Definition

Diabetes = “excessive urine‟   Mellitus = “honey sweet‟

DM is a group of disorders characterised by hyperglycaemia

▫ Hyper = too much
▫ Glycaemia = “sugar in the blood‟

• DM is a disorder of metabolism
• Most of the food people eat is broken down into 
glucose, the form of sugar in the blood
• After digestion, glucose passes into the 
bloodstream, where it is used by cells for growth 
and energy
• Insulin is a hormone produced by the pancreas, 
a large gland behind the stomach
• For glucose to get into cells, insulin must be 
present

• When people eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells
• In DM, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced
• Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine

Types of DM-T1 and T2

T1DM is caused by the destruction or dysfunction of insulin-producing beta cells by the cells of the immune system 


In T2DM, beta cells decline gradually over time, and insulin resistance plays a role in the disease – More common (90-95%) of all cases (US/UK)

Pathophysiology of T2DM

Risk factors

• Obesity
• Family history
• Ethnicity
• Gestational DM
• Increasing age
• Sedentary lifestyle
• (BP and high cholesterol)

Obesity & T2 DM

 • Up to 80% of all cases of T2DM would not exist if there were no obesity

• Obesity is associated with insulin resistance

 -Blood sugar levels often normalise with weight loss

▫ Even 5-10% reduction in weight has a significant effect

• Note that it is possible for T2DM to exist in normal weight individuals, but this is rare

Signs and Symptoms

The classic triad-

• Polydipsia = excessive thirst
• Polyuria = excessive urination • Polyphagia = excessive hunger

1. None

2. Polydipsia

3. Polyuria

4. Polyphagia

5. Fatigue

6. Recent weight loss

7. Recurrent infections

8. Others, depending on the 
organ/s involved

In addition to above, commonly seen symptoms by doctors:  Obesity
, Evidence of micro- or macrovascular complications , Evidence of neuropathy, Recurrent infections (e.g. thrush)

How is it diagnosed?

• History and examination
• BSL
• Fasting blood glucose
• Glucose tolerance test (GTT)
• Urinalysis
• HBA1C
• Autoimmune markers

Underdiagnosis

DM may be present for years in the absence of symptoms or signs. Up to 50% of diabetes cases goes undiagnosed, especially in developing countries

In the period prior to diagnosis, significant and potentially irreversible end-organ damage may occur. Prevention and early recognition are important to minimise the impact of complications

 Prevention

Eat well : Around 80% of people with Type 2 diabetes are overweight when diagnosed. Eating a healthy diet that is low in salt, sugar and fat with lots of fruit and veg is a simple way to prevent diabetes.

Be physically active: Apart from making you feel good, getting regular exercise can reduce your risk of developing Type 2 diabetes by up to 64%. 

Stop smoking: Smoking’s not just bad for your lungs. It can also lead to high blood pressure which causes heart disease, and this is a major risk factor for developing Type 2 diabetes.  The risk of dying from heart attack is 5 times higher in folks with diabetes.

Watch your waist: Putting on the pounds round your midriff increases your risk. If you’re a man and your waist is 37 inches or more, or you’re a woman and your waist is over 31.5 inches, then you could be at risk of Type 2 diabetes.

Get checked out: Type 2 diabetes can lay undetected for up to 12 years, which means that 50% of people already have serious complications by the time they’re diagnosed. If you have a large waist, are over 40 and a close member of your family has diabetes, you should get a diabetes test.

Treatment

I have deliberately omitted the section on treatment. I am not qualified to dispense medical treatment advice, kindly consult your doctor. Kindly note that none of the above constitutes medical advice; it is only shared as public health information. Always speak to a qualified medical practitioner