Diabetes Mellites

Diagnosis of diabetes:


Normal - < 5.7%, Prediabetes- 5.7% to 6.4%, Diabetes- 6.5% or higher

Fasting plasma glucose (FPG):

FPG is measured after at least 8 hours of fasting, that is, not eating or drinking anything except water for at least 8 hours before the test. It is usually done first thing in the morning before breakfast.

Normal- less than 100mg/dl

Prediabetes- 100mg/dl to 125mg/dl

Diabetes- 126mg/dl or higher

Oral Glucose Tolerance Test(OGTT)

The OGTT is a test to screen for type 2 diabetes. Your blood sugar levels are checked before and two hours after you drink a special sugar (glucose) solution.

Normal: less than 140mg/dl

Prediabetes- 140mg/dl to 199mg/dl

Diabetes- 200mg/dl or higher

Random Plasma Glucose Test:

This test is checked at any time of the day when you have severe diabetes symptoms. Diabetes is diagnosed at blood sugar of greater than or equal to 200 mg/dl.

Types of Diabetes

Type 1 DM:

Type 1 diabetes, previously known as insulin dependent diabetes, is commonly seen in younger individuals. It is characterized by insulinopenia i.e. total absence of insulin secretion from the pancreas. It is an autoimmune condition where there is immune mediated attack on one’s own pancreas resulting in a low or absent insulin secretion. Other autoimmune conditions like hypothyroidism, adrenal insufficiency, celiac disease, vitiligo etc. may be associated with type 1 DM. Most patients with type 1 diabetes are symptomatic at presentation and common symptoms include weight loss, increased thirst and increased frequency of micturition. Sometimes patients may present with diabetic ketoacidosis (DKA), a medical emergency characterized by very high blood glucose levels, severe dehydration and a confused state, requiring hospitalization. Insulin is the mainstay of treatment in type 1 diabetes. It can be administered either by injection or by pump. Duration of insulin therapy in type 1 diabetes is lifelong and stopping or skipping insulin doses will result in uncontrolled diabetes and DKA. It is important to achieve good blood sugar control to prevent complications due to diabetes like retinopathy, nephropathy and neuropathy in type 1 diabetes patients.

Type 2 diabetes:

Type 2 diabetes is the most common form of diabetes seen worldwide. It is multifactorial in etiology, mainly governed by the genetic composition of an individual and the lifestyle adopted in terms of diet and exercise. With increase in incidence of obesity across the world there has been a continuous rise in prevalence of type 2 diabetes especially in India. According to the International diabetes federation (IDF) 488 million people are suffering from type 2 diabetes across the world. The prevalence in our country is about 8.9% of the total population. Type 2 diabetes along with hypertension (increased blood pressure), dyslipidemia (abnormal cholesterol levels) and smoking, increases the risk of cardiovascular diseases (CVD) and mortality. Therefore, it is important to address each of these conditions in a patient suffering from type 2 diabetes. Unlike type 1 diabetes where there is absence of insulin secretion, in type 2 diabetes the insulin secretion from pancreas is normal in early stages of the disease. Treatment at this stage is by means of diet and various oral medication, used alone or in combination. However, with increase in duration of type 2 diabetes, pancreas fails to synthesize insulin in adequate amounts thereby warranting insulin initiation for adequate control of blood glucose levels. It is also important to note that unlike type 1 diabetes patients, most type 2 diabetes patients are asymptomatic in the early stage and therefore screening of high-risk individuals to detect type 2 diabetes is very important at this stage.

Screening for type 2 diabetes should be done in all asymptomatic adults who are overweight or obese (BMI > 23 in Asians) and who have one or more diabetes risk factors including:

-Physical inactivity

-First degree relative with diabetes

-Women who delivered a baby > 9 pounds (4 kg) or were diagnosed with gestational diabetes i.e. diabetes in pregnancy.

-High dense lipoprotein cholesterol (HDL-C) < 35 mg/dl +/- triglycerides TG > 250mg/dl

-Hypertension (> 140/90 mm Hg or on therapy)

-HbA1C >5.7%, impaired fasting glucose (fasting blood glucose between 100 and 126 mg %) or impaired glucose tolerance (post prandial blood glucose between 140 and 200 mg %) on previous testing

-Conditions associated with insulin resistance (e.g. Severe obesity, acanthosis nigrans, polycystic ovarian syndrome)

-Cardiovascular disease history

For all other patients, testing should begin at age 45. If results are normal, testing should be repeated at a minimum of three-year intervals with more frequent testing depending on initial results and risk status.

Preventing type 2 diabetes:

You will not develop type 2 diabetes automatically if you have prediabetes. For some people with prediabetes, early treatment can actually return blood sugar levels to the normal range.

Research shows that you can lower the risk for type 2 diabetes by 58% by:

1. Losing 7% of your bodyweight

2. Exercising moderately (such as brisk walking) 30 minutes a day, five days a week

Complications of uncontrolled diabetes:

Diabetes type 1 or type 2, if uncontrolled, can affect multiple organ systems. Grossly diabetic complications are classified as microvascular and macrovascular. Microvascular complications include diabetic retinopathy affecting vision, diabetic nephropathy affecting kidneys leading on to chronic kidney disease, kidney failure and ultimately dialysis or renal transplantation. Another important diabetic microvascular complication is diabetic neuropathy affecting peripheral nerves. It can be painful in early stages and at later stages it is painless leading to a decreased sensation of feet. Diabetic neuropathy is the most important risk factor for foot ulcerations, gangrene and foot amputation in diabetic population. Macrovascular complications of uncontrolled diabetes include myocardial infraction (heart attacks), cerebrovascular accidents (brain stroke), peripheral vascular disease(PVD). Other complications of uncontrolled diabetes include increased susceptibility to infections (skin, sinuses, lungs, urinary tract, nails) heart failure, early cataract, sudden cardiac death.