Diabetes Mellitus, DM
Summary
Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.
Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues. 1
Causes
There are four types of diabetes:
Type 1 diabetes due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency. Type 2 diabetes due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance. Gestational diabetes mellitus (GDM) is diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis and pancreatitis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation. 1,2
Symptions
Symptoms of type1 diabetes are including abnormal thirst and dry mouth, frequent urination, lack of energy, fatigue, constant hunger, sudden weight loss.
Symptoms of type2 diabetes are including excessive thirst and dry mouth, frequent and abundant urination, lack of energy, extreme tiredness. It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels. 1
Treatment
People with type 2 diabetes can often initially manage their condition through exercise and diet. However, over time most people will require oral drugs and or insulin.
Metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes. Once initiated, metformin should be continued as long as it is tolerated and not contraindicated; other agents, including insulin, should be added to metformin.
Among patients with type 2 diabetes who have established atherosclerotic cardiovascular disease, sodium–glucose cotransporter 2 inhibitors, or glucagon-like peptide 1 receptor agonists with demonstrated cardiovascular disease benefit are recommended as part of the antihyperglycemic regimen. 2,3
1. https://www.idf.org/aboutdiabetes/what-is-diabetes.html.
2. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetesd2019. Diabetes Care 2019;42(Suppl. 1):S13–S28.
3. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetesd2019. Diabetes Care 2019;42(Suppl. 1):S90–S102.