Diabetes mellitus

Diabetes Mellitus

1. Definition: Diabetes mellitus is a metabolic disorder characterized by persistent hyperglycemia (high blood sugar) due to defects in insulin secretion, insulin action, or both. Additional context: Diabetes mellitus is a leading cause of morbidity and mortality worldwide.

2. Synonyms: Diabetes, Diabetes mellitus type 1, Diabetes mellitus type 2, Gestational diabetes, LADA (latent autoimmune diabetes in adults)

3. Causes / Etiology:

   • Genetics: Family history and genetic predisposition play a significant role in the development of diabetes.
   • Obesity: Excess body fat, particularly around the abdominal area, increases the risk of developing type 2 diabetes.
   • Physical inactivity: A sedentary lifestyle contributes to insulin resistance and an increased risk of diabetes.
   • Diet: Consuming a diet high in sugar, refined carbohydrates, and unhealthy fats can lead to insulin resistance and diabetes.
   • Age: The risk of developing diabetes increases with age.
   • Ethnicity: Certain ethnic groups, such as African Americans, Hispanics/Latinos, and American Indians, are at a higher risk of developing diabetes.

4. Types / Classification:

   • Type 1 Diabetes:
     • Definition: A chronic autoimmune disease characterized by the destruction of pancreatic beta cells, leading to insulin deficiency.
     • Causes: Genetic predisposition, environmental triggers, and an imbalance of the immune system.
     • Clinical features: Rapid onset, weight loss, polyuria, polydipsia, and polyphagia.
     • Duration: Can occur at any age, but typically presents in childhood or adolescence.
     • Differences: Acute presentation, often requiring immediate insulin therapy.
   • Type 2 Diabetes:
     • Definition: A metabolic disorder characterized by insulin resistance and impaired insulin secretion.
     • Causes: Obesity, physical inactivity, diet, age, and genetic predisposition.
     • Clinical features: Gradual onset, weight gain, polyuria, polydipsia, and polyphagia.
     • Duration: Can occur at any age, but typically presents in adulthood.
     • Differences: Chronic presentation, often requiring lifestyle modifications and medication.

5. Pathophysiology / Pathology:

   • Type 1 Diabetes:
     • Stage 1: The immune system mistakenly attacks and destroys pancreatic beta cells, leading to insulin deficiency.
     • Stage 2: The body's remaining beta cells are destroyed, resulting in complete insulin deficiency.
     • Stage 3: The body's metabolic processes are disrupted, leading to hyperglycemia.
   • Type 2 Diabetes:
     • Stage 1: Insulin resistance develops due to genetic and environmental factors.
     • Stage 2: The pancreas produces more insulin to compensate for insulin resistance, but eventually, insulin production declines.
     • Stage 3: Hyperglycemia develops due to the combination of insulin resistance and impaired insulin secretion.

6. Clinical Features:

   • Acute Features: Rapid onset, weight loss, polyuria, polydipsia, and polyphagia.
   • Chronic Features: Gradual onset, weight gain, polyuria, polydipsia, and polyphagia.
   • Relevance: Early recognition and treatment are crucial to prevent complications and improve quality of life.

7. Complications:

   • Acute Complications: Diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic syndrome, and hypoglycemia.
   • Chronic Complications: Nephropathy, retinopathy, neuropathy, cardiovascular disease, and increased risk of infections.
   • Importance: Complications can be prevented or delayed through proper management and lifestyle modifications.

8. Investigations / Diagnosis:

   • Routine Tests: Fasting plasma glucose, oral glucose tolerance test, and hemoglobin A1c.
   • Specific Tests: C-peptide, insulin antibodies, and autoimmune antibody tests.
   • Confirmatory Tests: Genetic testing and pancreatic imaging.

9. Differential Diagnosis:

   • Key Points:
     • Pancreatitis: Abdominal pain, nausea, and vomiting.
     • Hypoglycemia: Confusion, tremors, and seizures.
     • Adrenal Insufficiency: Fatigue, weight loss, and hypotension.
     • Hyperthyroidism: Weight loss, tremors, and heat intolerance.
   • Distinction: Diabetes mellitus is characterized by hyperglycemia, polyuria, and polydipsia, whereas the other conditions have distinct clinical features and laboratory abnormalities.

10. Management / Treatment:

    • General Management:
      • Education and lifestyle modifications, such as diet and exercise.
      • Monitoring of blood glucose levels and HbA1c.
      • Regular follow-up appointments with a healthcare provider.
    • Modern Medicine Treatment:
      • Type 1 Diabetes: Insulin therapy, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins.
      • Type 2 Diabetes: Metformin, sulfonylureas, thiazolidinediones, and other oral medications.
    • Diet and Lifestyle Advice:
      • Balanced diet with emphasis on whole grains, fruits, and vegetables.
      • Regular physical activity, such as walking, cycling, or swimming.
      • Weight loss, if necessary, to improve insulin sensitivity.

11. Homeopathic Therapeutics:

    • Remedies:
      • Aconitum Napellus:
        • Causation: Acute onset, fear, and anxiety.
        • Characteristic symptoms: Headache, nausea, and vomiting.
        • Modalities: Worsening at night, with rest, and in a warm room.
        • Mental state: Anxiety, fear, and restlessness.
        • Thirst and appetite: Increased thirst and decreased appetite.
        • Nature of discharges or secretions: None.
        • Physical generals: Headache, nausea, and vomiting.
        • Suitable constitution or patient type: Sanguine and choleric.
        • Helps in the disease: Aconitum napellus helps to alleviate acute symptoms of diabetes mellitus, such as headache and nausea.
      • Borax:
        • Causation: Chronic onset, obesity, and sedentary lifestyle.
        • Characteristic symptoms: Weight gain, polyuria, and polydipsia.
        • Modalities: Worsening with rest and in a warm room.
        • Mental state: Fatigue, lethargy, and depression.
        • Thirst and appetite: Increased thirst and increased appetite.
        • Nature of discharges or secretions: None.
        • Physical generals: Weight gain, polyuria, and polydipsia.
        • Suitable constitution or patient type: Phlegmatic and melancholic.
        • Helps in the disease: Borax helps to alleviate chronic symptoms of diabetes mellitus, such as weight gain and polyuria.
      • Carbo Veg:
        • Causation: Acute onset, hypoglycemia, and anxiety.
        • Characteristic symptoms: Confusion, tremors, and seizures.
        • Modalities: Worsening with rest and in a cold room.
        • Mental state: Anxiety, fear, and restlessness.
        • Thirst and appetite: Increased thirst and increased appetite.
        • Nature of discharges or secretions: None.
        • Physical generals: Confusion, tremors, and seizures.
        • Suitable constitution or patient type: Sanguine and choleric.
        • Helps in the disease: Carbo veg helps to alleviate acute symptoms of hypoglycemia, such as confusion and tremors.
      • Glycyrrhiza:
        • Causation: Chronic onset, obesity, and sedentary lifestyle.
        • Characteristic symptoms: Weight gain, polyuria, and polydipsia.
        • Modalities: Worsening with rest and in a warm room.
        • Mental state: Fatigue, lethargy, and depression.
        • Thirst and appetite: Increased thirst and increased appetite.
        • Nature of discharges or secretions: None.
        • Physical generals: Weight gain, polyuria, and polydipsia.
        • Suitable constitution or patient type: Phlegmatic and melancholic.
        • Helps in the disease: Glycyrrhiza helps to alleviate chronic symptoms of diabetes mellitus, such as weight gain and polyuria.

12. Prognosis:

    • Outcome: The prognosis of diabetes mellitus depends on the type, severity, and duration of the disease.
    • Factors Affecting Prognosis: Age, obesity, physical inactivity, and the presence of complications.
    • Significance: Early recognition and treatment are crucial to prevent complications and improve quality of life.

13. Prevention:

    • Lifestyle Modifications: Regular physical activity, balanced diet, and weight loss, if necessary.
    • Screening: Regular screening for diabetes and its complications.
    • Importance: Prevention and early detection are crucial to prevent complications and improve quality of life.

14. Diet:

    • Recommended Foods: Whole grains, fruits, vegetables, lean proteins, and healthy fats.
    • Avoided Foods: Refined carbohydrates, added sugars, and saturated fats.
    • Reasoning: A balanced diet helps to regulate blood glucose levels and improve insulin sensitivity.