ESSENTIALS you should know about DIABETES MELLITUS!!!

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Diabetes mellitus (DM) is a broad topic that cannot be discussed fully in this conversation; however, an attempt will be made to summarize it. As much as possible, I would try to limit the use of bogus medical terminologies.

Diabetes mellitus is a chronic (long-term) metabolic derangement of carbohydrates, fats, and proteins as a result of chronic hyperglycemia caused by defects in insulin secretion, insulin action, or both.

The types of diabetes mellitus are type 1 (insulin-dependent or juvenile onset), type 2 (non-insulin-dependent), and gestational (associated with pregnancy) DM.

These are the major types of DM; some other types include latent autoimmune diabetes of adults (LADA) with slower progression to insulin dependence in later life (a form of type 1), maturity-onset diabetes of the young (MODY), which is a rare autosomal dominant form of type 2 DM affecting young people with a positive family history, malnutrition-related DM, and finally, pre-diabetes, where there is a high sugar level but not enough to classify such a person as having type 2 diabetes.

Recently, a young man, barely 35 years of age, walked into my consulting room with complications of diabetes mellitus. It was alarming as his blood glucose was poorly controlled and he had been irregular on his medications until two weeks prior to the presentation. He was diagnosed with diabetes about two years ago. He was taking ceiling doses of oral hypoglycemic agents with no significant improvement. He equally presented with a diabetic foot ulcer of more than one month's duration, which was already oozing unpleasant odors. He already had blurry vision (retinopathy), urinary symptoms (nephropathy), reduced sensation on the skin (neuropathy), and a reduced libido.

It is quite pathetic for the young man, right? I had to refer him appropriately to a tertiary facility where he could get a multidisciplinary approach to his management. I must state here that the treatment of DM is multidisciplinary and patient-centered. Physicians are more concerned about the patient leading a normal life than only achieving normoglycemia.

The diagnosis of DM can be made from the clinical history with symptoms such as excessive thirst (polydipsia), excessive urination (polyuria), and excessive hunger (polyphagia). Some patients can be picked to be diabetic at random or during routine investigations. Usually, the doctor would run a fasting blood sugar (FBS) or random blood sugar for the diagnosis of DM. Urinalysis and a full blood count may also be carried out as supporting investigations. It is wise to give the doctor a history that may relate to the use of diuretics, anti-hypertensives, hormonal drugs, psychoactive drugs, antiretroviral drugs, and anti-epileptic drugs.

A patient with a sedentary lifestyle, alcohol, smoking, and poor nutrition where there is evidence of undernutrition like a low body mass index (BMI) can result in DM, especially the young-onset type.

A DM patient can come down with acute complications such as hyperosmolar hyperglycemic syndrome (HHS), which is characterized by high blood sugar (glucose), extreme dehydration, and decreased alertness or consciousness. Another acute complication is diabetic ketoacidosis (DKA), which can be life-threatening, and also hypoglycemia. These complications usually present with a loss of consciousness and need to be tackled head-on at a good healthcare facility.

A DM patient can come down with chronic complications, which medically we classify as macrovascular and microvascular complications.

The macrovascular complications include: breathlessness (ischemic heart disease), claudications (peripheral vascular disease), stroke, and transient ischemic attack (cerebrovascular complications).

The microvascular complications include: visual loss (retinopathy), pruritus, pleuritic chest pain, breathlessness (neuropathy), numbness, a needle or pin sensation that is worse at night, constipation, and diarrhea (autonomic neuropathy).

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The investigations routinely done to diagnose or rule out DM are fasting blood sugar and an oral glucose tolerance test. I will not bore us with the criteria to diagnose DM, as the clinicians would use it more. For patients whose level of compliance needs to be monitored, they are required to carry out an investigation called glycated hemoglobin, which reflects their level of control within the past two to three months.

DIABETIC FOOT ULCER

This arises from infection, ulceration, and/or destruction of deep tissue associated with neurological abnormalities and various degrees of severity of arterial circulatory disorders of the lower extremities.

It is a serious and common complication of DM, and its management is multidisciplinary, involving an endocrinologist, a plastic surgeon, and a podiatrist. Treatment can be pharmacological (treatment of DM and infection, etc.) or non-pharmacological, involving DM foot care, wound debridement, and daily wound dressing.

Diabetes mellitus is not a death sentence. Early diagnosis and treatment confer a better prognosis.

Thank you for reading. I would love to have your comments and contributions 🤗

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