Definition
The term Diabetes Mellitus describes a metabolic disorder of multiple aetiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism, resulting from defects in insulin secretion, insulin action, or both. Diabetes mellitus may present with characteristic symptoms such as polyuria, polydipsia, polyphagia, and weight loss; and chronic metabolic complications are caused by overall complications. Diabetes is also a chronic physical and psychological disease, associated with psychological factor and emotional factors.
Causes: genetic and environmental factors
These two causes among different types of diabetes are greatly different in character and extent. For example, genetic factor is the main mechanism for monogenic diabetes, while for the diabetes caused by toxic chemicals, environmental factor is the main mechanism.
When both of the factors representing either positive or negative, Type 1 and type 2 diabetes are the results of interaction of both the two factors.
Genetic complications
Genetic β-cell Defect, Genetic Insulin Dysfunction, Type 1 Diabetes, Type 2 Diabetes, Scarce Immune-mediated Diabetes, Gestational Diabetes, Endocrine Disease, Pancreatic Exocrine Disease, Drug Infection
Incidence
According to the report released by International Diabetes Federation (IDF), diabetes is in a period of high occurrence now all over the world：
l There is one diabetic patient that dies from diabetic complications every 10 minutes in the world;
l There are 2 new incidence of diabetes every 10 minutes in the world;
l More than 3,000,000 people die from diabetes every year;
l There are 6,000,000 new diabetic patients every year in the world;
l People at the age of 60~69 accounts the most population of diabetic patients in the developed countries;
l People at the age of 40~59 accounts the most population of diabetic patients in the developing countries;
l Type 2 diabetes occurs at a younger age presently.
There are about 210 million diabetic patients all over the world.
According to an official report, there are 40 million diabetic patients in China.
A certain proportion of diabetic patients are without symptoms, which are unknown. Therefore, there predicted to be about 50 million diabetic patients in China.
It’s a huge and hard task to prevent and manage the disease in such a large country of developing diabetes.
Types
There are 4 types of diabetes according to the report by WHO in 1999.
l Type 1 diabetes (insufficient insulin caused by destroyed insulin-producing beta cells in the pancreas), was called insulin-dependent diabetes in the past, including:
A. Immune-mediated
B. Idiopathic
l Type 2 diabetes was called non-insulin dependent diabetes in the past, including:
A. insulin resistance as the prior factor, and relative insulin deficiency as the secondary factor
B. relative insulin deficiency as the prior factor, and insulin resistance as the secondary factor
l Other types of diabetes
l Gestational diabetes, including:
A. Pregnancy in diabetes
B. Gestational diabetes
Clinical Symptoms
Characteristic symptoms: Polyuria, Polydipsia and Polyphagia, and Weight Loss
About 42% of Type 2 diabetic patients are without symptoms.
Diagnosis (WHO 1999)
Diagnosis evidence: history of illness, clinical symptoms, complications, blood sugars
Normal glucose
Fasting glucose: 3.9~6.1mmol/L
Postprandial glucose: <7.8 mmol/L
Abnormal Glucose Tolerance
Fasting glucose: normal
Postprandial glucose: ≥7.8 mmol/L & <11.1 mmol/L
Impaired Fasting Glucose
Fasting glucose: ≥6.1 mmol/L & <7.0 mmol/L
Postprandial glucose: normal
Diabetes (one repetition of testing or testing with dynamic glucose monitoring)
Fasting glucose: ≥7.0 mmol/L
Postprandial glucose: ≥11.1 mmol/L
Random Glucsoe: ≥11.1 mmol/L
Complications: Acute and Chronic
Acute complications:
Acute ketoacidosis;
Nonketogenic hyperosmolar coma;
Lactic acidosis;
Hypoglycemia (shock, brain disease, coma);
Infection.
Chronic syndromes:
Diabetic heart disease: coronary heart disease, myocardial disease, autonomic neuropathy;
Diabetic cerebrovascular diseases: cerebral infarction, brain hemorrhage);
Diabetic nephropathy;
Diabetic gastroparesis: gastroparesis, gastrointestinal dysfunction;
Diabetic eye diseases: cataract, opacity vitreous, retinal detachment, hemorrhage;
Diabetic oral diseases: periodontal diseases, etc;
Diabetic foot;
Diabetic neuropathy;
Diabetic erectile dysfunction;
Diabetic hypertension.
Principles of diabetes management
A disease for the whole life, requiring treatment for the whole life
Five items of comprehensive treatments:
1. Basic diet treatment
2. Proper exercise treatment (oral glucose-reducing drug, insulin)
3. Effective drug therapy
4. Self-monitoring
5. Psychological care
