SWEET SUGAR, BITTER CONSEQUENCES..... THE PARADOX!!!!

Is it not just Sugar? I don't eat lots of refined sugar so I'm probably safe, There are a lot of other diseases I should be more concerned about, blood sugar should be the least of all my worries now. My schedules are tight I don't have time for any blood sugar test for now. I look healthy and I think I'm good to go, Though my sugar level is high, free styling this once won't kill me.
As a medical student currently working with the endocrine unit, I have several times come in contact with lots of patients with different believes about blood glucose control but to mention a few here.
We probably must have heard of diabetes and had different beliefs about it. Diabetes Mellitus is a clinical syndrome characterised by an increase in plasma blood glucose (hyperglycemia) with a diagnostic criteria of;
Fasting plasma glucose = or > 7.0mmol/l (120mg/dl)
Glucose 2hrs after an oral glucose challenge =or> 11.1mmoll/l (200mg/dl)
This helps to identify those who have a degree of hyperglycemia which if untreated carries a significant risk of microvascular disease but less severe hyperglycemia called "impaired glucose tolerance" is not associated with substantial risk of microvascular disease but is connected with an increased risk of large vessel disease and with a greater risk of developing diabetes in future.
The incidence of diabetes is rising rapidly and a global pandemic with lots of people not knowing their status until complications arise which might be life threatening. Is a major burden upon health sector of all countries globally causing 4.6 million deaths in 2011 and lots of million dollars expenditure in health care.
TYPES OF DIABETES MELLITUS
Type one DM: in these patients, there is absolute insulin deficiency. Insulin simply putting is a hormone that helps to drive in glucose from blood into the body tissues thereby maintaining normal blood glucose levels and making glucose available for use in the body tissues. The absolute insulin deficiency can be as a result of autoimmune diseases (type 1A) or idiopathic (type 1B).
The patients with type 1 tend to be younger, however it may occur at any age but more commonly in younger age.
TYPE 2 DM: these patients have insulin resistance, they tend to be middle age and elderly and may have co-morbid conditions.
TYPE 3 DM (GESTATIONAL DM) : This is DM seen in a pregnant woman for the first time usually after 24 weeks of gestation. It usually resolves after pregnancy. 50% of patients with gestational DM may develop type 2 DM within the next 5-10years.
FOURTH TYPE (SECONDARY DM/ DM FROM OTHER CAUSE) : causes may include

1. Chromosomal disorders e.g Down's syndrome or Turner syndrome.
   2.End organ damage e.g chronic pancreatitis, pancreatectomy, cancer of the pancreas.
2. Infective causes e.g Coxsackie B, Rubella, Epstein Barr virus.
3. Side effects of drugs e.g long term use of steroids, hydrochlorthiazide, protease inhibitors, nucleotide inhibitors like lamivudine.

RISK FACTORS FOR DIABETES MELLITUS
Note these are not absolute causes of D.M but have been shown to have strong association with D.M and modifying the modifiable risk factors helps in preventing D.M. They are GENETIC as well as ENVIRONMENTAL FACTORS such as Obesity, Unsatisfactory diet, longevity, sedentary lifestyle, increasing urbanisation, viral infections stated above, Bovine serum albumin( a major constituent of cow's milk has been implicated since children who are given cow's milk early in infancy are more likely to develop type 1 D.M than those who are breastfed.

DIAGNOSIS OF DIABETES AND PRE-DIABETES
DIABETES IS CONFIRMED BY EITHER:

1. plasma glucose in random sample or 2hrs after a 75g glucose load =or >11.1 (200mg/dl)

2. Fasting plasma glucose =or >7.0mmol/l (126mg/dl)
   In asymptomatic patients, two diagnostic tests are required to confirm diabetes.
   PRE-DIABETES IS CLASSIFIED AS

3. Impaired fasting glucose = fasting plasma glucose = or >6.0<7.0 mmol/l

4. Impaired glucose tolerance = fasting plasma glucose <7.0mmol/l and 2 hours glucose after 75g oral glucose drink 7.8-11.1mmol/l

   SYMPTOMS OF HYPERGLYCEMIA

5. Thirst, dry mouth

6. Polyuria, Nocturia

7. Blurring of vision

8. Nausea

9. Tiredness, fatigue, lethergy

10. Change in weight (usually unintentional weight loss)

11. Headache

12. Hyperphagia,( predilection for sweet foods)

13. Mood change, irritability, difficulty in concentrating, Apathy

14. Pluritus vulvae, balanitis (genital candidiasis )

MANAGEMENT
This is aimed at improving symptoms of hyperglycemia and minimising the risks of long term microvascular and macrovascular complications.

1. Dietary/ lifestyle modification: Always consult a Dietitian, it must be a balanced diet, individualised, content of the diet include 45-55% carbohydrate, < 35% fat, 15-20% protein and five portions of fruit/ vegetables daily.

2. Oral anti diabetic drugs

3. Injected therapies (e.g insulin)
   In parallel with treatment of hyperglycemia, other risk factors for complications of diabetes need to be addressed including treatment of hypertension and dyslipidaemia and smoking cessation.

   COMPLICATIONS OF DIABETES MELLITUS
   Acute complications:
   A. Hyperglycemic complications

4. Diabetic ketoacidosis: is a medical emergency and remains a serious cause of morbidity, principally with people with type 1 D. M. They usually present with marked weight loss, fever, dehydration, Marked abdominal pain mimicking acute pancreatitis or appendicitis, unconsciousness.

5. Hyperosmolar Hyperglycemic state: previously called hyperosmolar non ketotic coma. Is an emergency characterised by severe hyperglycemia (>30mmol/l), hyperosmolality(>320mosm/kg) and dehydration in the absence of significant hyperketonaemia(<3mmole) or acidosis.

6. Lactic acidosis; presenting as joint pain, muscle ache and respiratory difficulty.
   B. Hypoglycemic complications
   In diabetes, this results from insulin therapy and less frequently from secretagogues and other anti diabetic drugs. This is one reason why you should not self medicate. All medications must be prescribed by a physician and you must adhere to the recommended dose. It can also be as a result of;

7. Missed, delayed or inadequate meal

8. Alcohol

9. Malabsorption

10. Lipohypertrophy at injection site

11. Unexpected exercise

12. Gastroparesis due to autonomic neuropathy

13. Unrecognised other endocrine disorders e. G Addison's disease

14. Breastfeeding

15. Factitious (deliberately induced)
    Clinical features :

16. Autonomic; Sweating, hunger, trembling, anxiety, pounding heart.

17. Neuroglycopenic; speech difficulty, irritability, inability to concentrate, incoordination.

18. Non specific; nausea, headache, tiredness.

    Chronic complications
    A. Microvascular/neuropathic

19. Retinopathy, cataract; impaired vision.

20. Nephropathy; renal failure

21. Peripheral neuropathy; sensory loss, pain, motor weakness.

22. Autonomic neuropathy; Gastrointestinal problems (gastroparesis,altered bowel habit), postural hypotension, erectile dysfunction.

23. Foot disease; ulceration, anthropathy
    B. Macrovascular

24. Coronary circulation; myocardial ischemia /infarction

25. Cerebral circulation; transient ischemic attack, stroke

26. Peripheral circulation; claudication, ischemia
    Over 50% of diabetes patients currently admitted in my training center have foot ulcer due to late presentation with some requiring amputation. This can be prevented with regular hospital check up and proper management of blood glucose level.
    So you see friends, D. M is a syndrome that affects virtually all systems in the body. A simple blood glucose test with adherence to medical advice can be life saving. Now that you are aware please educate others, save lives and please don't try to self medicate, always visit a medical personnel preferably an endocrinologist.