What is Diabetes Mellitus?

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  • February 15, 2021
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Diabetes Mellitus, commonly known as diabetes, is a metabolic disorder caused due to deficiency in insulin production and its action leading to adjustment or physiological changes in almost all areas of the body.

In simpler words, it is known as a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia or high blood sugar) resulting from defects in insulin secretion, insulin action, or both.

There are two main types of diabetes:

  • Type 1 Diabetes occurs from autoimmune destruction of beta cells characterized by a gross deficiency of insulin. Type 1 diabetes is also known as insulin-dependent diabetes because the pancreas fails to make insulin. Thus, people with diabetes 1 use insulin injections to control the blood glucose level. It accounts for (5-10) % of cases of diabetes. It often occurs in childhood or adolescents.

  • Type 2 Diabetes occurs because even though our body produces insulin, it becomes insulin resistant and sugar builds up in our blood. It is known as non-insulin-dependent diabetes or adult-onset diabetes. Type 2 diabetes is seen mostly in people above 40 years of age but can occur even in childhood.


  • Other types of diabetes includes Gestational Diabetes. It occurs due to the hormonal changes during pregnancy which affects the action of insulin production causing high blood glucose levels. Usually, the blood glucose level returns to normal after childbirth. However, the women who develop gestational diabetes during their pregnancy have higher risk of developing Type 2 Diabetes in the future.

What causes Diabetes Mellitus?

The exact causes of Diabetes Mellitus are unknown. But here are some risk factors listed below:

  • History of diabetes in sibling or parents

  • Genetic defects in beta cell function

  • Autoimmune reactions

  • Infectious disease like Mumps, Coxsackie’s virus, Cytomegalic virus

  • The disease of pancreas and drug-induced i.e. Steroids.

  • Obesity (especially upper body)

  • Physical inactivity

  • Race ethnicity: African American, Hispanic, or American Indian origin

  • Women: a history of gestational diabetes, polycystic ovary syndrome

  • Environmental toxins such as rodenticides/insecticides and the early introduction of cow’s milk protein are also responsible to develop Diabetes Mellitus in children.

What are the sign and symptoms to consider?

The 3 major signs of diabetes are:

  • Polyuria (need to frequently urinate, particularly at night.)

  • Polydipsia (increased thirst & need for fluids)

  • Polyphagia (an increased appetite.)

Other includes:

  • Blurry vision

  • Weight loss

  • General weakness, tiredness, and bodily pains.

  • Fainting attack

  • Pain abdomen, nausea, vomiting

  • Irritability

  • Poor wound healing, skin infection, dry skin

How can Diabetes Mellitus be diagnosed?

  • History of classical features and history of illness including family history.

  • Physical examination findings.

  • Laboratory investigations:

  • Blood sugar tests, if random blood sugar levels 200 mg/dl or more on two separate occasions. Clinical features or fasting blood sugar level 126 mg/dl or more on two occasions suggestive and 160 mg/dl id diagnostic.

  • Oral glucose tolerance test in doubtful cases with oral glucose intake of 1.75 gm/kg of ideal body weight (maximum 75 gm).

  • Symptoms of hyperglycemia and persistent blood glucose >200 mg/dl

  • Glycosylated hemoglobin (HbA1C)>6.5%

  • Urine examination for the presence of sugar and ketone bodies.

What are the complications of Diabetes Mellitus?

It is divided into two types:

  1. Acute complication of Diabetes Mellitus is:

  • Ketoacidosis

  • Hypoglycemia

  1. The chronic complication of Diabetes Mellitus is:

  • Diabetic Neuropathy (nerve damage that can occur due to diabetes)

  • Diabetic Retinopathy (a complication of diabetes, caused by high blood sugar levels damaging the back of the eye i.e., retina)

  • Diabetic Cardiomyopathy (a disorder of the heart muscle in people with diabetes)

  • Diabetic Nephropathy (kidney disease that results from having diabetes)

  • Diabetic foot (a foot affected by ulceration in a patient with diabetes)

  • Hyperglycemic hyperosmolar non-ketosis coma (resulting from very high blood glucose levels in a patient with normal ketone levels)

How can we manage Diabetes Mellitus?

Management of Diabetes Mellitus includes a combination of insulin therapy, dietary management, physical exercise, prevention of complications, promotion of growth and development. Management starts with:

1) Hospitalization:

The patient needs hospitalization till the condition is stabilized. Educate the family members about home care and follow up. After that treatment can continue at home.

2) Insulin therapy:

Insulin therapy is the main treatment for diabetes mellitus 1 and also in some cases of diabetes mellitus 2. The main goal of insulin therapy is to keep the blood sugar levels within a normal range. Insulin doses are prescribed by doctors according to the needs of the patient. The doctor will develop a schedule that is right for the patient. Most people having diabetes need insulin shots at least 2 times a day for good blood sugar control. Some people need 3 to 4 shots a day. Periodic blood glucose level and urine sugar are evaluated to adjust the doses of insulin therapy in patients.

3) Diet:

Diet should be recommended depending upon the blood sugar level, metabolic status and the types of food one consumes. The blood sugar level increases due to starchy or sugary food. Protein and fat also contribute to it. Thus, the diet should be consulted with a dietician who will help to design the diabetes meal plan. The amount of carbohydrate intake should also be reduced and balanced properly with the insulin doses. The right balance of protein, fat, and carbs can help to control the blood sugar level. Diet should be planned for three major meals and three mid-meals with snacks to avoid hypoglycemia.

Micronutrients (magnesium, zinc, fruits, vegetables, whole grains, protein, and healthy fats such as nuts) should also be included in the diet plan.

4) Exercise:

The usual exercise includes healthy walking, jogging, swimming, aerobic exercise, and games like badminton, tennis. The diabetic patient should be taught about the effect of exercise on blood glucose and adjustment to be made in insulin dose and diet.

What can be done to prevent complications of Diabetes Mellitus?

  • Early identification of signs and symptoms of complication.

  • Early treatment and management

  • Regular medication as prescribed.

  • Regular exercise.

  • Follow-up care: Every 3 – 4 months child should become for follow-up and as early as per need.

  • Emotional support should be provided.

  • Health teaching to the patient and family members are essential for long term care.

  • The diabetic patient should always carry some chocolate/sugar and an identification card which will help them in times of emergency situation.

Article Credit :

Richa Bhattarai 

The author is currently pursuing B.Sc. Nursing at OM Health Campus in Chabahil, Kathmandu.


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