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Diabetes Mellitus : Type 1 and Type 2

Diabetes Mellitus : Type 1 and Type 2

Diabetes can manifest itself in two different forms and severities. When there is an occurence of diabetes due to an inadequate production of insulin by the pancreas, it is a condition of Diabetes mellitus. Insulin is a hormone which regulates the level of glucose (sugar) in the blood stream. Glucose serves as a vital source of energy for all organs in the body and is the only source of energy that can be utilized by the brain. But insulin is needed to control the glucose levels in the blood so that the body can effectively use it for regulation of metabolism. Insulin is critical in the transport of glucose to the cells for energy metabolism.

The two forms of diabetes are discussed below:

TYPE 1 Diabetes: Diabetes of this kind usually manifests in childhood or adolescence. Patients suffering from this type of diabetes are dependent on insulin injections to maintain normal body chemistry. This type of diabetes can be inherited. If this is not tackled with insulin, diabetic ketoacidosis and death can result. Type 1 Diabetes is referred to as insulin dependent diabetes.

TYPE 2 Diabetes: Usually, middle aged and overweight people suffer from this type of diabetes when their blood sugar is higher than normal. This manifestation of diabetes is also known as adult onset diabetes. Insulin injections are not needed to conrol this form of diabetes but a suitable diabetes diet and weight reduction can help. But this form of diabetes can lead to long term diabetic complications.

Complications arising out of long-term diabetes
1. Diabetic Retinopathy: There is damage to the retina (perceptive structural tissue of the eye). This condition results in decreased vision and sometimes leads to blindness.
2. Kidney Disease: Impaired kidney function can be a resultant of long term diabetes. It can even lead to overt kidney failure.
3. Stroke: Diabetics have an increased risk of stroke.
4. Heart Disease: Increased risk of myocardial infarction (heart attack).
5. Peripheral Vascular Disease
6. Poor Wound Healing: Ulcers and foot problems are common
7. Decreased immunity to infection
8. Peripheral Neuropathy: Patients suffering from Diabetes face damage to the peripheral nerves and altered sensation. It is also accompanied by numbness, tingling and/or burning pain to the extremeties.
9. Females who are diabetic need to be carefully monitored during pregnancy

Type I Diabetes manifests itself in symptoms such as increased frequency of urination, increased thirst and hunger. Type I Diabetic patients also experience weight loss and increased fatigue. Read up the symptoms of diabetic ketoacidosis

Type II Diabetes is characterized by increased hunger and thirst and increased fatigue. Persons suffering from this form of diabetes face numbness or tingling in the hands and feet as well as frequent infections along with slow healing of cuts, ulcers and sores. Impotence is yet another resultant condition.

Random and fasting blood sugar testing can help in revealing any indications of diabetes. Examining the medical history combined with a physical examination is also done by a physician. To confirm the diagnosis, a Glucose tolerance testing is also done. Blood tests for kidney profile and blood counts are also done. Urinalysis will show the excess presence of glucose.

Treating Diabetes
1. Controlling the symptoms of diabetes.
2. Achieving and maintaining a desirable weight.
3. Achieving and maintaining a healthy level of physical activity.
4. Achieving and maintaining a nearly-normal blood glucose level (between 70 mg/dl and 140 mg/dl).

Treatment of type 1 diabetes requires adherence to a strict diabetes diet and regular doses of insulin. Failure to take care of the diabetic condition can lead to potentially serious outcomes. Blood glucose levels must be monitored so that complications are avoided. Diabetics must be trained to check their own blood and urine glucose levels. They can use the newer forms of ambulatory glucose monitors that can give you automatic readings and help in diabetes management. Avoiding sweets is an elementary precaution that needs to be followed. Many a time, oral hypoglycaemic agents (Orinase, Glucatrol) may be used for regulating blood sugar levels. Find out more on a diabetes diet (in total calories). You can seek help from an Internist or Endocrinologist

Use of Steroid medications (i.e. Prednisone and Medrone) can increase blood sugar levels. They can affect the control and treatment of diabetes. Beta-blocker antihypertensive medications are yet another set of medicines that can cause serious complications for the diabetic patient and should be avoided.

Diabetic Neuropathy

When there is loss of normal function of the nervous system as a result of long standing diabetes, it is a condition of Diabetic neuropathy. This may manifest as a dysfunction in the autonomic nervous system, which regulates bodily functions such as the maintenance of blood pressure and heart rate. Peripheral nerves that supply sensation to the extremeties may also get affected by Diabetic neuropathy. This condition is known as peripheral neuropathy.

Patients suffering from Diabetic Neuropathy complain of loss of feeling in the feet and legs along with associated burning pain in the lower extremeties. The loss of feeling can give rise to injuries to the patient without his being aware of it. It has been noticed that wounds and ulcers heal poorly on diabetic's legs.

Another manifestation of diabetic neuropathy is impotency since it has been noticed that 50% of men with diabetes develop impotence within 6 years of the onset of diabetes.

There are medications to control the symptoms though there is no cure for the complications that arise from a diabetic condition. An Internist or Endocrinologist can assist you in the regulation of your diabetes by closely monitoring and regulating the blood sugar levels.

Cirrhosis

The liver is responsible for neutralizing the blood of toxins, germs and bacteria as well as producing immune agent to contrl infections. Bile, critical to the absorption of fats and fat-soluble vitamins is made by the liver. Cirrhosis is a condition where the liver is affected by irreversibble scar tissue leading to its damage and consequent failure. Blood flow to the liver is then affected. Symptoms of cirrhosis range from exhaustion and fatigue to weight loss and abdominal pain. A person suffering from liver cirrhosis may experience abdominal pain and loss of appetite. There are noticeable red spider veins under the skin and the skin and eyes may turn yellow. There is decreased interest in sex and edema (swelling on hands and legs) might be noticed. A person suffering from cirrhosis and damaged liver may notice an increased tendency to bruise and bleed easily. Intense itching is felt on account of the bile products being deposited in the skin. Gallstones may develop as a result of inadequate bile reaching the gallbladder. There might be a buildup of toxins in the brain bringing about bouts of unresponsiveness and forgetfulness. Cirrhosis can bring on Portal hypertension - a condition where there is reduced flow of blood to the portal vein and increased pressure within it. Cirrhosis can eventually lead to liver cancer caused by carcinoma. Impotence, kidney dysfunction and osteoporosis are other likely complications of liver disease.

Cirrhosis of the liver is usually caused by chronic alcoholism or hepatitis C. Other possible factors leading to cirrhosis are problems in the immune system and damaged bile ducts.
Chronic Alcoholism - One of the common causes for cirrhosis is alcoholism. But this condition occurs only after atleast 10 years or more of heavy drinking. Alcohol affects the liver's ability to metabolise proteins, fats and carbohydrates.
Chronic hepatitis - Hepatitis C virus can lead to severe inflammation and damage of the liver, thereby causing cirrhosis. Hepatitis B is one of the most common causes of liver inflammation in many of the developing nations.
Blocked bile ducts - In such a condition, the bile is unable to travel out of the liver and instead ends up damaging liver tissue. This can be a congentinal defect in some infants.

Cirrhosis of the liver can cause many other abnormalities. It can leads to elevated levels of triglycerides, cholesterol and sugar. Diabetes mellitus is a common fallout. There might be a fall in platelet count and GI bleeding. In severe cases of cirrhosis, there can be an immune system dysfunction or even brain swelling and later coma. The liver of an affected person will feel be larger and harder to touch. A liver scan or ultrasound can help detection of cirrhosis. A liver biopsy is sometimes resorted to. Damage to the liver due to cirrhosis cannot be reversed but further complications can be reduced with the right treatment. Cirrhosis caused by excess alcohol consumption needs lifestyle changes such as avoiding alcohol and following a nutritious diet. Low-sodium diet can help drain excess fluid-buildup within the body. Chronic viral hepatitis B and C are treated with prednisone and azathioprine. Any bacterial infection is treated with appropriate antibiotics. Liver transplantation surgery is done on cases where the liver is not capable of functioning. With the help of modern drugs such as cyclosporine and tacrolimus, the success of liver transplantation surgery has risen manyfold.