Category Archives: Diameties Mellitus and Other Desorder of Metabolism

Hypoglycaemia

Hypoglycaemia develops when hepatic glucose output falls below the rate of glucose uptake by peripheral tissues. Hepatic glucose output may be reduced by: • The inhibition of hepatic glycogenolysis and gluconeogenesis by insulin • Depletion of hepatic glycogen reserves by malnutrition, fasting, exercise or advanced liver disease • Impaired gluconeogenesis (e.g. following alcohol ingestion) In the first o

Infections

There is no evidence that diabetic patients with good glycaemic control are more prone to infection than normal subjects. However, poorly controlled diabetes entails increased susceptibility to the following infections: 1 Skin (a) Staphylococcal infections (boils, abscesses, carbuncles) (b) Mucocutaneous candidiasis 2 Urinary tract (a) Urinary tract infections (in women) (b) Pyelonephritis (c) Perinephric absce

The diabetic kidney

The kidney may be damaged by diabetes in three main ways: 1 Glomerular damage 2 Ischaemia due to hypertrophy of afferent and efferent arterioles 3 Ascending infection Diabetic glomerulosclerosis Clinical nephropathy secondary to glomerular disease usually manifests 15-25 years after diagnosis and affects 30-40% of patients diagnosed under the age of 30 years. It is the leading cause of premature death in young

Diabetic Eye Disease

Diabetes can affect the eyes in a number of ways. The most common and characteristic form of involvement is diabetic retinopathy. About one in three young patients is likely to develop visual problems, and in the UK 5% have in the past become blind after 30 years of diabetes; diabetes is the commonest cause of blindness in the population as a whole up to the age of 60 years. Other forms of eye disease may al

Problems of management

HYPOTENSION. This may lead to renal shutdown. Plasma expanders (or whole blood) are therefore given if the systolic blood pressure is below 80 mmHg. A central venous pressure line is useful in this situation. A bladder catheter is inserted if no urine is produced within 2 hours, but routine catheterization is unnecessary. COMA. The usual principles apply. It is essential to pass a nasogastric tube to prevent a

DIABETIC METABOLIC EMERGENCIES

Diabetic ketoacidosis CAUSES Diabetic ketoacidosis is the hallmark of IDDM. Its main causes can be grouped as follows: • Previously undiagnosed diabetes • Interruption of insulin therapy • The stress of intercurrent illness The majority of cases reaching hospital could have been prevented by earlier diagnosis, better communication between patient and doctor, and better patient education. The most common e

Social implications

Patients starting on insulin need to inform the driving licence authority and their insurance companies. They are also wise to inform their employers. Certain types of work are unsuitable for insulin-treated patients, including driving heavy goods or public service vehicles, working at heights, piloting an aircraft or working close to dangerous machinery in motion. Certain professions such as the police and

TREATMENT OF DIABETES

Guidelines to therapy All patients with diabetes require diet therapy. Good glycaemic control is unlikely to be achieved with insulin or oral therapy when diet is neglected, especially when the patient is also overweight. Insulin is always indicated in a patient who has been in ketoacidosis, and is usually indicated in patients who present under the age of 40 years. Insulin is also indicated in older patient

AETIOLOGY

Genetic susceptibility 100M is not genetically predetermined, but an increased susceptibility to the disease may be inherited. Identical twins The identical twin of a patient with mOM has a 30-35% chance of developing the disease. This implies that nongenetic factors must also be involved. Inheritance The child of an insulin-dependent diabetic patient has anincreased chance of developing mOM. This risk, curiousl

Diameties Mellitus and Other Desorder of Metabolism

Diabetes Mellitus Introduction Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycaemia due to relative insulin deficiency, or resistance or both. It is common and affects approximately 30 million people worldwide. Diabetes is usually irreversible and, although patients can have a reasonably normal life-style, its late complications result in reduced life expectancy and cons