Complications

The diabetes can lead to many complications especially to the nerve and blood vessels.

Acute complications include:

• Hypoglycemia


• Diabetic ketoacidosis


• Diabetic nonketotic hyperosmolar coma

Chronic complications include:

• Disorders of the eyes (diabetic retinopathy, cataracts, etc)


• Disorders of the kidneys (intercapillary glomerulosclerosis, infection, renal tubular necrosis)


• Disorders of the nervous system (peripheral neuropathy, cranial neuropathy, autonomic neuropathy)


• Disorders of the skin (leg and foot ulcers, diabetic dermopathy, candidiasis)


• Disorders of the cardiovascular system (heart disease)
  

Medications

Type I Diabetes mellitus

Insulin is injected into loose skin such as upper arms, thighs, abdomen, and upper buttocks. Avoid inject at the same site each time the insulin is administered to prevent lipohypertrophy. Reuse of disposable syringe is allowed until the needle is blunt. Maintain its sterility by recapping syringes between uses. Cleansing the needle with alcohol is not recommended.

Type II Diabetes mellitus

Diet

• Calories restriction for obese patients to reduce weight
  
• Adequate calories to maintain body weight for non obese patients
  
• Well balanced, nutritious diet
  

Restrict these foods:

• Pure sugar
  
• Candy
  
• Soft drink
  
• syrup
  
• Ice cream
  
• Cakes
  
• Sweet cookies
  
• Etc.

Exercise

Hypoglycemic drugs

Insulin for type II diabetic patients whose hyperglycemia does not respond to hypoglycemic drugs.

Laboratory findings

• Glucosuria (the presence of sugar in the urine)
  


• Ketonuria (the presence of keton bodies in the urine)
  


• Positive plasma glucose levels or oral glucose tolerance test for diabetes mellitus
  


• Elevated HBA1c

Symptoms and signs

These are the common triad symptoms of diabetes mellitus:

• Excessive of appetite


• Excessive production of urine


• Abnormal thirst
  

Type I Diabetes mellitus:

• Wight loss


• Fatigue


• Nausea


• Paresthesias


• Prone to ketoacidosis
  

Type II Diabetes mellitus:

• Often asymptomatic


• Abdominal obesity


• Chronic skin infections


• Ever gave birth to macrosomic baby

Gestational Diabetes

Gestational diabetes mellitus is an intolerance of glucose during pregnancy. This form of diabetes is the most common medical complication in pregnancy also increases risk of fetal death, most of the patients have normal sugar levels before pregnancy and discovered during the pregnancy maybe this form of diabetes is induced by pregnancy or the patients have masked type II diabetes mellitus. It may causes an excessive fetal growth and leads to macrosomic infant (> 4500g).

Type II Diabetes Mellitus

This form diabetes mostly occurs on older person but these days this form can be found in children and young adults. The endogenous insulin is not enough to prevent hyperglycemia. In addition, there is an impairment of insulin action due to insensitive peripheral tissue to insulin. The underlying cause is still unknown.

This form diabetes is associated with sedentary life and abdominal obesity. The accumulation of fat in visceral organ influence the insensitivity to insulin and accumulation of subcutaneous fat has less effect to insulin insensitivity. Because the insulin is still produced, most of the patients will show no symptom until late complication occurs such as blurred vision, ulcus diabeticum, etc. But they are not easily prone to ketoacidosis. That is why this form diabetes is called Non Insulin Dependent Diabetes Mellitus (NIDDM) because the insulin is still produced. Exercise can help to reduce the blood sugar levels and they may have normal blood sugar levels after losing weight.

Type I Diabetes Mellitus

This form occurs predominantly at children and young adults. This form is immune mediated and insulin dependent. The cells that produce insulin known as pancreatic B cells fail to respond all stimuli (stimuli to insulin production) because they are attacked by immune system and the rate of destruction is quite variable. That means the patients need exogenous insulin because the circulating insulin is usually absent. Excessive of appetite, excessive production of urine, abnormal thirst, weight loss, prone to ketoacidosis are common symptoms of type I Diabetes mellitus. There are many factors that can promote ketoacidosis such as:

• Fever
  
• Infection
  
• Pregnancy
  
• Others conditions that increase basal metabolism
  

On those conditions the cells have to eat more but they can not use glucose, so they use fat for their need, and fat metabolism produces ketones.

Types of Diabetes

Among all of the degenerative diseases, diabetes is the one that will rise in the future. There are four types of diabetes mellitus:

1. Type I diabetes
• Immunologic process
• Unknown cause
  
2. Type II diabetes


3. Others specific types
• Genetic defect on cell B function
• Genetic defect on insulin action
• Exocrine pancreas disease
• Endocrinopathy
• Drug toxic
• Infection
• Immunology
• Other genetic syndromes
  
4. Gestational diabetes mellitus.