Diabetes Mellitus and Hypoglycemia

Disease classification

Diabetes Mellitus is a group of metabolic diseases, diabetes mellitus happen when body does not capable to use insulin efficiently or the insulin is not produce more enough in a person blood. According to Kowalczyk N (2013), this syndrome is related with chronic hyperglycemia in combination with glucose intolerance and alterations in the metabolism of carbohydrates, fats and proteins. There is certain test to indicate the presence of this syndrome. Usually patient undergo blood glucose levels test, before the patient take this test, they need to fast 12.00 mid night, the normal blood glucose levels range from 70 to 120 mg/dL, but if the blood glucose levels is greater than 126 mg/dL it is show that patient might have Diabetes Mellitus syndrome.

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According to Kishore,P (2013), Pancreas released a hormone called Insulin which controls the amount of glucose in the blood. The pancreas is stimulated by glucose in the bloodstream. Insulin allows glucose to move from the blood into the cells. Inside the cells glucose can transformed to energy, which is used instantly or the glucose is stored as fat glycogen until it is required.

Insulin production is related with the levels of glucose, when the glucose in blood is high the insulin production increases, once the levels of glucose in the blood come back to normal, insulin production will decreases, normal blood glucose levels for healthy people is about 70 to 120 miligrams per deciliter (mg/dL).

Symptoms and complications of diabetes happen when the body does not generate enough insulin to move the glucose into the cells or if the cells stop responding normally to insulin, the consequential high levels of glucose in the blood and the insufficient amount of glucose in the cells together produce the symptoms and complications of diabetes.

There were three types of diabetes mellitus, Type 1, Type 2 and Gestational Diabetes

Diabetes Mellitus Type 1

Diabetes mellitus type 1 is a genetic disorder and can be classify as an autoimmune disease, this disease also know as juvenile diabetes or insulin dependent diabetes, according to Kowalczyk N (2013) diabetes mellitus type 1 is usually diagnosed in children and young adults, these young individuas produce little to no insulin because of an autoimmune disease of the pancreatic B cells and are insulin dependent from a young age. Type 1 diabetes accounts for 5 to 10 percent of cases of diabetes worldwide which is stated by The Health on the Net (HON) (2014).

Diabetes Mellitus Type 2

Diabetes mellitus type 2 is categorized as insulin resistant diabetes with an insufficient secretion of insulin. Type 2 dibetes mellitus is more common than type 1 and the risk of developing this type increases with age, especially after the age of 40 years. It is also more prevalent in women than in men which are stated by Kowalczyk N (2013). According to Wisse B (2014) type 2 diabetes happen when insulin is not been respond correctly by fat, liver and muscle cells, this is called insulin resistance, therefore blood sugar or glucose does not get into these cells to be stored for energy. When sugar cannot go into cells, a high level of sugar builds up in the blood. This is called hyperglycemia

Gestational Diabetes

This type affects females during pregnancy. Gestational diabetes is caused when insulin receptors do not function properly, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in increasingly rising levels of glucose. Undiagnosed or uncontrolled gestational diabetes can elevate the risk of problems during childbirth. The baby may be bigger than he/she should be.

Disease process

Etiology

Generally the cause of type 1 diabetes mellitus is unknown. A number of descriptive theories have been put forward, and the cause may be one or more. One of the causes is autoimmune disease. This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue, an infection causes the body to mistakenly attack the cells in the pancreas that make insulin in which destruction or damaging of the beta cells, beta cells is special cells that produced insulin hormone in the pancreas. According to Wisse B (2014) Insulin is needed to move glucose into cells. Inside the cells, glucose is stored and later used for energy. Without sufficient insulin, glucose builds up in the bloodstream instead of going into the cells. This increase glucose in the blood is called hyperglycemia, therefore body is unable to use the glucose for energy.

Genetics is one of the causes, according to American Diabetes Association (2014) if you are a man with type 1 diabetes; the chances of your child developing diabetes are 1 in 17. If you are a woman with type 1 diabetes and your child was born before you were 25, your child’s risk is 1 in 25, if your child was born after you turned 25, your child’s risk is 1 in 100. Your child’s risk is doubled if you developed diabetes before age 11. If both you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1 in 4.

Another cause of Type 1 diabetes mellitus is viruses that might promote autoimmunity. According to American Diabetes Association (2014) A significant number of viruses have been associated with type 1 diabetes, including enteroviruses such as Coxsackievirus B , but also rotavirus, mumps virus, and cytomegalovirus . Rubella virus has been suggested to cause type 1 diabetes, but so far only congenital rubella syndrome has convincingly been linked with the disease. The prime viral candidates for causing type 1 diabetes in humans are enteroviruses.

Type 2 diabetes mellitus generally causes from the pancreas does not make sufficient insulin or the body is unable to use the insulin that is produced, as we know insulin resistance. According to Khardori. R (2014) Type 2 diabetes mellitus appears to involve complex relations between environmental and genetic factors, environmental factor is including lifestyle for example (excessive caloric intake, inadequate caloric expenditure, obesity), high body mass index (BMI) increases risk for diabetes. In addition, an in utero environment consequential in low birth weight may influence some individuals to develop type 2 diabetes mellitus. Infant weight velocity has a small, indirect effect on adult insulin resistance. In addition about 90% of obese patient develop type 2 dibetes mellitus.

According to Winter S (2014). Second diabetes mellitus type 2 causes is by genetic, diabetes mellitus type 2 strongly has a hereditary component. However not everyone who carries a mutation will get diabetes.

Gestational Diabetes type affects females during pregnancy. The cause’s gestational diabetes according to Mayo Clinic (2014) during pregnancy, the placenta, which connects your baby to your blood supply, produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar. As your baby grows, the placenta produces more and more insulin-blocking hormones. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of your baby. Gestational diabetes usually develops during the trimester.

Pathogenesis

According to Nucleus Medical Media (2014) Pathogenesis for diabetes mellitus type 1 is summaries that beta cells in the pancreas lose their ability to produce insulin, resulting in high blood glucose levels.In type 1 diabetes, your immune system, specifically your white blood cells, mistake your pancreatic beta cells for foreign invaders.In an autoimmune response, your white blood cells secrete auto antibodies that destroy your own beta cells.As a result, your pancreas produces little or no insulin.Without insulin, glucose cannot get into your cells, so they are starved for the calories they should be receiving from glucose.In addition, the glucose level builds up in your bloodstream, resulting in a condition called hyperglycemia.

Diabetes mellitus type 2 usualy caused by obesity and physical inactivity, Diabetes mellitus type 2 is categorized as insulin resistant diabetes, it commonly referred to as the metabolic syndrome according to Hannele Yki-Järvinen (2011) Insulin resistance can be defined as the inability of insulin to produce its usual biological actions at circulating concentrations that are effective in normal subjects. In addition pathogenesis diabetes mellitus type 2 happen when beta cells of the pancreas are no longer capable to meet the body’s requirement for insulin. Hyperglycaemia therefore develops earlier in the course of beta cell failure, and in association with a greater beta cell mass, in insulin-resistant compared with insulin-sensitive individuals. The relative importance of reduced secretion of insulin and increased demand insulin resistance ranges along a range from one individual or population to the next.

Pathogenesis of gestational diabetes. According to Manda A, when pregnant, human body will produce several hormones. Some pregnancy hormones disrupt the usual function of insulin by interfering cell signalling pathways. In the bloodstream insulin will stimulates fat tissue and skeletal muscle cells to absorb glucose. Because of presence insulin resistance the process uptake of blood glucose is prevented as a result the blood sugar level remains high. In the pregnancy glucose usually present in the blood stream in the placenta through the Glucose transporter 1 (GLU1) carrier to reach the fetus. If not been treated, amount of insulin develop by the fetus will increase, then the baby born larger body than is normal. After baby born the excess of glucose through placenta is done. However, the insulin production still increased it may lead to low blood glucose levels or hypoglycaemia.

Manifestation

According to Kishore P (2013), The types of diabetes have very related symptoms. The first symptoms are related to the direct effects of high blood glucose levels. When the blood glucose level rises above 160 to 180 mg/dL, glucose spills into the urine. When the level of glucose in the urine rises even higher, the kidneys excrete additional water to dilute the large amount of glucose. Because the kidneys produce excessive urine, people with diabetes urinate large volumes frequently. The excessive urination creates abnormal thirst. Because excessive calories are lost in the urine, people may lose weight. To compensate, people often feel excessively hungry. Other symptoms include blurred vision, drowsiness, nausea, and decreased endurance during exercise.

Significant Lab Tests

There are severe test can done to demonstrate diabetes mellitus (DM). According to Mayo Clinic (2014), the common test done is Glycated hemoglobin (A1C). Test this blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal. However If the A1C test results aren’t consistent, the test isn’t available, or if you have certain conditions that can make the A1C test inaccurate — such as if you’re pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the next tests to diagnose diabetes such as.

Random blood sugar test.

Fasting blood sugar test.

Oral glucose tolerance test