• Who are at Risk?
    • Diabetes Mellitus is a group of metabolic disorders leading to defects in Insulin Secretion and/or Insulin action leading to high blood sugar levels and other Systemic and Metabolic changes(Including Proteins and Fat metabolism).
    • Almost 370 million people worldwide have Diabetes Mellitus in various stages.
    • In India, there are approximately 65 million Diabetic patients (second only to China).
    • Almost every living being is at risk of contracting Diabetes Mellitus.
    • Family history of Diabetes (First degree relative) :

      1. No Diabetic parent : Risk is 14%

      2. One Diabetic Parent : Risk is 29.2%.

      3. Father having Diabetes : 20 times more risk than the General population.

      4. Mother having Diabetes : 7 times more risk than the General population.

      5. If both parents are Diabetic then the risk of acquiring Diabetes is about 40%.

    • Indian Ethnicity.
    • Urban more than rural.
    • Early exposure to cow's milk protein (Absence of Breast feeding in infancy).
    • Children kept away from socialization and mixing with other people.
    • Patients of Polycystic Ovarian Syndrome.
    • Low Birth weight babies.
    • Obesity.
    • Sedentary life style people.
    • Increased waist circumference.
    • Females on long term Oral Contraceptive Therapy.
    • Smokers
    • Alcoholics
  • Symptoms of Diabetes Mellitus
    • Involuntary weight loss.
    • Loss of Muscle mass.
    • Excessive thirst (Polydipsia)
    • Excessive Hunger (Polyphagia)
    • Excessive urination (Polyuria)
    • Unexplained weight gain (Diabetes Mellitus type 2 ; Insulin Resistance Syndrome)
    • Sexual Dysfunction (Low Libido, Erectile Dysfunction , Anorgasmia)
    • Unexplained Infertility
    • Abortion, Miscarriage, Stillbirth
    • Polyhydramnios during pregnancy
    • Repeated Vaginal and Penile infections (Candida)
    • Repeated Urinary Infections
    • Skin Changes (Hyperpigmentation, Skin thickening/Thinning, Premature Greying of hairs, Dermatitis, Eczema, Repetitive fungal infections etc.)
    • Non Healing wounds/Ulcers
    • Unexplained Fatigue, Weakness, Lethargy
    • Unexplained Mood Changes
    • Unexplained Irritability
    • Unexplained Bowel Complains (Constipation/Diarrhoea)
    • Unexplained Abnormal Sweating pattern
    • Unexplained Giddiness while changing posture
    • High Blood Pressure OR Low Blood Pressure
    • Changes in Vision (Refractory Errors, Cataract , Glaucoma , Retinal Changes etc.)
    • Abnormal sensations like Tingling, Numbness, paresthesia, loss of sensations.
    • Repeated Dental and Gum infections

    Following Incidental Investigations/ Imaging Findings also call for Diabetes Evaluation :

    • Hyperlipidemia (High Cholesterol , Triglycerides, LDL)
    • High Random Blood Sugar levels
    • Incidental finding of Abnormal ECG and Stress Test
    • Abnormal findings in Fundoscopy and other ophthalmic examination
    • Abnormal findings in Audiometry
    • Abnormal Nerve Conduction studies and Electromyography
    • Abnormal Kidney function test (Including Creatinine)
    • Abnormal Urinary analysis (Sugar/Ketones/Proteins/Bacteria/Pus Cells in Urine)
  • Causes of Diabetes Mellitus
    • Environmental
    • Genetic
    • Hereditary
    • Autoimmune
    • Pancreatitis
    • Obesity
    • Sedentary Life style/Lack of Physical Exercise
    • High Carbohydrate / Fat intake in diet
    • Refined Sugar Intake
    • Oxidative Damage
    • Inflammation
    • Infections like Rubella, CMV, Coxsachie Virus etc.
    • Other Endocrine diseases likePCOD, Cushing's disease,Acromegaly,Hyperthyroidism etc.
    • Stress
    • Medicines Induced like Niacin,Glucocorticoids, OCP, Growth hormone, Thiazides, Thyroid hormones, Phenytoin etc.
    • Addictions/Substance Abuse like Alcohol, Smoking, Neuroexciting drugs etc.
    • Tumours
    • Toxins
  • Types of Diabetes Mellitus
    • Diabetes Mellitus Type 1
    • Diabetes Mellitus Type 2
    • Insulin Resistance Syndrome
    • Gestational Diabetes
    • Others (Genetic, Drug induced , Infections, Endocrinopathies etc)
  • Complications of Diabetes

    "Once you are diagnosed to have Diabetes Mellitus, your risk of getting Cardio Vascular (Heart) complications are equal to any patient who has already had a heart attack"

    Almost all the systems of the body can be affected adversely by Diabetes Mellitus :

    • Atherosclerosis
    • Hypertension
    • Obesity (DM Type II)
    • Cachexia (DM Type I)
    • Ischemic Heart Disease
    • Cardiomyopathy
    • Pericarditis
    • Pericardial Effusion
    • Neuropathy
    • Myopathy
    • Non healing ulcers/ Diabetic Foot
    • Autonomic Dysfunction (Postural hypotension, Erectile Dysfunction, Premature Ejaculation, Bladder and Bowel disturbances, Abnormal sweating, Giddiness, Dizziness, Fainting, Syncope etc.)
    • Mood and Memory Disturbances
    • Hypoglycemia leading to convulsion/Coma.
    • Diabetes Keto acidosis
    • Hyper osmolar Coma
    • Electrolyte imbalances leading to Seizures, Convulsions, Unconsciousness.
    • Nephropathy leading to Kidney Failure/End Stage Renal Disease.
    • Ophthalmic Complications (Cataract, Glaucoma, Retinopathy)
    • Erectile Dysfunction , Impotence, Infertility
    • Abortion, Miscarriage, Stillbirth
    • Polycystic Ovarian Syndrome
    • Macrosomia and other birth defects in newborn
    • Premature Ovarian Failure
    • Dermatological Complications (Acantosis Nigricans, Hirsutism , Dermatitis, Eczema, Ulcers, Alopecia etc)
    • Repeated Infections
    • Low Immunity
    • Fatty Liver, Gall Stones
    • Bronchiectasis, Emphysema
    • Pancreatitis
    • Sleep Apnea
    • Multiple Endocrine disturbances
    • Others
  • Association with other Endocrine Disturbances

    Diabetes Mellitus is associated bi-temporally with other Endocrine (Hormone) Disturbances and diseases including :

    • Hypothyroidism
    • Hyperthyroidism
    • Obesity
    • Acromegaly
    • Cushing's syndrome
    • Pheochromocytome
    • Polycystic Ovarian Syndrome (PCOS)
    • Hirsutism
    • Low Testosterone in Men
    • High Testosterone in women
    • High Estrogen in Men
    • Abnormally low/high Estrogen and Progesterone in women
    • Low Dopamine
    • High Prolactin
    • High counter-regulatory hormones like Growth Hormone , Glucagon , Glucocorticoids
    • Abnormal IGF-1
    • High Aldosterone
    • Low DHEA
    • Low Vit D
    • Inappropriate Incretins effects
    • Abnormal Adipokines (Leptin, Adiponectin) effects.
    • Others

    Diabetes Mellitus management should therefore not be limited to Insulin management. The associated Endocrine and Systemic imbalances need to be corrected simultaneously.

  • Association with other Autoimmune Disorders
    • Grave's Disease
    • Hashimoto's Disease
    • Pernicious Anaemia
    • Addison's Disease
    • Vitiligo
    • Cystic Fibrosis
    • Celiac Disease
    • Polyglandular diseases
    • Others
  • Association with Genetic Disorders
    • Down's Syndrome
    • Turner's Syndrome
    • Kleinfelter Syndrome
    • Prader Willi Syndrome
    • Myotonic Dystrophy
    • Others
  • Gestational Diabetes

    What is Gestational diabetes?

    • There occurs some physiological alteration in the carbohydrate metabolism in pregnancy.
    • Human pregnancy is characterized by Increased Insulin Resistance which helps to ensure a steady glucose supply to the fetus.
    • The hormones like human placental lactogen, Estrogen and progesterone contribute to this state.
    • If these alterations are exaggerated then there is abnormal glucose tolerance leading to "Gestational Diabetes".
    • Alternatively pregnancy may unmask an underlying pre-diabetic state.
    • GDM can be diagnosed by Glucose Tolerance Test.This can be done during the first visit and then repeated on 24 weeks and then 32-34 weeks.
    • 2 hrs GTT of more than 140mg/dl or above indicates GDM.
    • Obesity, Over weight, Family history of Diabetes are risk factors of developing GDM.
    • High occurrence in Asians.

    How does it affect the mother and the baby?

    • Excessive Fetal growth (big baby)
    • Obstructed labour.
    • Increased chances of developing Gestational Hypertension.
    • Increased mortality rate of mother and fetus.
    • Increased chances of developing overt Diabetes in mother (almost 50%).
    • Chances of Respiratory distress Syndrome in baby.
    • Increased risk of abortions.

    Is there any way to avoid it?

    • Weight Control.
    • Maintaining the calorie intake.
    • Small frequent meals during pregnancy (Balanced diet).
    • Avoid Obesity/Over weight before conception.
    • Stay active through out pregnancy.
    • Pre-conception screening and counselling.

    How is it treated?

    • Calorie Control 30-35 Calories/Kg of present weight.
    • 50-55% Carbohydrate, 20-25% Proteins and rest in form of fat.
    • Split the daily meals in 5-6 portions.
    • Insulin Therapy, whenever needed.
    • Normal physical activity plus graduated daily exercise like walking.
    • Monitor Body weight, Blood Pressure, Haemoglobin, Glycosylated Haemoglobin, Blood Sugar and other parameters.
    • Fetal development assessment by Ultrasonography.
    • Educate the patient and the family about GDM.
    • It needs to be a team approach comprising of Gynecologist, Diabetologist, Neonatologist, Trained nurse and Educator.

    Is it a common occurrence?

    • In developed countries the rate is almost 7%.
    • In developing countries Including India the prevalence is almost 16-17%.
    • It seems to happen almost equally in rural and urban areas in India.
  • Investigations in Diabetes Mellitus
    • Investigations in Diabetes Mellitus do not simply end in monitoring the Blood Sugar levels (Fasting Blood Sugar, Post Prandial Sugar, Glucose Tolerance Test, Glycosylated Hb etc.).
    • Being a multisystem, metabolic and Endocrine disease influenced by Genetics and Life Style, the cause and complications should be investigated/monitored simultaneously.
    • The whole series of Clinical Systemic examination, Biochemical laboratory evaluation and Imaging parameters (Diagnostics and Screening) are key for successful management of Diabetes Mellitus.
    • The Occupational, Psychological, Social evaluation is equally important.
    • Diabetes Mellitus being a multisystem disease calls for the evaluation of all the systems of the body.
    • Diabetes Mellitus being a Metabolic disease calls for evaluation of the Metabolic profile.
    • Diabetes Mellitus being an Endocrine Disease calls for evaluation of all the related hormones.
  • Genetic Testing for Diabetes Mellitus

    Who should do Genetic Testing ?

    • Family history of Diabetes Mellitus.
    • Vague symptoms of Diabetes Mellitus but Laboratory reports normal.
    • High risk ethnicity with unhealthy life style.
    • Obesity with no signs of Diabetes Mellitus.
    • Low birth weight babies.
    • Down's Syndrome.
    • Turner's syndrome.
    • Kleinfelter syndrome.
    • Other Genetic disorders.
    • Pre Marriage Counselling.
    • Pre natal Counselling and risk assessment.
    • Risk assessment in an individual with genetic testing.
  • Diabetes Management
    • BLOOD SUGAR CONTROL
    • 1. Life style management

      2. Weight management

      3. Dietary management

      4. Medical Management (Including Insulin and Incretins)

    • Identification of Risk Factors.
    • Management of Metabolic factors including Hyperlipidemia and hypoproteinemia
    • Prevention of Complications
    • Balancing other Hormonal and Systemic disturbances
    • Diabetic Foot Management
    • Management of Cardiac Complications
    • Management of Neuropathy, Nephropathy, Retinopathy, Myopathy
    • Psychological management
    • Occupational and Social management
    • Management of Sexual Dysfunction including Erectile Dysfunction
    • Surgical management
    • 1. Metabolic/Bariatric Surgery

      2. Islet Cells Transplantation

    • Future Therapies
    • 1. Gene Therapy

      2. Stem Cells Therapy

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