INTRODUCTION

Diabetes mellitus (DM), commonly referred to as diabetes, is a

group of metabolic disorders in which there are high blood
sugar levels over a prolonged period. Symptoms of high blood sugar
include frequent urination, increased thirst, and increased hunger. If
left untreated, diabetes can cause many
complications. Acute complications can include diabetic ketoacidosis
, hyperosmolar hyperglycemic state, or death. Serious long-term
complications include cardiovascular disease. stroke. chronic kidney
disease. foot ulcers. and damage to the eyes.

Specialty Endocrinology

Symptoms Frequent urination, increased thirst, increased hunger

Complications Diabetic ketoacidosis , nonketotic hyperosmolar coma, heart

disease, stroke, chronic kidney failure, foot ulcers

Diagnostic High blood sugar

method

Treatment Healthy diet, physical exercise

Medication Insulin, metformin

Frequency 415 million (8.5%)

Deaths 1.5-5.0 million per year

 TYPES OF DIABETES:-
Diabetes is due to either the pancreas not producing enough insulin or
the cells of the body not responding properly to the insulin
produced. There are three main types of diabetes mellitus:

• Type 1 OM results from the pancreas's failure to produce enough

insulin. This form was previously referred to as "insulin-dependent
diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is
unknown.
• Type 2 OM begins with insulin resistance, a condition in which cells
fail to respond to insulin properly. As the disease progresses a lack of
insulin may also develop. This form was previously referred to as
"non insulin-dependent diabetes mellitus" (NI DOM) or "adult-onset
diabetes". The most common cause is excessive bodyweight and not
enough exercise.
• Gestational diabetes is the third main form and occurs when pregnant
women without a previous history of diabetes develop high blood
sugar levels.
Comparison of type 1 and 2 diabetes

Feature Type 1 diabetes Type 2 diabetes

Onset Sudden Gradual

Age at onset Mostly in children Mostly in adults

Body size Thin or normal Often obese

Ketoacidosis Common Rare

Autoantibodies Usually present Absent

Normal, decreased
Endogenous insulin Low or absent
or increased

Concorda nee
50% 90%
in identical twins

Prevalence -10% -90%

 CAUSES
• Type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta

cells of the pancreatic islets, leading to insulin deficiency. This type can be
further classified as immune-mediated or idiopathic. The majority of type 1
diabetes is of the immune-mediated nature, in which a T cell-
mediated autoimmune attack leads to the loss of beta cells and thus insulin. It
causes approximately 10% of diabetes mellitus cases in North America and
Europe. Most affected people are otherwise healthy and of a healthy weight
when onset occurs. Sensitivity and responsiveness to insulin are usually
normal, especially in the early stages. Type 1 diabetes can affect children or
adults, but was traditionally termed "juvenile diabetes" because a majority of
these diabetes cases were in children.

• Type 2
Type 2 DM is primarily due to lifestyle factors and genetics. A number of
lifestyle factors are known to be important to the development of type 2 DM,
including obesity (defined by a body mass index of greater than 30), lack of
physical activity, poor diet, stress, and urbanization. Excess body fat is
associated with 30% of cases in those of Chinese and Japanese descent, 60-
80% of cases in those of European and African descent, and 100% of Pima
Indians and Pacific Islanders. Even those who are not obese often have a
high waist-hip ratio.

• Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 DM in several respects,

involving a combination of relatively inadequate insulin secretion and
responsiveness. It occurs in about 2-10% of all pregnancies and may improve
or disappear after delivery.
 DIAGNOSIS
Diabetes mellitus is characterized by recurrent or persistent high blood sugar,
and is diagnosed by demonstrating any one of the following:

• Fasting plasma glucose level~ 7.0 mmol/1 (126 mg/di)

• Plasma glucose~ 11.1 mmol/1 (200 mg/di) two hours after a 75 g oral
glucose load as in a glucose tolerance test
• Symptoms of high blood sugar and casual plasma glucose~ 11.1 mmol/1
(200 mg/di)
• Glycated hemoglobin (HbA1c) 48 mmol/mol (~ 6.5 DCCT %).
A positive result, in the absence of unequivocal high blood sugar, should be
confirmed by a repeat of any of the above methods on a different day. It is
preferable to measure a fasting glucose level because of the ease of
measurement and the considerable time commitment of formal glucose
tolerance testing, which takes two hours to complete and offers no prognostic
advantage over the fasting test. According to the current definition, two fasting
glucose measurements above 126 mg/di (7.0 mmol/1) is considered diagnostic
for diabetes mellitus.

WHO diabetes diagnostic criteria

Condition 2 hour glucose Fasting glucose HbA1,

mmol/
Unit mmol/1 (mg/di) mmol/1 (mg/di) DCCT%
mol

Normal <7.8 (<140) <6.1 {<110) <42 <6.0

~6.1{~110) &
lm11aired fasting glllcaemia <7.8 (<140) 42-46 6.0-6.4
<7.0(<126)

lml!l!ired glucose tolerance ~7.8 {~140) <7.0 {<126) 42-46 6.0-6.4

Diabetes mellitus ~11.1 (~200) ~7.0 (~126) ~48 ~6.5

 PREVENTION
There is no known preventive measure for type 1 diabetes.
Type 2 diabetes- which accounts for 85-90% of all cases -
can often be prevented or delayed by maintaining a normal
body weight, engaging in physical activity, and consuming a
healthful diet. Higher levels of physical activity (more than 90
minutes per day) reduce the risk of diabetes by 28%.Dietary
changes known to be effective in helpingto prevent diabetes
include maintaining a diet rich in whole grains and fiber, and
choosing good fats, such as the polyunsaturated fats found in
nuts, vegetable oils, and fish. Limiting sugary beverages and
eating less red meat and other sources of saturated fat can
also help prevent diabetes. Tobacco smoking is also
associated with an increased risk of diabetes and its
complications, so smoking cessation can be an important
preventive measure as well.

The relationship between type 2 diabetes and the main

modifiable risk factors (excess weight, unhealthy diet,
physical inactivity and tobacco use) is similar in all regions of
the world. There is growing evidence that the underlying
determinants of diabetes are a reflection of the major forces
driving social, economic and cultural change: globalization,
urbanization, population aging, and the general health
policy environment.
 MANAGEMENT
• LIFESTYLE

People with diabetes can benefit from education about the disease
and treatment, good nutrition to achieve a normal body weight, and
exercise, with the goal of keeping both short-term and long-term
blood glucose levels within acceptable bounds

• MEDICATIONS

Medications used to treat diabetes do so by lowering blood sugar

levels. There are a number of different classes of anti-diabetic
medications. Some are available by mouth, such as metformin.
while others are only available by injection such as GLP-1 agonists.
Type 1 diabetes can only be treated with insulin, typically with a
combination of regular and NPH insulin. or synthetic insulin analogs.

• SURGERY

A pancreas transplant is occasionally considered for people with

type 1 diabetes who have severe complications of their disease,
including end stage kidney disease requiring kidney transplantation.

• SUPPORT

In countries using a general practitioner system, such as the United

Kingdom, care may take place mainly outside hospitals, with
hospital-based specialist care used only in case of complications,
difficult blood sugar control, or research projects. In other
circumstances, general practitioners and specialists share care in a
team approach. Home telehealth support can be an effective
management technique.
 YOGA CURES DIABETES

Yoga Asana useful for Diabetes cure are those which bring about a
stretch and twist in lower thoracic and upper lumbar region, where
pancreas is located. These yoga asana are believed to increase the
blood supply, massage the organs, activate its cells and thereby
cause an increase in secretion of insulin; reducing high blood sugar.

• Yoga asana regenerates/rejuvenates pancreatic cells by abdominal

stretching; also by enhancing enzymatic process it may increase
utilization and metabolism of glucose in peripheral tissues.
• Yoga Asana can cause muscular relaxation, enhance muscular
development and improve circulation to muscles; all of these
might enhance insulin receptor expression on muscles and causes
increase in glucose uptake by muscles and thus reducing blood
sugar.
• It has been seen that various yoga postures can improve
sensitivity of b-cells of the pancreas to glucose signal and also
improve insulin sensitivity. This can result in better glucose uptake
and reduction of blood sugar.
• Certain Yoga Asana can directly stimulate pancreas by enhancing
circulation in the meridian of pancreas and rejuvenates its
capacity to produce insulin.
• Evidence suggests that regular yoga practice can significant reduce
body weight, which is particularly important to keep diabetes
under check.
• Symptoms of diabetes can be worsened by increase in blood
pressure. Yoga Asana like corpse pose, bridge pose child pose and
yoga nidra has been seen beneficial in controlling hypertension.
 CONCLUSION: CARE AND
PREVENTION

1. Plan what you eat and follow a balanced meal plan. See your
dietitian at least once a year.

2. Exercise at least five times a week for 30 minutes each session.

Talk to your doctor before starting any exercise program. Tell your
doctor what kind of exercise you want to do so adjustments can be
made to your medicine schedule or meal plan, if necessary.

3. Follow your medicine schedule as prescribed by your doc tor.

4. Know what medicines (brand and generic names) you are taking
and how they work. Keep a list of your medicines with you at all
times.

5. Test your blood glucose regularly, as recommended by your health

care provider. Test your blood glucose more often when you're sick.

6. Try to continuously keep your blood glucose level at the

recommended range. If your blood glucose is less than 70 mg/di and
you have more than one unexplained low blood glucose reaction a
week, call your doctor. If your blood glucose is greater than 160
mg/di for more than a week or if you have two consecutive readings
greater than 300 mg/di, call your doctor.

7. Contact your doctor when your blood glucose is over 300 mg/di.
Test your urine for ketones if recommended by your doctor.
8. Record your blood glucose and urine ketone test results in a
record keeping log. Bring your log book with you to all of your
doctor's visits.

9. Keep your scheduled appointments with your health care

providers. See your doctor at least every three to four months for
regular check -ups if you are treated with insulin. See your doctor
every four to six months if you are treated with other diabetes
medicines or if you are managing diabetes with diet and exercise
alone.

More frequent visits might be necessary if your blood glucose is not

controlled or if complications of diabetes are progressing. Make sure
your health care provider checks your blood pressure and weight and
examines your feet and insulin injection sites.

10. Have a glycosylated hemoglobin test (HbAlc) at least two times a

year or more frequently as recommended by your doctor.

11. Have an eye exam (including a retinopathy screening test) and

urinalysis test once a year, or as recommended by your doctor. (Your
doctor might request that you have these tests more frequently.)

12. Have your cholesterol and triglyceride levels checked (lipid profile
test) once a year.

13. Have a dental exam every six months.

14. If you have any signs of infection, call your doctor or health care
provider.

15. DO NOT SMOKE.

 BIBLOGRAPHY
• N.C.E.R.T. CLASS XII- BIOLOGY textbook.
• https://en.wikipedia.org/wiki/Diabetes mellitus
• https://www.mokshamantra.com/yoga-for-
diabetes-high-blood-sugar
• http://www.alamy.com/stock-photo-diabetes-
mellitus-diabetic-high-blood-sugar-signs-and-
symptoms-stick-89511273.html
• http://www.who.int/diabetes/en/
• http://ndep.nih.gov