Assignment of Physiology

Topic: Diabetes mellitus

Submitted to: Sir Sajjad Sarwar

Submitted By: Urooj Fatima (1096)

Semester: 5th (Morning)

Section: B

Session: 2018-2022

Department: Zoology
Diabetes mellitus:
The body does not generate adequate insulin or naturally respond to insulin, producing an
abnormally elevated level of blood sugar (glucose) known as diabetes mellitus.
Diabetes mellitus is a condition that raises the sugar content in the blood. Doctors also differentiate
this condition from diabetes insipidus by the entire name of diabetes mellitus, rather than by
diabetes alone. Diabetes insipidus is a relatively rare condition that does not affect blood glucose,
but also induces increased urination, including diabetes mellitus.
In the following conditions, diabetes may occur:
There is no cholesterol or insulin in the pancreas (organ behind the stomach). Insulin is a natural
hormone that is formed by pancreatic beta cells that assists the body in using sugar for energy.
On other hand, Insulin is created by the pancreas, but it doesn't function as it does. This disease is
known as resistance to insulin.
There are millions of cells in the body. Cells require food in a very basic way in order to generate
electricity. Most of the diet is divided into basic sugar called glucose when you eat or drink. The
energy that your body uses for everyday tasks is provided by glucose. Blood vessels and blood are
the paths from which sugar is taken (in the stomach) or manufactured (in the liver) into cells
(muscles) or deposited (fat). Sugar alone cannot enter the cells. The pancreas releases insulin into
the blood as an aid or the "key," that allows sugar to be used as energy in the cells. The blood sugar
levels are decreased as sugar exits the plasma and reaches the cells. Sugar can't reach the cells of
the body for use as energy without insulin or the "key," This adds to a spike in sugar. Too high
blood sugar is referred to as hyperglycemia (high blood sugar).

Causes of Diabetes mellitus:

There are no known causes of diabetes. You will be able to develop the following risk factors:
 Diabetes family history or gestational diabetes personal history.
 Hispanic, Native American and Asian American, Pacific Island or ethnic origins; • African
American or Hispanic.
 Pancreas damage (such as infection, tumor, surgery or accident).
 Autoimmune illness.
 Age (risk increases with age).
 Stress in physics (such as surgery or illness).
You may have better influence over risk factors, including:
 Low blood pressure. Blood pressure.
 Excessive amounts of cholesterol in the blood or triglycerides.
 Tobacco.
 To be overweight.
 Use of certain drugs, including steroids
Types of diabetes mellitus:
Prediabetes mellitus:
Prediabetes is a state wherein glucose levels in the blood are excessively increased, yet not
adequately increased to be viewed as typical to be called diabetes. Prediabetes happens in
individuals if their fasting blood glucose level is between 100 mg/dL (5.6 mmol/l) and 125 mg/dL,
or if the blood glucose level is between 140 mg/dL (7.8 mmol/l) and 199 mg/dL (11.0 mmol/l)
inside two hours of a glucose tolerance examination. The danger of prediabetes is more prominent
later on and heart illnesses is higher. Diet and exercise decreases the danger of creating future
diabetes altogether by 5 to 10%.

Type 1 diabetes mellitus:

The body's immune system targets insulin-producing cells in the Pancreas and permanently kills
more than 90% of them in Type 1 diabetes (formerly known as insulin-dependent diabetes or junior
diabetes). This causes little to no insulin in the pancreas. Of all individuals with diabetes, about 5
to 10 percent have a type 1 disorder. The condition occurs by the age of 30 most individuals with
type 1 diabetes, but this can occur later in life. Researchers conclude that the immune system
allows the insulin generating pancreatic cells to be killed by an external factor, probably a viral
infection or diet factor during adolescence or early adulthood.

Type 2 diabetes mellitus:

Type 2, or adult diabetes, pancreas, sometimes tends to release insulin, often even at higher than
average levels, particularly at an early stage of the disease. The liver, however, develops tolerance
to the insulin effects because insulin is not adequate to fulfill the needs of the body. The insulin-
producing potential of the pancreas declines with the onset of type 2 diabetes. In children and
teenagers, type 2 diabetes was once rare but became more normal. However, it typically starts in
people older than 30 and becomes increasingly more prevalent with age. About 26% of people
aged 65 suffer from diabetes of type 2. People who live in certain origins in race and ethnicity are
at greater risk of having Type 2 diabetes: Black, Asian, American and Spanish or Latin American
origin people who live in the United States have twice or three times higher risk than white people.
Also in families, type 2 diabetes tends to occur.
The largest factor in risk for type 2 diabetes, obesity is 80 to 90% in overweight or obese patients
with this condition. Because of obesity, the obese require very large quantities of insulin to sustain
regular levels of blood glucose.
Some disorders and medicines can influence the way the body uses insulin and cause diabetes type
2.
Examples of typical conditions leading to degraded use of insulin are:
 The corticosteroid levels are high (most commonly due to use of corticosteroid drugs or
Cushing syndrome)
 Pregnancy (gestational diabetes)
In individuals with excess growth hormone production (acromegaly) and in people with some
hormone-secreting tumors, diabetes can also occur. Serious or recurring pancreatitis and any other
conditions that damage the pancreas directly can cause diabetes.

Gastrointestinal diabetes mellitus:

In general, pregnancy induces some resistance to insulin. This is termed gestational as it becomes
diabetes. The medically or late pregnancy is frequently spotted by doctors. Since blood sugars in
a woman pass through their placenta to the infant, gestational diabetes must be managed to ensure
the child's growth and development.
In 2 to 10% of births, doctors record gestational diabetes. Typically after birth it goes out.
However, up to 10% of females suffering from gestational diabetes are type 2, or even years older.
Gastric diabetes is a concern to the baby rather than to the mother. An infant may have an
extraordinary increase in weight before birth, breathing difficulties or a higher risk of diabetes and
obesity later in life. Because of too big a child, a mother may require a cesarean section or her
heart, kidneys, nerves, and eyes may be affected.

Symptoms of diabetes mellitus:

When blood glucose is dramatically increased, all kinds of diabetes may cause very similar
symptoms.
High blood glucose signs include
 Increased appetite
 Enhance urination
 Enhanced starving
As blood glucose levels spike between 160 and 180 mg/dL, glucose is overflowing into the urine
(8.9 and 10.0 mmol/L). As the glucose level in the urine raises, the kidneys excrete extra water,
which dilutes the high glucose content. Owing to the misuse of urine by the kidneys, people with
diabetes often urinate largely (polyuria). The irregular thirst caused by prolonged urination
(polydipsia).
Because extra calories in the urine are wasted, people may lose weight. People also feel overly
hungry to compensate for this.
Additional diabetes symptoms include:
 Vision blurred
 Versatility
 Vomiting
 Lower stamina during exercise
Type 1 diabetes mellitus:
Symptoms frequently occur suddenly and rapidly in people with type 1 diabetes. An acute
syndrome known as diabetic ketoacidosis will rapidly evolve, a disorder in which the body
produces excess acid. Apart from usual symptoms of diabetes, excessive thirst and urination,
nausea, vomiting, tiredness and abdominal pain are the initial symptoms of ketoacidosis, especially
in children. The respiration tends to be profound and fast when your body tries to correct acidity
of blood (see Acidosis) and the breath smells like a fruity polishing agent. Diabetic ketoacidosis
can sometimes progress very quickly into coma and death without therapy. Some people after type
1 diabetes have begun, due to a partial recovery of the secretion of insulin, have a lengthy but
transient period of almost normal glucose level.

Type 2 diabetes mellitus:

Persons with diabetes type 2 cannot have signs for years or decades previous to diagnosis. It may
be slight symptoms. Increased urination and thirst at first are mild and then intensify over the
course of weeks or months. Finally, there is a great deal of tiredness in people, a feeling of
blurriness and dehydration.
At times, blood glucose levels are abnormally low during the early stage of diabetes, also known
as hypoglycemia.
Owing to the insulin-producing aspect of type 2 diabetes people typically do not experience
ketoacidosis even though type 2 diabetes is not treated for a long time. Rarely, the levels of blood
glucose (even over 1000 mg/dL [55.5 mmol/L]) are exceptionally high. This elevated levels also
arise because of overlapping tension like an illness or the use of medications. If the level of blood
glucose is high, people will develop severe hyperglycemic conditions that can cause mental
confusion, sickness and seizures. Before such serious elevated blood glucose levels are established,
many patients with type 2 diabetes are diagnosed with regular blood glucose checks.

Complications of diabetes mellitus:

Diabetes affects blood vessels, allowing them to compress and thereby limiting blood supply.
Because blood vessels are damaged in the body, people may suffer from multiple diabetes
complications. Many structures, including the following, may be affected:

Retinopathy (eye disease):

An eye test should be carried out regularly on all patients with diabetes by an ophthalmologist (eye
specialist). Patients with documented eye disorder or signs of blurred vision in one eye or who
have blind spots may need to see their ophthalmologist more frequently.

Nephropathy (kidney disease):

The urine test should be administered periodically. Regular blood pressure controls are critical as
a slowing kidney disease involves the treatment of elevated blood pressure. On each appointment
with your healthcare provider, get your blood pressure tested. The American Diabetes Association
advises that the blood pressure for most people is below 140/90. The persistent swelling in the legs
and feet can also be a sign of kidney disease.

Neuropathy (nerve disease):

The doctor should be told about stunning or punching in your foot at your daily appointments.
Look for redness, calluses, fractures or disintegration of the skin tissue every day. Please contact
your doctor immediately if you find these signs before your regular appointments.
Other complications in the long run can include:
 Additional vision conditions, such as glaucoma and cataracts.
 Oral difficulties.
 Hypertension
 Coronary and stroke attacks.
 Issues in sexual wellbeing.

Diagnosis of diabetes mellitus:

 Blood glucose tests measurement
When individuals have an abnormally elevated blood glucose level, diagnoses are made for
diabetes. Physicians test patients with a risk but no signs of diabetes.

Measuring blood glucose:

Physicians monitor for levels of blood glucose in people with diabetes symptoms such as elevated
appetite, thirst and urination. In addition, physicians should regulate blood glucose levels in
patients with conditions such as frequent illnesses, foot ulcers and yeast infections, which can lead
to diabetes complicates.
Typically doctors use a blood test administered when people swim overnight to correctly measure
their blood glucose levels. The blood glucose levels fasting more than 125 mg/dL (6.9 mmol/L)
may be diagnosed with diabetes. Blood samples obtained after individuals have fed, though, can
be used. Some levels of glucose in the blood following eating are common, but levels should not
be too high even after a meal. The diabetes will be detected if the blood glucose level is greater
than 9 mg/dL (11.0 mmol/L), which is random (not achieved after fasting).

Hemoglobin A1C test:

The blood of hemoglobin A1C (also known as glycosylated or glycolated hemoglobin) can be also
determined by physicians in the protein. The red oxygen carriers in red blood cells is hemoglobin.
Hemoglobin when elevated blood glucose levels are introduced to blood over a period of time,
glucose binds to hemoglobin which makes hemoglobin glycosylated. The Hemoglobina A1C level
is a result of the long-term trends in blood glucose levels instead of fast fluctuations (reported as
the percentage of hemoglobin A1C). Hemoglobin A1C tests can be used to monitor for Diabetes
in approved labs (not in home or doctor's office instruments). Diabetes exists in individuals with
6.5% or higher hemoglobin A1C levels. They have prediabetes if the number is between 5.7 and
6.4.

Test of tolerance for oral glucose:

In such cases, a blood test, an oral glucose tolerance test, such as pregnant women for gestational
diabetes or elderly persons who have signs of diabetes, however, natural glucose levels, as they
fast, can be administered. It is not, though, routinely used for diabetes testing because it can be
very long.
This test takes people rapidly to detect the rapid blood glucose level by taking a blood sample and
then drink a special solution with a large, normal glucose content. During the next 2-3 hours more
blood tests are collected and examined for an excessive elevation of glucose in the blood.

Diabetes testing:
During regular physical tests, blood glucose levels are regularly tested. Regularly inspecting
glucose levels in the blood is especially important for the elderly, since diabetes in a later age is
too widespread. People can and do not know about diabetes, particularly type 2 diabetes.
Doctors do not perform regular diabetes screening tests except for patients at high risk for type 1
diabetes (such as siblings or children of people who have type 1 diabetes). Nevertheless, checks
for those who are at risk for type 2 diabetes, including those are:
 45 years of age
 Have prediabetes mellitus
 Are fat or overweight
 Have a diet sedentary
 Have elevated blood pressure and/or high cholesterol lipid disease.
 Get a heart condition
 Have a diabetic family history
 During birth, you have diabetes or a kid that was weighing more than 9 lbs.
 Have ovarian cancer polycystic
 African Americans, Hispanics, Asia-Americans, or American Indians.
Diabetes should be tested at least once every three years for patients with these risk factors. Online
risk calculators can predict diabetes risk. Physicians can assess fasting blood glucose and A1C
levels, or conduct oral glucose tolerance tests. When the outcomes of the scans are at the boundary
between usual and abnormal, at least once a year the doctors administer the tests more frequently.

Treatment for diabetes mellitus:

 Proper Diet.
 Workout
 Loss of weight
 Education
  Hormone doses with type 1 diabetes
 Diabetes type 2, sometimes with oral treatment, and often with insulin or other injection
medicine
Diet, exercise and education are the cornerstones of diabetes care and are also the initial guidelines
for individuals with moderate diabetes. For people who are overweight, weight loss is significant.
Medicines are still required for those who appear to have higher levels of blood glucose after
dietary changes, or have extremely high levels of blood glucose.
Owing to the reduction of complications if individuals with diabetes monitor their blood glucose
levels closely, the purpose of diabetes therapy is to maintain the levels of blood glucose as similar
as possible to normal.
High blood pressure and high cholesterol, which can help prevent some diabetic complications,
can also help to treat circulatory problems. In people with risk factors for heart disease, a low dose
of aspirin taken every day is advised. A statin (a drug to reduce the level of cholesterol) is offered
to all individuals with diabetes between 40 and 75 years regardless of the cholesterol level. People
less than 40 years of age or older than 75 years of age should also take statin at an increased chance
of heart disease.
People with diabetes should use a badge or sticker to hold or wear medical identification to alert
health providers of the incidence of diabetes. It is helpful. This knowledge helps healthcare
providers to immediately initiate life-saving rehabilitation, specifically in the event of psychiatric
injury or transition.
Hyperosmolar and diabetic ketoacidosis are a medical emergency, since they can cause coma and
death. Treatment with all intravenous fluids and insulin centers is close.

Goals of treatment of glucose mellitus:

Experts warn people to control their blood glucose levels
• Fasting from 80 to 130 mg/dL (4.4 to 7.2 mmol/L) (before meals)
• 2 hours after dinner less than 180 mg/dL (10.0 mmol/L)
The A1C levels of hemoglobin should be below 7%.
Since intensive therapy raises the risk for blood glucose (hypoglycemia) to be too insufficient to
meet certain aims, certain thresholds are tailored for those persons with especially unwelcome
hypoglycemia, such as seniors. Other targets are to control systolic blood pressure below 140 mm
Hg and diastolic blood tension below 90 mm Hg. Blood pressure target is less than 130/80 mm Hg
for diabetics who have heart failure or who have a high chance of heart disease.

Specific diabetes management:

Diabetes individuals benefit immensely from the knowledge of the condition, how diet and
exercise affect their levels of blood glucose and how problems can be prevented. A diabetes-
trained nurse may offer guidance about diet prevention, fitness, blood glucose regulation and drug
usage. Diabetes people should avoid smoking and only drink mild alcohol (up to one drink per day
for women and two for men).

Diet for diabetes patients:

In people with both forms of diabetes, food control is very important. Physicians prescribe a safe,
nutritious diet and healthy weight loss efforts. Diabetics may benefit from a dialogue in order to
create an optimized meal schedule with a dietitian or a diabetes instructor. Easy sugars and refined
foodstuffs must be removed, food fibres, starch rich servings and unhealthy foods must be
decreased (especially saturated fats). People who take insulin should avoid hypoglycemia from
eating long meals. While protein and fat add to a person's calories, it only influences blood glucose
levels through the amount of carbohydrates. There are also useful nutrition hints, including
ingredients, for the American Diabetes Association. Cholesterol-lowering treatments are often
important to lower the risk of heart failure, particularly though people adopt a healthy diet.
Coupled with your meals' carbohydrate count or carbohydrate exchange, people living with type1
diabetes and some people with type2 diabetes can take their dose of insulin with the carbon content
of their meal. "Counting" glucose in a meal, the amount of insulin consumed by the person prior
to eating is determined. The ratio of carbohydrates to insulin is however different, and people with
diabetes need to work closely with a dietician with experience dealing with those who are diabetes
in order to master the procedure. They need the amount of insulin they are taking with the gram of
glucose in their meals. Some researchers have proposed that the glycemic index be used to
distinguish between quickly and slowly metabolized carbohydrates (a calculation of the effects of
a food containing carbohydrate on the blood glucose level).

Workout for diabetic patients:

Workout will also help people regulate their weight and increase blood glucose levels in sufficient
doses (at least 150 minutes a week for three days). If the amount of blood glucose declines during
exercise, people need to be alert to hypoglycemic symptoms. During extended exercises, certain
people need to take a small snack, lower their insulin or both.

Loss in weight for diabetes patients:

There are many people who are overweight or obese, particularly with type 2 diabetes. Any people
with type 2 diabetes can discourage or postpone the use of medications by healthy weight. Weight
loss in these individuals is also important as overweight leads to diabetes complications. If diabetes
people have weight loss issues on their own with food, physicians may use weight loss medications
or prescribe bariatric operations (surgery to cause weight loss).

Complication Management of Diabetes:

Proper foot care and routine eye checks can help avoid or prolong the incidence of diabetes
complications. Diabetes patients are vaccinated against Streptococcus pneumonia and physicians
typically prescribe regular vaccines against flu because patients with diabetes fear influenza.
Diabetes drug treatment:
Diabetes is treated with several medications. Insulin injections for those with type 1 diabetes are
needed for lower levels of blood glucose. Many patients suffering from type 2 diabetes use oral
medicine to suppress blood glucose but others may use insulin and other injectable medicines.

Diabetes treatment management:

Treatment for diabetes is a vital feature of blood glucose control. The knowledge required in order
to make necessary improvements in medications, diet, and workout regimens is given by regular
blood glucose screening. The risk of waiting for low to high level of blood glucose signs is
potentially dangerous to regulate blood glucose.
Much has modified the levels of blood glucose:
 Diet
 workout
 Tension
 Illness
 Drugs.
 Daytime
After people ingest foods that are not found to be rich in carbohydrates, blood glucose levels could
increase. Emotional tension, infection, and certain medications aim to raise blood glucose. In
certain people the levels of blood glucose rise early in the morning due to natural hormone release
(crop hormone, cortisol), a reaction known as the morning phenomena. If the body frees some
hormones in reaction to low blood glucose level, blood glucose can shoot too high (Somogyi
effect). The amount of glucose in the blood is induced by exercise will decrease.

Blood glycemia screening:

The levels of blood glucose at home or anywhere can accurately be assessed. The most widely
used blood glucose testing is a fingerstick glucose test. Most blood glucose measurement
instruments (glucose meters) are based on a drop in blood collected with a small lancet on the tip
of the finger. The lancet has a tiny needle that can quickly and fastly pierce the tissue, which can
either be tossed into the finger or inserted in a jump-in unit. The pricking creates only mild pain
for most people. A drop of blood is then placed on a strip of reagent. There are substances in the
strip that differ according to the amount of glucose. The glucose meter reads and comments on the
changes in the test strip. Certain instruments facilitate blood sampling from other places, including
thumb, wrist, upper arm, thigh or veal. Household glucose meters are less than a card deck.
Continuous CGM systems use a tiny glucose monitor beneath the skin. CGM systems have the
same effect. A few minutes, the sensor monitors blood glucose. There are two distinct types of
CGMs:
 Skilled Workers.
 Personal
CGMs gather information on constant blood glucose over a span of time (72 hours up to 14 days).
Providers in health services use this detail to make decisions for therapy. The CGMs do not provide
the individual with diabetes with details. The user uses personal CGMs and supplies blood glucose
information in the real time on a tiny handheld monitor or on an attached smartphone. When the
blood glucose levels fall too low and rise too high, warnings on the CGM system will be set off,
so that people can easily sense alarming increases in blood glucose.
Previously, fingerstick glucose checking involved regular CGMs. Its findings were not that
accurate so that people had to still review the readings on their CGM before measuring an insulin
dose (for example, before meals or to correct a high blood sugar). Yet new advancements in
technology have boosted CGMs and promise to continue in the near future. They can now be worn
for up to 14 days, mostly not calibrated, without fingerstick glucose confirmation and can be used
for insulin dosing. Finally, the CGM machine now includes insulin pumps, either to interrupt the
supply of insulin as blood glucose rises, or to insulin regularly. (Suspended Threshold) or hybrid
closed loop system.
In some cases, CGM systems are especially useful in people with type 1 diabetes who experience
regular, sudden blood glucose changes (particularly when glucose levels often go very low) that
are hard to find with fingerstick tests. Many diabetic patients should keep track of their level of
blood glucose and consult their doctor or nurse on the modification of the insulin or oral
antihyperglycemic. A lot of people will learn how to self-adjust the insulin dosage. Any patients
with moderate or early type 2, well regulated diabetes with one or two medications may be able to
track glucose levels in their fingerstick relatively rare.
While urine may also be screened for glucose, urine testing is not an efficient method of measuring
or adapting treatment. Urine checks can be tricky because the amount of glucose in the urine may
not indicate the blood glucose content that is actually present. Without any modifications to the
amount of glucose in the urine, blood glucose levels may become extremely low or relatively
elevated.

Hemoglobin A1C test:

A blood test known as hemoglobin A1C will track the treatment. The hemoglobin, a protein that
contains oxidation in the blood, changes when blood glucose levels are elevated. Such differences
are directly proportionate over a prolonged time of blood glucose levels. The larger the level of
hemoglobin A1C, the higher the level of glucose. Therefore the hemoglobin A1C test shows that
blood glucose level was regulated over the past few months, as opposed to blood glucose
measurement, which exposes the level at any single moment.
Diabetes patients target for less than 7 percent hemoglobin A1C. It's hard to reach this level, but
the lower the A1C hemoglobin, the less likely problems are to arise. The doctors can prescribe for
some patients, depending on their individual health status, a significantly greater or lower goal.
However, levels above 9% are poorly managed and levels above 12% are poorly monitored. Some
diabetic doctors consider testing hemoglobin A1C every 3 to 6 months.
Fructosamine:
The amino acid fructosamine, which is glucose-linked, is often beneficial for measuring the
regulation of blood glucose for a number of weeks and usually used in people who have irregular
levels of hemoglobin where the A1C findings are unsustainable.

Transplantation of the pancreas:

People with type 1 diabetes can be transplanted from a donor pancreas from an entire pancreas or
only from insulin generating cells. This treatment will retain regular levels of glucose for people
with type 1 diabetes mellitus. But because immunosuppressant must be used to keep the body from
rejecting cells transplanted, pancreatic transplantation is generally only performed in individuals
with severe diabetic problems or obtaining other transplanted organs such as the kidney and who
may need immunosuppressive medication anyway.

Refrences:
https://www.msdmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-
and-disorders-of-blood-sugar-metabolism/diabetes-mellitus-dm
https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview
https://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus
https://www.healthline.com/health/diabetes