DIABETES MELLITUS

I. Concept:
It is a disease that is characterized by an increase in the amount of sugar in the
blood. It is produced by the inability of the body to transform the sugar (glucose)
obtained from food. For the body to transform sugar into energy, it needs a
substance that produces the pancreas called insulin. If the pancreas does not
produce insulin or produces it insufficiently, sugar accumulates in the blood,
causing this disease.

Diabetes cannot be cured, but it can be treated successfully. The complications

caused by diabetes can be avoided by controlling the blood glucose level, blood
pressure (blood pressure) and high cholesterol levels when they occur.

II. Types of diabetes

a) Type 1 diabetes: Also called juvenile or insulin-dependent, occurs
when the pancreas does not produces a sufficient amount of insulin (the
hormone that processes glucose). Often the Type 1 diabetes occurs in
childhood or adolescence and requires treatment with insulin lifelong. It
usually occurs abruptly and often regardless of whether there is a family
history.
b) Type 2 diabetes: Also called adult's diabetes is much more frequent
(for each case of type 1 diabetes, there are 9 cases of type 2 diabetes). In
the case of type 2 diabetes there is a reduction in the efficacy of insulin to
process glucose (this reduction is called insulin resistance) due to the
presence of abdominal obesity. For this reason it is beginning to see the
appearance of type 2 diabetes in obese adolescents. When type 2
diabetes is evolved (after 10-15 years), there is also a reduction in the
production of insulin by the pancreas. Its main cause is obesity because
the fatty tissue produces certain substances that decrease the sensitivity
of insulin receptors.
 c) Gestational diabetes: Diabetes that is diagnosed during pregnancy It
is clearly not a persistent disease, although pregnant women require good
glucose control to avoid complications during pregnancy and childbirth. It
usually disappears after childbirth, but these women have a high risk of
developing type 2 diabetes throughout their lives.
d) Other types of diabetes more infrequent, such as genetic
defects in insulin production, genetic defects in the action of insulin or
defects caused by diseases of the pancreas either induced by drugs (after
a transplant) or by destruction of pancreatic cells (cystic fibrosis or chronic
pancreatitis).

III. CAUSES
Diabetes Mellitus type 1

It is of autoimmune origin. This means that it is the patient's own immune system
that attacks and destroys the pancreatic beta cells responsible for making insulin.

When the initial symptoms appear, the pancreas has already lost the ability to
manufacture insulin almost completely, so insulin treatment is needed from the
first day.

The most common is that it appears in children or young people, however it can
appear at any age.

Diabetes mellitus type 2

It is caused mainly by obesity and sedentary lifestyle. It is the most frequent type
of diabetes (> 90% of the total).

The main problem is insulin resistance (insulin does not work properly), which is
why it is usually treated with oral drugs. However, as time passes, the beta cells
that make insulin die slowly until finally the insulin treatment is also necessary.
This is the most common evolution, although if you lose weight and exercise, the
progression of the disease may stop.

It is very important to be clear that it is a progressive disease most of the time

and that above all we can avoid or delay its progression if we act in the initial
phases.
Another typical characteristic of type 2 diabetes mellitus is that it is frequently
associated with other cardiovascular risk factors such as arterial hypertension,
hypercholesterolemia, sedentary lifestyle or smoking. Undoubtedly, the most
effective treatment is the "multifactorial approach" that includes the treatment of
diabetes and all other risk factors.

Gestational diabetes

It is a type of diabetes that appears in the 2nd or 3rd trimester of pregnancy in

women without previous diabetes. It is due to multiple factors such as obesity or
genetics. The trigger is pregnancy itself, since fetal hormones cause the increase
of blood glucose.

When the pregnancy ends, diabetes disappears, but it must be taken into account
that women suffering from gestational diabetes are more at risk of developing
Type 2 Diabetes Mellitus in the future. The usual treatment is diet and exercise
after meals and only in some cases insulin is needed.

IV. SYMPTOMS
Symptoms of diabetes include:

 increased thirst and the urge to urinate

 Appetite increase
 fatigue
 blurry vision
 Numbness or tingling in the hands or feet
 ulcers that do not heal
 Weight loss for no apparent reason
The symptoms of type 1 diabetes can appear quickly, in a matter of weeks.
In contrast, the symptoms of type 2 diabetes usually progress very slowly,
over several years, and can be so mild that sometimes they are not even
noticed. Many people with type 2 diabetes have no symptoms. Some of
them only have the disease when there are health problems related to
diabetes, such as blurred vision or heart problems

V. DIAGNOSIS
It is based on the single or continuous measurement of plasma glucose
concentration (glycemia).

TESTS FOR TYPE 1 DIABETES, TYPE 2 DIABETES AND PREDIABETES

 Glycosylated hemoglobin test (A1C). This blood test, which does not
require fasting, indicates your average blood sugar level in the last two or
three months. It measures the percentage of blood sugar attached to
hemoglobin, the protein that carries oxygen in red blood cells.

The higher your blood sugar levels, the more hemoglobin with linked sugar
you will have. An A1C level of 6.5% or more in two individual tests indicates
that you have diabetes. An A1C between 5.7% and 6.4% indicates
prediabetes. Below 5.7 is considered normal.

 Random blood sugar test. A blood sample will be taken at a random

moment. Regardless of when you ate for the last time, a random blood
sugar level of 200 mg / dl or 11.1 mmol / l or more suggests diabetes.

 Fasting blood sugar test. A blood sample will be taken after fasting
overnight. A fasting blood sugar level less than 100 mg / dl (5.6 mmol /) is
normal. A fasting blood sugar level of between 100 mg / dL and 125 mg /
dL (5.6 mmol / L and 6.9 mmol / L) is considered prediabetes. If the values
are 126 mg / dl (7 mmol / l) or more in two individual tests, you have
diabetes.

 Oral glucose tolerance test. For this test, you must fast for one night,
and your fasting blood sugar level is measured. Then you drink a sugary
liquid and the blood sugar levels are analyzed several times during the
next two hours.

A blood sugar level less than 140 mg / dl (7.8 mmol / l) is normal. A value
of more than 200 mg / dL (11.1 mmol / L) after two hours indicates
 diabetes. A value between 140 mg / dL and 199 mg / dL (7.8 mmol / L and
11.0 mmol / L) indicates prediabetes.

TESTS FOR GESTATIONAL DIABETES

 Initial glucose overload test. You will begin the glucose overload test by
drinking a glucose solution similar to a syrup. An hour later, you will have
a blood test to measure your blood sugar level. A blood sugar level of less
than 140 mg / dL (7.8 mmol / L) is generally considered normal in a glucose
tolerance test.

 Follow-up glucose tolerance test. For the follow-up test, they will ask
you to fast for one night and they will measure your fasting blood sugar
level. Then you will drink another sweet solution, which will have a higher
glucose concentration, and your blood sugar level will be controlled every
hour for a period of three hours.

If at least two of the blood sugar values are higher than the normal values
set for each of the three hours of the test, you will be diagnosed with
gestational diabetes.