I.

INTRODUCTION

Diabetes mellitus often referred to simply as diabetes—is a condition in which the body does not produce enough, or
properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into
energy. In diabetes, the body either doesn't respond properly to its own insulin doesn't make enough insulin, or both. This causes
glucose to accumulate in the blood, often leading to various complications. Many types of diabetes are recognized:

The principal three are:

• Type 1: Results from the body's failure to produce insulin. It is estimated that 5-10% of Americans who are diagnosed with
diabetes have type 1 diabetes. Presently almost all persons with type 1 diabetes must take insulin injections.
• Type 2: Results from Insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with
relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

Diabetes mellitus type 2 or type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus (NIDDM), or adult-onset
diabetes) is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin
deficiency. While it is often initially managed by increasing exercise and dietary modification, medications are typically needed as
the disease progresses. Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in
parallel to rising obesity rates due to alterations in dietary patterns as well as in life styles during childhood.

Unlike type 1 diabetes, there is little tendency toward ketoacidosis in type 2 diabetes, though it is not unknown. One effect
that can occur is nonketonic hyperglycemia which also is quite dangerous, though it must be treated very differently. Complex and
multifactorial metabolic changes very often lead to damage and function impairment of many organs, most importantly the
cardiovascular system in both types. This leads to substantially increased morbidity and mortality in both type 1 and type 2
patients, but the two have quite different origins and treatments despite the similarity in complications.

Up to 65% of people with diabetes also suffer from hypertension, or high blood pressure. Blood pressure increases when
arteries are narrowed, due to atherosclerosis or to chronically high blood glucose levels, and blood flow is restricted. One study of
over 3500 newly diagnosed patients of Diabetes Mellitus Type II found that 39 percent were already hypertensive. In
approximately one-half of these patients, the elevation in blood pressure (BP) occurred before the onset of microalbuminuria.

1
What are diabetes symptoms?

• The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High
amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased
thirst and water consumption.

• The inability of insulin to perform normally has effects on protein, fat and carbohydrate metabolism. Insulin is an anabolic
hormone, that is, one that encourages storage of fat and protein.

• A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite.

• Some untreated diabetes patients also complain of fatigue, nausea and vomiting.

• Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas.

• Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and
coma.
• Ketosis (A condition characterized by an abnormally elevated concentration of ketone bodies in the body tissues and fluids.
It is a complication of diabetes mellitus and starvation).

Four point one (4.1%) of Filipinos have diabetes mellitus. At the current estimate of the population, this means 2.5 million
Filipinos with diabetes, with perhaps an equal number which remain undiagnosed. Though more than 2 million Filipinos are
afflicted with diabetes, the vast majority of the population - including many of the victims themselves - know very little or nothing
at all about the deadly disease. (www.diabetescenter.org.ph, January 14, 2010).

One out of every five adult Filipinos is diabetic, according to the latest national survey on the prevalence of the disease.
Compared to a decade ago, more Filipino children may now be at risk of contracting diabetes due to the growing cases of
childhood obesity, among other factors, according to a panel of doctors who presented the findings recently. The survey
conducted on the year 2008 by the Philippine Cardiovascular Outcome Study on Diabetes Mellitus also found that as many as
three out of five adults may already be diabetic or on the verge of becoming one unless they change their lifestyle.
(www.unilab.com.ph, March 9, 2009)

Diabetes causes about

2
 5 percent of all the deaths globally each year. 80% of people with diabetes live in low and middle income countries. Most people
with diabetes in low and middle income countries are middle-aged (45-64), not elderly (65+). Diabetes deaths are likely to
increase by more than 50% in the next 10 years without urgent action (World Health Organization).

3
PATHOPHYSIOLOGY
NON-MODIFIABLE FACTORS:
• Hereditary (genetics/
family history)
>(20-40% decreased beta
MODIFIABLE FACTORS: cell mass, dysfunction)
• Diabetogenic lifestyle >(intracellular post-receptor
• excessive caloric intake defect)
• inadequate caloric • Age 54y/o
expenditure • Idiopathic

Food
consumption

Carbohydrates are broken

down into glucose
molecules

These glucose are absorbed in the

bloodstream, elevating the blood glucose
level
Rise in blood glucose
stimulates
Pancreas
(the endocrine gland: Islet of
Langerhans) – hormone secreting
cells (beta cells)

Secretes Insulin (inefficiently)

& distributed in the body through
the bloodstream
4
 Yet, the smooth muscle cells, the
epithelial cells and fat cells has
increased resistance to insulin (target
cells has insulin resistance)

Glucose are not entering (almost)

to the target cells (normally Cell
glucose enters cell and are utilized starvation
as energy)
Increase appetite
Causing glucose molecules to (polyphagia) and Excessive
accumulate in the bloodstream, thirst (polydipsia)
resulting in:

Increased Blood glucose

(Hyperglycemia) (CBG elevated)

In an attempt to rid the body of In the vasculature: glycation of protein,

excess glucose fats and nucleic Acid (viscous blood)

Kidneys excrete glucose along Accumulates deposits of glycated

with water & electrolytes proteins called “ advanced glycation and
(sodium and potassium) products”
(decrease GFR)
AGE – modified (arterial) collagen
accumulates causing thickening of the
vessel wall and narrowing of the
Excessive lumen
Urination
(Polyuria)
5
 Decreased sensation (viscous

Soft tissue injury on

Increased left big toe (blister)
Vascular Pressure

Goes unnoticed; Gangrene of

Increased
impaired wound big toe
Blood pressure
healing
(Hypertension)

Infection

Fever, chills,
body malaise

6
7