Diabetes Mellitus

Diabetes Mellitus

Written by, Eneregbu Akunna Isobel. (Registered Dietitian According to the American Diabetes Association (ADA), diabetes is a group of metabolic disorder characterized by hyperglycemia (high level of glucose in the blood) resulting from defects in insulin secretion, insulin action, or both. This disease was named diabetes by a Greek physician, which means “to flow through,” because of the large amounts of urine generated by patients. Later, the Latin word mellitus, which means “honeyed,” was added because of the amount of glucose in the urine. Diabetes Mellitus is one of the leading causes of death in the world. An estimated 23.6 million people in the United States and 366 million people worldwide have diabetes according to center for Disease Control and Prevention. The number of adults with diabetes will rise to 439 million in the year 2030. In addition diabetes underlines or contributes to, several other major diseases including heart disease, stroke, hypertension, blindness and kidney failure. Statistics in Nigeria in Africa, Nigeria has the highest number of people with diabetes. According to WHO, Nigeria has the highest mortality rate from the disease. Approximately 1,218,000 people are affected and an estimated 3.85 million people have impaired glucose tolerance says International Diabetes Federation (IDF). According to Diabetes Association of, Nigeria an estimate of 6 million people have full blown diabetes mellitus. the who/IDF report of 2011 alerted that diabetes mellitus will continue to be a major threat to public health beyond the year 2030. Classification of Diabetes Mellitus Diabetes as it is commonly called is clinically classified into four distinct types namely: Type 1diabetes: In type 1 diabetes, the body develops antibodies to its insulin And destroys the pancreatic cells that produce the insulin (the hormone that regulates blood glucose, creating an insulin deficiency). Type 1 diabetes is usually diagnosed in children and young adults hence its former name “juvenile diabetes.” The patients require insulin injections in order to regulate their blood sugar, another reason it was called “Insulin Dependent Diabetes Mellitus (IDDM).” Type 1 diabetes can account for 5% to 10% of all cases of newly diagnosed diabetes. Type 2diabetes was previously called “adult onset diabetes” because it usually occurs in adults over the age of 40. Although, the onset of type 2 diabetes can be at any age – even during childhood – such is mainly caused by obesity. The primary defect in type 2 diabetes is insulin resistance, a reduced sensitivity to insulin. Patients who have Type 2 diabetes do not have an absolute dependence on injectable insulin for their survival (especially in the early stages), a reason for its other name “Non-Insulin Dependent Diabetes Mellitus (NIDDM).” The hyperglycemia can often be controlled by dietary means only and physical activity, or with an oral hypoglycemic drug. Many individuals are asymptomatic and their glucose elevation may be detected as the result of a routine blood test. Thus most people lose 50% of pancreatic beta cell function by the time it is detected because Type 2 diabetes is progressive. Gestational diabetes also known as “gestational diabetes mellitus” (GDM) or “diabetes during pregnancy” is a type of diabetes that is diagnosed in the course of a pregnancy. It associated with an increased risk of developing Type 2 diabetes in later life. Gestational diabetes can occur between the sixteenth and twenty-eighth week of pregnancy. If it is not responsive to diet and exercise insulin injection therapy will be used. It is recommended that a dietitian or a diabetic educator be consulted to plan an adequate diet that will control blood sugar for mother and baby. Secondary diabetes occurs infrequently and is caused by certain drugs or by a disease of the pancreas. Among these types of diabetes mellitus Type I and Type II are major types with the later composing of 90-95% of diabetic cases. Causes of Diabetes Mellitus Diabetes Mellitus according to the British Medical Association Medical Dictionary is caused by insufficient production or absence of the hormone insulin by the pancreas or resistance of tissue to insulin action. Risk Factors of Diabetes Mellitus Although the causes of diabetes mellitus have been mentioned above, the risk of developing it is substantially increased by obesity (especially abdominal obesity), poor dietary habits, aging, physical inactivity, heredity, race, smoking, and excessive alcohol consumption etc. These are explained below. Obesity: This in itself can directly cause some degree of insulin resistance (Whitney and Rolfes, 2011) which is one of the causes of Type II diabetes. Obesity has led to a dramatic rise in the incidence of Type 2 diabetes among children and adolescent. Poor dietary habits: High intake of foods high in saturated fats (in the form fatty foods like pastries such as burgers cakes etc. fatty meat) and low in dietary fiber increases the risk of type 2 diabetes according to WHO. Aging: Insulin resistance increases with aging giving rise to incidence and prevalence of Type 2 diabetes among the elderly according to American Diabetes Association. Physical Inactivity: Studies have clearly indicated that increased physical inactivity has the potential to substantially enhance insulin sensitivity hence reduce the risk of developing Type 2 diabetes. Heredity: A strong family history of autoimmune disorder (a condition in which the body develops antibodies to its own proteins and then proceeds to destroy cells containing these proteins) predisposes one to Type 1 diabetes. Individuals who have both parents with Type 2 diabetes have a 50% chance of having the disease Race: Type 2 diabetes is more common in certain ethnic populations, such as Native Americans, Hispanic Americans, Mexican Americans, African Americans, Asian Americans, and Pacific Islanders. Gestational Diabetes: Children born to mothers who have gestational diabetes tend to develop obesity in childhood and are at risk of developing type 2 diabetes at an early age. Also women who had gestational diabetes are prone to develop Type 2 diabetes. Symptoms of Diabetes The following are common symptoms of diabetes. There is what I call the 3P’s they are polyuria (excessive urination), polydipsia (excessive thirst) and polyphagia (excessive hunger/appetite) others include weakness, fatigue, glycosuria (excess glucose in the urine), loss of weight (typical of type 1 diabetes), frequent infection, blurred vision, hyper glycaemia, ketouria (ketones in urine), ketonaemia, (ketones in the blood-ketones are product of fatty acid breakdown due to inability of the body to use carbohydrate for energy), the ketones can cause diabetes coma by increasing the acidity of the blood. How Do I Know I Have Diabetes For to know and be sure you have diabetes a physician must make the diagnosis. You may be required to run the following tests (other test may be conducted to identify the type of diabetes): Glycated hemoglobin (A1C) test; Random Blood Sugar (RBS) test; Fasting blood Sugar (FBS) or Fasting Plasma Glucose (FPG); Oral Glucose Tolerance Test (OGTT). Complications Of Diabetes Mellitus Uncontrolled diabetes can lead to the following complications: Diseases of the Large Blood Vessels; Diseases of the Small Blood Vessels; Diseases of the Nerves and Hypoglycemia Other complications include urinary tract infection, sexual dysfunction (weak erection). Prevention of Diabetes It is especially important to make diabetes prevention a priority if you’re at increased risk of diabetes, for example, if you’re overweight or have a family history of the disease. Do the following: Cultivate a healthy body weight; watch your diet; get more physical activity; do not smoke and limit alcohol intake and exercise. BREAKFAST 3 slices of whole wheat bread 1 cup cut up raw vegetables 3 tablespoons skimmed milk in tea or coffee (decaffeinated). 1 egg boiled 2 tsp. margarine 1 apple Midmorning snack 1/8 cup groundnuts 5 medium-sized garden eggs 1 ring pineapple (#50) SAMPLE MENU FOR DIABETIC (UNCOMPLICATED) PATIENT BASED ON 1800 CALORIE DIET LUNCH supper OR OR 1 oz meat (lean) 1 cup jollof rice 2 tsp. vegt.oil 1 cup cooked Vegt 4 small tangerine 1 oz fish 1 cup cooked beans with 1 teaspoon of palm oil 1/2 cup cooked vegetables 1small banana Mid afternoon Snack 5 salt less crackers or plain biscuits 1 large cucumber Evening snack 1 cup low fat yoghurt/skimmed milk 1 slice bread 1 medium size guava 1oz fish 1cup of porridge plantains (unripe) 2 tsp. palm oil 1 cup cooked vegt. (Ugu) 1 medium size Orange 1 oz meat 1 cups cooked pasta (spaghetti) with 1teaspoon of vegt. Oil 1 cup vegetable salad. 1 medium size (N50) pineapple Note No salt should be used at the table. Avoid processed meat, cheese, tinned or canned foods- in order to prevent hypertension. Use only one teaspoon in cooking per day i.e. 1/3 teaspoon per meal. Chicken should be skinned before consumption. Use cooking methods that require minimum amount of fat such as boiling, steaming, or baking method of cooking. Serving adjustments using handy measures ½ cup cooked rice = a cupcake wrapper full 1 slice of bread = audiocassette tape 1 cup vegetable = a fist 1 oz nuts = 1 handful 1 oz cooked meat, poultry, or fish is about the size of a matchbox. 3 oz cooked meat, poultry, fish = your palm; a deck of cards 1 medium size fruit = a fist 1 cup milk= 3 tablespoons of milk in 250ml of water.
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