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Diabetes mellitus and its complications

 Project Topic: Diabetes mellitus and its complications


SUMMARY

Diabetes mellitus and its complications:  Diabetes mellitus is a group of metabolic disorder in which a person has high blood sugar either because the body does not produce enough insulin or because cells do not respond to the insulin. There are three main types of diabetes. Symptoms include increased thirst, frequent urination, constant hunger weight loss, blurred vision etc, complications includes hypo/hyperglycemia, diabetic ketoacidosis, hypertension, neuropathy, nephropathy etc. insulin therapy is used for the treatment of diabetes by administration of exogenous insulin. Islet cell transplantation is a procedure which effectively controls blood glucose level for diabetic patients. A number of plants have been described as a traditional medicine for the treatment of diabetes. Vitamine D supplementation has been found to lower the incidence of type I diabetes. Several classes of oral hypoglycemic agents like sulfonyhreas, biguanides and alpha-glucosidase inhibitors are available for the treatment of type 11 diabetes. Targeted drug delivery for the treatment of diabetes using nanotechnology is one of the recent advances in nanomedicine.

CHAPTER ONE

Introduction

Glucose homeostasis, a balance between glucose production and glucose utilization is primary regulated by the pancreteatic islet B-cells, which secrete insulin and a-cells, which secrete glucagons. Glucose production occurs predominantly in liver whereas glucose utilization occurs in muscles and adipose, brain, kidney, red blood cells etc. (Kahn C.R et al 1994) Diabetes mellitus is a group of metabolic disorder in which a person has high blood sugar either because the body does not produce enough insulin or because cells do not respond to the insulin that is produced. Diabetes mellitus affect most of the people of both developed and developing countries. This can usually be controlled with dietary management, exercise, oral hypoglycemic drugs and insulin therapy. The diet most often recommended is high in dietary fiber, especially soluble fiber, but low in fat.

Diabetes mellitus

It is estimated that more than 100 million people worldwide are affected by the diabetes mellitus and in recent years prevalence of type 11 diabetes has significantly increased. In 1995 the estimated prevalence of disease in worldwide adults was 4% and projected to 5.4% by year 2025 which amounts to 300 million. ( king H, Aubert R.F and Herman W.H, et al 1998) There are three main types of diabetes. They are type 1 diabetes mellitus also called insulin dependent diabetes mellitus (IDDM), type 11 diabetes mellitus also called Non Insulin Dependent Diabetic Mellitus (NIDDM) and gestational diabetes.

Type 1 diabetes mellitus: Type 1 diabetes mellitus is caused by immunological destruction of pancreatic B cells leading to insulin deficiency. (Notkins A.L, et al 2007) It is associated with ketoacidosis. The majority of type 1 diabetes is of the immune-mediated nature. Where beta cell is destroyed due to T-cell mediated autoimmune attack. (Rother K.I, et al 2007) Type 1 diabetes can affect children or adults but was traditionally termed “juvenile diabetes” because it represents a majority of the diabetes cases in children. Type 1 diabetes can develop in people with a family history of type 1 diabetes. Environmental factors may also trigger autoimmune response. Symptoms of type 1 diabetes include increased thirst, frequent urination, constant huger, weight loss blurred vision and extreme tiredness.

Due to the binding of diminished insulin to its receptor in the cell membrane glucose uptake into the cells is decreased. Due to this, glucose builds up in the blood stream causing hunger, thirst, fatigue and increased urination. In 5 to 10 years insulin producing cells are all destroyed causing type 1 diabetes. Autoimmune destruction of B-cells has multiple genetic predispositions. CD4 T cells are major immune players in the initiation and pathogenesis of type 1 diabetes. Nearly 20 different proteins have been identified as targets for T cells in the NOD mouse and 12 of these are auto antigens in humans. (Babad J, Geliebter A. and Dilorenzo T.P et al 2010) Diabetic patients are prone to other autoimmune disorders such as Graves’ disease, hashimoto’s thyroiditis Addison’s disease, autoimmune hepatitis, myasthenia gravis and pernicious anemia.

Type 11 diabetes mellitus: Type 11 diabetes is characterized with insulin resistance and is the most common type of diabetes. Type 11 diabetic patient’s food are converted to glucose but the cells cannot utilize it and hence the glucose remains in the blood and does not enter into the cells where it should have been present. It is a common disorder with a prevalence that rises markedly with increasing degrees of obesity. (Harris M.I, et al 1989) Type 11 diabetes is common in individual over 40 years of age. Symptoms include feeling tired or ill, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections and slow wound healing. Type 11 diabetes is associated with physical inactivity and obesity.

SOME OF THE RISK FACTORS ARE:

(1) Having food with high fat content

(2) Not doing enough exercise

(3) Fatty deposit in pancreas

(4) Set of genes inherited from parents makes islets cells of pancreas to wear out easily

(5) Genes responsible for insulin resistance.

Gestational diabetes: Gestational diabetes occurred during pregnancy. Some pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. Such type of diabetes is called gestational diabetes. It occurs in about 2% -5% of all pregnancies and may improve or disappear after delivery. About 20%-50% of affected women develop type 2 diabetes later in life.

Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 11 diabetes. Many people spend many years in a state of pre-diabetes before getting type 11 diabetes which has been termed “America’s largest healthcare epidemic (Yehuda H, et al 2009).

Complications:

The disease is characterized by chronic hyperglycemia which if not effectively controlled can cause blindness, kidney, heart failure or nerve damage. Both genetic and environmental factors such as obesity and lack of exercise appear to play a role for the occurrence of diabetes (Li W.I, Zheng H.C, Bukuru J, and Kimpe N, et al 2001). The cause of diabetes depends on the type. Type 1 diabetes is partly inherited and then triggered by certain infections (by Coxsackie B4 virus). Type 11 diabetes is due primarily to lifestyle factors and genetics (Riserus U, Willett W.C, and Hu F.B, et al 2009). complications are of three types. They are Acute, sub-acute and Chronic. Acute a complications include hypoglycemia, diabetic ketoacidosis, hyperosmolar and hyper glycogenic, non-ketosis syndrome. Sub acute complications include thirst, polyuria, lack of energy, visual blurriness and weight loss (Kumar P.J, and Clark M, et al 2002). Chronic complications include hypertension, neuropathy, nephropathy and diabetes foot ulcer (Notkins A.L, et al 2007).

In a study of elderly nursing home patients who were initially free of heart failure, 39% of those with diabetes vs. 23% of those without diabetes had developed heart failure after 43 months of follow up (Aronow W.S and Aln C, et al 1999). The risk of heart failure was 2-fold higher in men and 5-fold higher in women with diabetes (Kannel W.B, and MeGee D.L, et al 1979). Patients with heart failure also have a higher risk of developing diabetes. Some of the complications of diabetes, including retinopathy and atherosclerotic vascular disease, have been linked to oxidative street in diabetic patients (Baynes J.W, et al 1991). In diabetic patients isooricntin decreases the circulating of radical scavengers and reduces symptoms of associated complications.

The diabetic patients have a 25 fold increased risk of blindness, a 20 fold increased risk of renal failure, a 20 fold

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