|
|
Diabetes Mellitus is considered worldwide to
be one of the most notorious diseases of the adrenal glands.
It raises the blood sugar levels as a result of the
decrease in insulin hormone or its non efficacy. This
in turn has its damaging effect on different systems of the
body particularly the blood vessels whether in the eyes, the
kidneys or the nervous system.
In the USA there are 10 million diabetics and
this rate doubles every 15 years.
|
 |
Statistics have proven that 1.9/1000 children
and 2-5% adults are diabetic. It has been noted that
children and young people in Japan and Sri Lanka are rarely
inflicted.
1. The Symptoms and complications
of Diabetes Mellitus:
The first diagnosis of the disease may be a
case of coma resulting from increased sugar level in the
blood and acetone in the blood or urine. This may also
become noted in case of dizziness or vomiting or
hyperventilation.
Diabetics are 25 more times susceptible to
loss of eye sight, 17 more times to kidney diseases and 5
more times to gangrene infection which may lead to
amputation of the afflicted organ. In addition,
diabetics are twice as prone to other complications such as
heart disease and brain tumors as normal persons.
Diabetes causes death to 30,000 persons in
the USA each year, and is considered the seventh cause of
infant deaths.
2. Types of Diabetes Mellitus:
|
a. Type I
Insulin Dependant Diabetes Mellitus
This usually attacks younger persons
(Juvenile Diabetes). It is caused by decrease in
insulin hormone, therefore the only treatment for it is
Insulin injections. It may also attack 15-20% of adults
above age 40 and is extremely dangerous and may cause death.
|
 |
b. Type II
Non Insulin Dependant Diabetes Mellitus
This type attacks older persons and only 5%
of persons under 30 (Maturity Onset Diabetes Mellitus).
It is caused by obesity, non-efficacy of insulin hormone due
to antibodies or as a result of anti-insulin hormones.
c. Secondary
Diabetes Mellitus
This is a result of the use of
cortisone tablets in large dosages for extended periods, or
contraceptive pills, diuretics or as a result of chronic
pancreatic infection or increased secretion of anti-insulin
hormone in certain diseases such as Acromegaly and
Pheochromocytoma.
d.
Gestational Diabetes
1-3% of women are afflicted during the
first three months of pregnancy. In most cases this is
a transient state caused by decrease in sugar flow
allowed to the urine by the kidneys due to hormonal changes
during pregnancy. This may cause delivery of a large,
heavy baby, prone to problems of the respiratory system and
reduced sugar levels.
3. Role of the lab in diagnosis
and follow-up:
If diagnosis of diabetes is confirmed,
then a long journey of continuous lab tests begins, in order
to ensure control of the disease, since its complications
are dangerous not only due to the length of the disease but
more importantly the loss of control over blood sugar
levels.
1. Measuring Blood Glucose
a. Blood glucose is
measured while the patient has been fasting between 6
and 8 hours or after eating. This means that a sample
is taken 2 hours after the start of a meal. Diagnosis
is confirmed if the fasting sugar level or the
sugar level 2 hours after eating exceeds 126 mg.% for
two consecutive times.
b. In certain
cases, diagnosis is not confirmed except after doing a
complete glucose curve. This means that the first
sample is taken while the patient is fasting, then he/she
drinks a glucose fluid then samples are taken after
half an hour, then one hour then 2 then 3 hours thereafter.
Usually, children do not need a
complete glucose curve to determine if they are diabetic,
contrary to adults, particularly in suspicious cases such as
persons who were afflicted once whether due to pregnancy,
stress (Stress Diabetes) or any other bodily infection.
It is recommended that susceptible persons such as twin to a
diabetic parent do a complete sugar curve.
2. Measuring Glucose in Urine
This is for quick screening and cannot be
relied upon for diagnosis, follow-up or treatment.
Glucose level may be high in the blood but
does not show in the urine because the level is lower than
that allowed to flow to the urine through the kidney.
Glucose may be present in the urine in other
diseases and may not be accompanied by raised blood sugar
levels such as in cases of dysfunctional digestive system
(Alimentary Glucosuria) or kidneys (Renal Glucosaria) and
pregnancy (Pregnancy Glucosaria).
3. Glycosylated Hemoglobin
This test is done regularly each 3 months to
ensure control of blood glucose levels during the previous 3
months and consequently throughout the year.
This represents that part of the hemoglobin to which glucose
gets attached inside the red blood cells. It's
rate in normal persons is between 6-8%.
4. Fructosamine
This test is performed monthly to give an
indication of the control of glucose levels in the
blood.
5. Measuring the Insulin Hormone
This hormone must be measured coincidently
with blood glucose levels.
The downside of this test is that it does not differentiate
between insulin secreted internally by the pancreas and
external insulin if the patient is being treated by it.
The most important use of this test is to diagnose failed
response to diabetes treatment by tablets and in this case,
it is usually found that insulin levels are low.
6. C-Peptide
This hormone secretes an amount of insulin
equal to that secreted by the pancreas without being
influenced by external insulin or inactive insulin present
in the body. Therefore, it is a good indicator of the
function of the Beta cells which secrete insulin. 75%
of diabetic children pass through a phase called Honeymoon
Period for its recurrent decreased blood glucose which
necessitates gradual reduction in insulin. This phase
may last for several weeks or months upto two years.
In this case, C-Peptide is considered a very accurate
test of the insulin secreting cells.
7. Insulin Antibodies
This test is useful in the diagnosis of
patients who do secrete insulin, but their bodies also
secrete antibodies which block the effects of insulin.
This is caused by the use of animal
derived insulin because of its low price.
8. Microalbuminaria
This is considered the most accurate method
for early detection of kidney dysfunction as a result of
diabetes or hypertension.
Is Diabetes Hereditary?
Diabetes is not hereditary. However, what is
hereditary is the easy susceptibility to the disease as a
result of numerous factors such as tendency for obesity,
hypertension, continuous stress etc.
- In the case of Insulin Dependent Diabetes
Mellitus, the chances of
having it are 1.7% if the mother is afflicted and 4.7% in
case of the father. In
case both are diabetic, then the chances increase to 23%.
Additionally, it has been noted the rate increases even
further in case of Mongoloidism.
- In the case of Non Insulin Dependent
Diabetes Mellitus the rate increases 8-fold in 70% of
obese patients and it may reach 100% in the case of
identical twins.
The importance of knowing the basis of
heredity and its percentages in Diabetes
Mellitus is that the above persons are considered High Risk
and must therefore be checked periodically to diagnose the
disease at its early stages and prevent complications.
|
LABORATORY TESTS
Monthly Tests: Blood Glucose + Fructosamine
Trimestrial Tests: Glycosylated + Hemoglobin
+ Microalbuminuria
Annual Tests: General Check-up
Specialized Tests: Insulin, Insulin
antibodies, C-Peptide
|
 |
Health tips topics
|