Diabetes mellitus facts

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Diabetes mellitus (DM)

Type 1 diabetes is characterized by a lack of insulin production and type 2 diabetes results from the body’s ineffective use of insulin or insuline resistance.

Type 2 diabetes is much more common than type 1 diabetes, and accounts for around 90% of all diabetes worldwide. Most common cause of death in DM is heart diseases or kidney failure.

Sign and symptom:-3Ps:- polyurea (frequent night micturition) ,polyphagia,polydypsia .

Complication related to DM:- OPHTHALMOLOGIC :- blindness is primarily due to diabetic retinopathy(nonproliferative to proliferative ) and macular edema. Appearance of neovascularisation in response to retinal ischemia is the hallmark of proliferative diabetic retinopathy.

RENAL:- microalbuminuria to macroalbuminuria • Microalbuminuria: 30 to 300 mg/day • Macroalbuminuria: >300 mg/day The earliest sign of diabetic kidney disease is microalbuminuria.
NERVOUS SYSTEM:- The most common form of diabetic neuropathy is distal symmetric polyneuropathy. Pain typically involve the lower extremities and it usually present at rest and worse at night . as the dz progress pain subside not sensory deficit persist. For mononeuropathy CN3 (occulomotor is most commonly involved results diplopia, ptosis.) Hyperhidrosis of the upper extrimities and anhidrosis of the lower extrimities result from sympathetic dysfunction . Anhidrosis of the feet can promote dry skin with cracking which increase the risk of foot ulcer.

GIT/ GENITOURINARY :- Most prominent GIT symptoms are delayed gastric emptying (gastroparesis) it may present with anorexia ,nausea ,vomiting ,early satiety and abdominal bloating. and altered small and large bowel motility (constipation or diarrhea). Nocturnal diarrhea alternate with constipation is a feature of DM related GI autonomic neuropathy. Erectile dysfunction and retrograde ejaculation (entry of semen into bladder instead of going out during ejaculation) are very common so it may be the earliest sign of diabetic neuropathy.

CARDIOVASCULAR:- Absence of chest pain (silent ischemia) is common in DM It is the worst risk factor of coronary heart dz BP goal is <130/80 mmHg. 

LOWER EXTREMITY :- It is the leading cause of nontraumatic lower extremity amputation. Foot ulcer and infection are the major source of morbidity in DM Foot ulcer :-Most common site is great toe or MTP(metatarsophalyngeal  area.)plantar surface of foot.:

DERMATOLOGICAL- Most common skin manifestation of DM are protracted wound healing and skin ulceration.:

INFECTION – greater frequency and severity of infection because of decreased cell mediate immunity and phagocytic function.

Treatment:- Drug of choice in type2 DM:- metformin Drug of choice in type1 DM:-insuline Drug of choice in Hypertension with DM:-ACE inhibitor. Drug of choice dyslipidemia in DM:-statin Low dose aspirine for prophylaxis of CHD. •Proliferative retinopathy (PR): first line therapy is laser retinal photocoagulation. If unsuccessful, perform vitrectomy. PR with macular edema: consider intravitreal steroids and subcutaneous VEGF inhibitors as adjuncts. When to start screening for:- • Nephropathy:- Type 1 DM: 5 years after diagnosis. Type 2 DM: Soon after diagnosis • Retinopathy:- Type 1 DM: 3–5 years after diagnosis Type 2 DM: Soon after diagnosis Screening interval :- annually

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