Abstract
Diabetes mellitus disease occurs all over the world, but it is more common in the well developed countries. there is high incidence of diabetes in developing countries because of changing life style and the termed of urbanization. According to World Health Organization, more than 150 million people wide, in the year 2004.but due to its growing incidences, its thought that by the year 2025 this number will double.
Musaiger said" Bahrain has faced a rapid transition in its socio-economic status, which resulted in great changes both in life-style and in patterns of health and disease. There has been a marked decline in infectious diseases and an increase in chronic diseases. Diabetes mellitus has become one of the most common public health problems in the country. In 1988 it was estimated that 3.4% of total deaths in Bahrain were due to diabetes. A community-based study among mothers aged 18 to 48 years showed that 8.5% of them had diabetes. The percentage was found to be higher among elderly Bahrainis (12.9%). Obesity, lack of physical activity, alteration in food habits, and change in social conditions has all played a vital role in the changing prevalence of diabetes in this country. The current programmes to manage and control diabetes are limited and ineffective. Thus measures to treat diabetes should be given a high priority in the national health policy. Training of physicians in the management of diabetes, public education, epidemiological surveys, and nutritional evaluation of local foods are among the most important measures needed to control diabetes in Bahrain."
As diabetes continues to grow at an alarming rate, affecting millions of people around the world, this paper provides an overview of this often serious and chronic condition it will discusses the types, signs and symptoms, diagnosis methods, management, and the complications.
WHO define diabetes as" Diabetes is a chronic disease, which occurs when the pancreas does not produce enough amount of insulin, or when the body cannot effectively use the insulin it produces. This leads to an increase concentration of glucose in the blood (hyperglycemia)".Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs. Insulin, is a hormone released from the pancreas, controls the amount of sugar in the blood. When people eat or drink, food is broken down into small substances, including the simple sugar glucose that the body needs to function. Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, it is converted to energy, which is either used immediately or stored as fat or glycogen until the time is needed.
The levels of sugar in the blood vary normally throughout the day. The level of sugar rise after a meal and return to normal within about 2 hours after eating. Once the level of sugar in the blood return to normal, insulin production decreases. The variation in blood sugar levels is usually within a limited range, between 70 to 110 milligrams per deciliter (mg/dL) of blood. If people eat a large amount of carbohydrates, the levels may increase more. If the body does not produce enough insulin to move the sugar into the cells, the resulting high levels of sugar in the blood and the inadequate amount of sugar in the cells together produce the symptoms and complications of diabetes. Doctors often use the full name diabetes mellitus, means "to flow, honey" in Greek Diabetes Mellitus, commonly referred to as "diabetes," means "sweet urine."
Types of DM
There are many forms of diabetes, but the three most common types of diabetes that have been recognized over the last three decades are type 1, type 2 and gestational diabetes. These three types of diabetes are caused by a variety of identifiable or yet-to-be-identified causes.
Type 1 diabetes
Previously referred to as insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, occurs when the pancreas can not make insulin. This form of diabetes usually develops in childhood or young adulthood. And it generally persists as a lifelong condition that usually cannot be treated only with diet or lifestyle modifications. Type 1 diabetes patients need insulin (delivered by injection, pump, or oral medications) in order to store and use glucose.
The cause of this form of diabetes is most likely associated with auto-immune, a condition in which the body does not properly recognize its own cells (beta cells). In the case of type 1 diabetes, the body attacks the beta cells in its own pancreas, reducing or destroying their ability to produce insulin. Along with auto-immune, genetics and environmental factors likely play a role as well.
Type 2 diabetes
Previously known as non-insulin dependent diabetes mellitus or adult-onset diabetes, occurs when the body stops recognizing the insulin secreted by the pancreas. This is the most common form of diabetes, affecting 85-90% of all people with the disease. Because it can arise with minimal outward signs or symptoms, millions of people don't even know they have it. Type 2 diabetes can affect people of any age, even children. It begins with insulin resistance and leads to a situation similar to type 1 diabetes in which the pancreas can't secrete enough insulin. Your cells start off being unable to use the insulin being produced and eventually your pancreas stops making it. The disease is strongly genetic in origin but lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are major risk factors for its development.
In another explanation in normal situations, the body releases insulin in response to foods the body can break down and use as glucose mainly carbohydrates. If the blood is constantly high in insulin due to a diet high in refined carbohydrates diet, the cells become desensitized to it and the glucose can't get into the cells.
This form of diabetes is associated with obesity, older age, a family history of diabetes, a history of gestational diabetes, certain medications, impaired glucose metabolism, psychological factors, and physical inactivity. The good news when it comes to type 2 is that if patient in the early stages, he/she can get control of the disease with diet and lifestyle modifications.
Gestational diabetes
Like type 2, is a form of insulin resistance that occurs in the later stages of pregnancy. As the placenta supports the growing fetus, it produces hormones. These hormones may interfere with the mother's ability to produce and use her own insulin. It is important to get control of gestational diabetes early in order to prevent exposing the baby to an excess of glucose, later store as fat. Too much glucose in the womb not only leads to an excessively fat baby, but may lead to other complications, such as obesity and type 2 diabetes, in adulthood.
Gestational diabetes usually disappears in the mother after the baby is delivered. However, once women have had gestational diabetes they are more likely to develop it in future pregnancies and more likely to develop type 2 diabetes.
Signs and Symptoms
In Type 1 diabetes the signs and symptoms will usually be very obvious, developing quickly, usually over a few weeks. In people with Type 2 diabetes the signs and symptoms will not be so obvious or even non-existent in people with Type 2 diabetes.
Common symptoms of both major types of diabetes:
Diagnosis of Diabetes Mellitus
The first thing when doctors suspect somebody with diabetes, they do some tests to make sure that their assumptions are true. Such a test to diagnose diabetes is a glucose test.
The American Diabetes Association (ADA) issued diagnostic criteria for diabetes mellitus in 1997, with follow-up in 2003. The diagnosis is based on one of three abnormalities: fasting plasma glucose, random elevated glucose with symptoms, or abnormal oral glucose tolerance test (OGTT).
Some studies have indicated that a hemoglobin A1C or similar test (glycosylated hemoglobin or glycohemoglobin) may be used to diagnose diabetes; however, the ADA does not recommend this test for this purpose. The hemoglobin A1C test estimates the average blood sugar level over the previous 2 to 3 months and is recommended as the test for monitoring blood sugar control after diagnosis.
Diabetes Treatment
The major goal in the treatment of diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar. Treating diabetes involves diet, exercise, education, and for most people drugs. If a person with diabetes keeps blood sugar levels tightly controlled, complications are less likely to develop. The goal of diabetes treatment is to keep blood sugar levels within the normal range.
People with diabetes benefit greatly from learning about the disease, understanding how diet and exercise affect their blood sugar levels, and knowing how to avoid complications. Adherence to a diabetic diet is an important aspect of controlling elevated blood sugar in patients with diabetes. The American Diabetes Association has provided guidelines for a diabetic diet which is balanced; nutritious that is low in fat, cholesterol, and simple sugars.
Diet management is very important in people with both types of diabetes. Doctors recommend a healthy, balanced diet and efforts to maintain a healthy weight. Having regular exercise can also help people control their weight and maintain blood sugar levels within the normal range.
Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. People with type 1 diabetes who are able to maintain a healthy weight may be able to avoid the need for large doses of insulin. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. People with type 2 diabetes may be able to avoid the need for all drugs by achieving and maintaining a healthy weight. The majority of people with Type 2 diabetes take oral medications, which include sulfonylurea (e.g., Glyburide), which augment insulin secretion; biguanides (e.g., Metformin), which increase the effectiveness of insulin; and intestinal enzyme inhibitors, which delay the digestion of carbohydrate foods. In Type 2 diabetes, patients may require insulin if hypoglysemic medication fails to control blood glucose levels.
Complications of Diabetes Mellitus
Acute complications of diabetes are severe and can lead to coma. They are directly related to blood glucose levels and include: Diabetic ketoacidosis, this more common in Type 1 diabetes and is caused by the breakdown of fatty acids into ketones when there is not enough glucose stored in the cells for energy, Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS) usually associated with insulin deficiency and dehydration, and hypoglycemia due to too much insulin/oral medication is used or too little glucose. All three of these conditions are emergencies and failure to treat quickly can lead to coma and/or death.
Chronic complications of diabetes involve changes in blood vessels, tissues and organs. Consistently high blood glucose levels can cause a hardening and thickening of the blood vessels which can lead to many other diseases. Cardiovascular disease involves both the large and small blood vessels that supply blood to your heart. Cerebrovascular disease involves the blood vessels that supply oxygen and nutrients to your brain. Diabetic Retinopathy is caused by a blockage of blood vessels within the eye that leads to the blood vessels leaking into the retina this eventually leads to blindness.
In conclusion I believe that diabetes is not a complicated disease because it can be prevented easily if people from all age groups maintained a healthy life style which will definitely reduce the risks of developing the disease. It is easy in terms of controlling the disease once we get it by complying with the doctor's orders taking medications and by adjusting our lifestyle to prevent or delay the devastating complications of diabetes. It is hard if we ignore the symptoms, we ignore the orders of the doctors and continue living the lifestyle we have which will worsen the condition. It's hard and devastating if we get the complications of the long standing high blood glucose.
Moreover, I believe that we play a great role in our community and we can do good for those who are around us by educating them about the disease, its symptoms, treatment, and life adjustment. We should do once we get the disease and most important is the complications. We should start from the media, doctors, nurses, any health worker or any person who is aware of the disease and knows about it, and even those who have the disease should create awareness.
References
Retrieved Dec20, 2009, from http://www.who.int/diabetes/en/
Musaiger, A.O."Diabetes in Bahrain: An Overview." Diabetic Medicine 9(6):754-758.
Retrieved Dec 20, 2009, from http://www.diabetes.org/
Crabbe, MJC, ed. Diabetic complications: scientific and clinical aspects. London, United Kingdom: Churchill Livingstone, 1987.
Rifkin H and Forte D, 4th Ed, diabetes mellitus theory and practice. New York, NY, Elsevier, 1990.
