Diabetes Mellitus

By: Zergabachew Asfaw MD, FACP

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Diabetes is a common metabolic problem that affects millions of people all over the world. More than three million cases are identified each year. More than 30 million Americans live with diabetes. It is the most common cause of non-communicable illness that leads to morbidity and mortality. It affects almost every organ in the body. 
    Diabetes is caused by relative deficiency or absence of insulin secretion by the pancreas. There are two types of diabetes. Type I is an early onset of diabetes and type II is adult-onset diabetes. The type one has genetic preponderance. The change in lifestyle has resulted in an epidemic of diabetes mellitus. 
     The diagnosis of diabetes is based on identifying the symptoms and checking laboratory tests. The symptoms include polydipsia- drinking water excessively and polyuria (excessive urination). Other manifestations may include fatigue, weight loss, or weight gain and generalized weakness. Morbidity from diabetes involve both macrovascular (atherosclerosis) and microvascular (retinopathy, nephropathy, and neuropathy) diseases. Intervention can limit end-organ damage, and therefore, patients with diabetes require initial and ongoing evaluation of diabetes-related complications. 
    Diabetes, if not treated, can affect every organ of the body. It can lead to blindness, renal failure, and a variety of cardiovascular disorders. There is not a single organ that is spared from the complications of diabetes. Therefore, early diagnosis and management are very essential to prevent those complications. The effect on the vision is called diabetic retinopathy. In addition, it can result in early cataract formation. The effect on the kidney is called diabetic nephropathy and when it progresses, it would lead to renal failure and the affected individual ends on hemodialysis. The impact of diabetes on the nervous system is multiple. It can cause peripheral diabetic neuropathy and damage to the central nervous system. The other impact is diabetic foot ulcers, which is also a major challenge to treatment. 
    Type I diabetes require insulin administration for treatment. We perform a history and physical examination two or four times a year to obtain information on nutrition, physical activity, reductions of cardiovascular risk factors, current management, and diabetic-related complications. 
    Initial treatment of patients with type II diabetes includes lifestyle change focusing on diet, increased physical activity, and exercises, and weight reductions, reinforced by consultation with a registered dictation and diabetic self-management education. 
    Glycemic control can minimize the risk of retinopathy, nephropathy, and neuropathy in both type I and type II diabetes. The goal of management is to reduce HA1C to less than 7% and maintain fasting blood glucose 80 to 130 mg/dl. To live the best life with diabetes, a comprehensive plan of diabetic care is necessary. Quality evidence-based diabetes self-management education and support service are fundamental parts of the treatment plan. To take control of your diabetes, you need to educate, empower, and motivate yourself. 

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