association. Standards of medical care in diabetes

—2012. Diabetes Care. 2012;35(Supp 1):S12,

Take note for pre-diabetes:

Ø Fasting plasma glucose refer to impaired fasting glucose

Ø OGTT refer to impaired glucose tolerance (1GT)

Table 4: Plasma glucose goal during pregnancy.

Common Symptoms

High levels of sugar in the blood (hyperglycemia)
High levels of sugar in the urine (Glycosuria)
Frequent urination (Polyuria)
Extreme hunger (Polyphagia) lead to excessive eating
Long term extreme thirst (Polydipsia)
The presence of ketone in the blood (Ketonemia)
The presence of ketone in the urine (Ketonuria)
Weakness and tiredness.
Involuntary weight loss
Irritability
Frequent infections
Blurred vision
Cuts/bruises that are slow to heal
Tingling/numbness in the hands/feet
Recurring skin, gum, or bladder infections

(ADA, 1995-2012)

The Problem occurred in Type 1, Type 2 and Gestational Diabetes Mellitus

i. Diabetic Ketoacidosis (DKA)

It can happen in all types of diabetes mellitus however it is commonly seen in T1DM patient. DKA occurs when the blood glucose is too high (blood glucose > 11 mmol/L), associated with the absence of insulin. This problem affects the regulation of two hormones.

When there is lack of insulin in the body, it will increase the glucagon hormone secretion by the liver lead to the glucose formation results from glycogen. Thus, the glucose level increases in the blood and inhibit the glucose uptake by the liver and muscle cell as energy. When cells don't get the glucose they need for energy, the body begins to burn fat for energy, which produces ketones.

What is ketone?

DKA can be diagnosed by blood and urine test.

The symptoms of DKA

Deep, rapid breathing
Dry skin and mouth
Flushed face
Fruity breath odour
Nausea or vomiting, inability to keep down fluids
Stomach pain

i. Hypoglycaemia

Hypoglycaemia occurs if blood glucose levels fall below normal which is below 70 mg/dL or 3.9mmol/L.

Insufficient intake of food and excess exercise or alcohol intake may cause hypoglycaemia. Hypoglycaemia may be mild, moderate and severe. Usually the condition is manageable. But, occasionally, it can be severe or even life threatening. Particularly if the patient fails to recognize the symptoms, especially while continuing to take insulin or other hypoglycaemic drugs. Severe hypoglycaemia occurs most often in people with type 1 diabetes who must take insulin for survival.

Hypoglycaemia has been associated with reduced cognitive functioning and can, rarely, be a cause of death. Co-morbidities such as coeliac disease (An autoimmune disease characterized by a permanent intolerance of gluten) and Addison’s disease (A disorder of inability of endocrine gland to produce enough hormones) can increase the risk of hypoglycaemia.