Diabetes related issues (1)

OverviewThe term "diabetes" describes a metabolic disorder with multiple etiologies, characterized by chronic hyperglycemia, accompanied by disorders of carbohydrate, fat, and protein metabolism
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It is caused by defects in insulin secretion, insulin action, or both
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The effects of diabetes include long-term damage, dysfunction, and failure of various organs (WHO 1999)
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There are two main types ofdiabetes : Type 1 diabetes usually occurs in childhood and adolescence, and patients need to be injected with insulin throughout their lives in order to survive
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Type 2 diabetes usually occurs in adults.
It is related to obesity, lack of physical activity, and unhealthy diet
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This is the more common type of diabetes (accounting for 90% of diabetes cases worldwide)
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Disease treatment may involve pure life>
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Other types of diabetes Other types of diabetesare: gestational diabetes (this is a state of high blood sugar that occurs during pregnancy) and the more rare "other" causes (genetic syndromes, acquired disease processes such as pancreatitis, such as cystic Fibrosis and other diseases, exposure to certain drugs, viruses, and unknown causes)
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　　In addition, the presence of intermediate hyperglycemia (impaired fasting blood glucose or impaired glucose tolerance) is also determined
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The importance of these disease states is that they can develop into diabetes, and after weight loss and life>
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　　Hyperglycemia can cause symptoms such as easy thirst, polyuria, easy hunger, and weight loss in the short term
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However, in a longer period of time, it can cause damage to the eyes (causing blindness), kidneys (causing kidney failure), and nerves (causing impotence and foot disorders/may cause amputation)
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In addition, it increases the risk of heart disease, stroke and poor blood flow in the legs
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Studies have shown that good metabolic control can prevent or delay the occurrence of such complications
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　　Therefore, the primary goal of treatment is to reduce the blood glucose level to the normal range, which can improve the symptoms of diabetes and prevent or delay the onset of complications of diabetes
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As far as the health care system is concerned, achieving this goal requires a comprehensive, coordinated and patient-centric approach
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　　Types of diabetes 　　 type 　　1 diabetes (T1D) 　　description　　 •In the  past, it was called insulin-dependent diabetes
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　　•  It is characterized by high blood sugar, which is caused by an absolute lack of insulin hormone secreted by the pancreas
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　　•  In order to survive, the patient needs to be injected with insulin for life
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　　• It  usually occurs in children and adolescents (although it can happen later in life)
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　　•  Severe symptoms may occur, such as coma and ketoacidosis
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　　•  Such diabetic patients are usually not obese, but obesity does not conflict with the diagnosis of the disease
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　　•  Patients are at increased risk of microvascular and macrovascular complications
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　　Causes　　 •  Usually (but not always) the beta cells of the pancreas are destroyed due to autoimmunity, and certain antibodies are present in the blood
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　　•  A complex disease caused by more than one gene mutation and environmental factors
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　　Symptoms　　 •  Increased urination frequency (polyuria), thirst (polydipsia), hunger (polyphagia), and unexplained weight loss
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　　•  Numbness in the limbs, foot pain (feeling dull), fatigue, and blurred vision
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　　•  Recurring or severe infections
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　　•  Loss of consciousness or extreme nausea/vomiting (ketoacidosis) or coma
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Ketoacidosis is more common in type 1 diabetes than in type 2 diabetes
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　　Diagnosis　　 •The  diagnosis can be made when there are typical symptoms of hyperglycemia and abnormal blood tests
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　　•  Blood glucose concentration>=7 millimol/L (or 126 mg/dl) or >=11.
1 millimol/L (or 200 mg/dl) two hours after drinking 75g of glucose
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　　•  For patients without typical symptoms, the diagnosis can also be made based on two abnormal blood test results on different dates
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　　•  In most cases (although these conditions are not always available in resource-poor countries), another test called glycosylated hemoglobin (HbA1C) can be done to estimate metabolic control in the past 2-3 months.
And guide treatment decisions
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　　Treatment
　
　　 •  The overall goal of treatment is to relieve symptoms and prevent or delay the occurrence of complications by maintaining blood sugar at a normal level
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　　• Use different combined methods to inject insulin for life: short-acting/long-acting, multiple injections before meals for intensive management, once or twice a day, insulin pump
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　　•  Insulin must be continuously provided (but in many poor countries, people cannot get insulin and cannot afford it) to 　　monitor blood glucose by using a blood glucose meter　　 •  Early detection and treatment of complications (at intervals recommended by national and international guidelines); eye examinations, Urine tests, foot care, and specialist referrals as needed
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　　•  Educate patients how to monitor the signs/symptoms of hypoglycemia (such as hunger, heart palpitations, tremors, sweating, drowsiness, and dizziness) and hyperglycemia on their own
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　　•  Educate patients about diet, physical exercise, and foot care issues
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　　•  Where possible, involve patient-led support groups and communities
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　　Description of 　　Type 2 Diabetes (T2D)　　 •  Formerly known as Non-Insulin Dependent Diabetes (NIDDM)
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　　•  Characterized by high blood sugar, insulin secretion is usually impaired due to insulin resistance
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　　•  Patients usually do not need to use insulin for life, but only using diet and physical exercise, or a combination of oral medication or insulin supplementation can control blood sugar
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　　• It  usually (but not always) occurs among adults (it is on the rise in children and adolescents)
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　　• Related to obesity, reduced physical activity, and unhealthy diet
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　　•  Like type 1 diabetes, patients have an increased risk of microvascular and macrovascular complications
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　　Causes　　 •  Related to obesity, reduced physical activity, and unhealthy diet (almost all cases are related to insulin resistance)
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　　• It  occurs more often with high blood pressure, dyslipidemia (abnormal cholesterol), and central obesity, which are part of the "metabolic syndrome"
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　　• It  often occurs in families, and this is a complex disease caused by mutations in more than one gene and due to environmental factors
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　　Symptoms　　 •  In the years before the diagnosis, the patient may have no symptoms or only mild symptoms
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　　•  Increased urination frequency (polyuria), thirst (polydipsia), hunger (polyphagia), and unexplained weight loss may occur
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　　• There  may be numbness in the extremities, foot pain (numbness), and blurred vision
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　　•  Recurring or severe infections may occur
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　　• The  patient may have loss of consciousness or coma, but it is less common than type 1 diabetes
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　　Diagnosis　　 •The  diagnosis can be made when there are typical symptoms of hyperglycemia and abnormal blood tests
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　　• Blood glucose concentration>=7 millimol/L (or 126 mg/dL) or two hours after drinking 75g of glucose>=11.
1 milliL/L (or 200 mg/dL)
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　　•  For patients without typical symptoms, the diagnosis can also be made based on two abnormal blood test results on different dates
.
　　•  In most cases (although these conditions are not always available in resource-poor countries), another test called glycosylated hemoglobin (HbA1C) can be done to estimate the metabolic control in the past 2-3 months.
And guide treatment decisions
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This test can also be used to diagnose type II diabetes
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　　•  Some asymptomatic patients are diagnosed through “opportunistic screening” of high-risk groups (during routine medical examinations, health care providers may determine that the patient is at a higher risk of diabetes and recommend screening tests)
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　　• For  example, age> 45 years old, body mass index> 25 kg/m2, belonging to certain ethnic groups or hypertension, may prompt screening
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　　• In  some cases, the patient himself requests a screening
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　　Treatment　　 •  The overall goal of treatment is to relieve symptoms and prevent or delay the occurrence of complications by maintaining blood sugar at a normal level
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　　•  Patients take diet/physical exercise, or add one or more oral medications, combine oral medications with insulin, or use insulin alone for treatment
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　　•  Use a blood glucose meter to test blood glucose by yourself (compared with type 1 diabetes, the frequency of testing is less)
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　　• Early detection and treatment of complications (at intervals recommended by national and international guidelines): eye exams, urine testing, foot care, and specialist referrals as needed
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　　•  Self-check for signs/symptoms of hypoglycemia (such as hunger, heart palpitations, tremors, sweating, drowsiness, and dizziness) and hyperglycemia
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　　•  Make the patient understand diet, exercise, and foot care issues
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　　Gestational Diabetes (GDM) 　　Description　　 •  Characterized by the diagnosis of hyperglycemia of varying severity during pregnancy (there is no known diabetes in the past), and usually (but not always) within six weeks after delivery Back to normal
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　　•  The risks to pregnancy itself include: congenital malformations, increased birth weight, and increased risk of perinatal mortality
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　　•  Women are at increased risk of developing diabetes (type 2 diabetes) in later life stages
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　　The etiology　　 and  pathogenesis are not very clear, but pregnancy hormones seem to conflict with the role of insulin
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　　Symptoms • The  more commonly noticed conditions (although other symptoms may appear) are thirsty (polydipsia) and increased frequency of urination (polyuria) .
•  Because pregnancy itself causes an increase in the frequency of urination, it is difficult to identify these symptoms as abnormalities .
•  If the baby is larger than normal during pregnancy (found during routine prenatal check-ups), it may prompt diabetes screening .
 　　　　　　　　Diagnosis　　 •  At 24-28 weeks of pregnancy, do an oral glucose tolerance test (fasting blood glucose and blood glucose 2 hours after drinking 75 grams of glucose) after one night of fasting
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　　•  2 hours concentration >=7.
8 mmol/L (or 140 mg/dL) can be diagnosed as gestational diabetes
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　　•  If fasting blood glucose and postprandial blood glucose rise in the first trimester of pregnancy, this may indicate a previous diabetes (this is considered a different disease, and its consequences are different)
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　　Treatment　　 •  Strict metabolic control of blood sugar to reduce obstetric risks
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　　•  Patients use diet/physical exercise, oral medications, or insulin for treatment
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　　•  Use a blood glucose meter to detect blood sugar by yourself
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　　•  Make the patient understand the diet and physical exercise issues
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　　•  Educate patients on weight loss/physical exercise after childbirth to prevent diabetes in the future
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　　•  Screening for type 2 diabetes for life, because patients are at high risk
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