Obesity Management On Diabetes Mellitus TypeII & Insulin Resistance

DIABETES PATHOPHYSIOLOGY & DIAGNOSIS

DIABETES PATHOPHYSIOLOGY & DIAGNOSIS

OVERVIEW

Diabetetes Mellitus is a Chronic disease Of Carbohydrate metabolism characterized by Hyperglycaemia. Hyperglycaemia is the result of insufficient Insulin production and release, resistance to the action of insulin or a combination of both factors. To understand the Strategies for management of Diabetes it is important to understand the relationship between Glucose, Insulin & counter regulatory Hormones and their role in glucose Homoeostasis. 

WHAT IS DIABETES ?

Diabetes mellitus is a group disease characterised by high blood glucose level, disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, or action, or both.

Symptom :-

01. Polyuria - Frequent urination

02. Polydipsia - Feel very thirsty

03. Polyphagia - Feel very hungry

04. General weakness

05. Decreased resistance to infection

06. Decreased ability of wound healing

07. Dehydration as a result of excessive water or electrolyte loss

There may be no symptoms at all.

INVESTIGATIONS :-

01. Fasting Blood Sugar

02. PP Blood Sugar

03. GTT

04. HbA1C

05. Urine sugar

What Causes Diabetes ?

There are two causes leading to Hyperglycaemia and Diabetes :-

01. Insufficient Production of Insulin (Either absolutely/relative to the body’s needs, or

02. The inability of cells to use Insulin properly and efficiently.

Type of DIABETES ?

01. IDDM(Insulin dependent Diabetes mellitus), Type-1

02.NIDDM (Non-Insulin dependent Diabetes mellitus), Type-2

03. MODY (Maturity-onset Diabetes of Young).

04. GDM(Gestational Diabetes Mellitus)

What Causes Insulin Resistance ?

Obesity

01. Pregnancy

02. Infection or Severe illness

03. Stress

04. During Steroid use.

Relationship between Insulin Resistance & Diabetes ?

As mentioned above insulin resistance precedes the development of type-2 diabetes, sometimes by years. In individuals who will ultimately develop type-2 diabetes, it is believed that blood glucose and insulin levels are normal for many years; then at some point, there is often an association of high insulin levels, Central Obesity, Lipid abnormalities, and /or high blood pressure, when this constellation of disease processes occurs, it is known as the metabolic syndrome.

The Metabolic Syndrome:-

01. Raised triglycerides.
02. Raised -Cholesterol.

03. Raised blood pressure.

04. Raised Fasting blood glucose.

Disease of the Exocrine Pancreas

Any condition that injure the pancreas diffusely can result in Diabetes. These condition imply that a mechanism other than simple reduction in beta-cell mass may also be responsible for diabetes.

01. Pancreatitis

02. Trauma or Surgical removal of the pancreas.

03. Cancer of the pancreas.

04. Cystic fibrosis.

05. Fibrocalculous Pancreatopathy.

06. Haemochromatosis, the iron storage disease. 

Diagnostic Criteria of Diabetes :-

Symptoms* of diabetes plus any of the following values :-

01. Random plasma glucose concentration >200mg/dl.

02.Fasting plasma glucose >126 mg/dl.

03. 2 hour plasma glucose >200mg/dl during a 75gm OGTT( oral glucose tolerance test) 

A 75g OGTT is required to confirm the diagnosis in individuals who are asymptomatic but have any one of the above values.

What is Ketones ?

Urine ketones are the result of Fatty acids that breakdown to give the body a form of energy. If the body cannot get energy from glucose, fat is used instead. The by-product of that fatty acid breakdown is KETONES.

What is Diabetes Ketoacidosis ?

DKA occurs when there is a deficiency of INSULIN in the body. This prevents the glucose molecules form entering into cells, hence leading to Hyperglycaemia. The secretion of counter-regulatory hormones such as Glucogon or epinephrine result in release of glucose from the liver, which contributes to increased Hyperglycaemia. This is followed by the Uncontrolled breakdown of Adipose and muscle tissues (CATABOLISM). Fatty acids are released and are rapidly metabolised into  ketones, which are strongly acidic. The excessive production of ketones lower the blood pH and leads to metabolic acidosis.

Signs and Symptoms of DKA :-

01.Thirst and urination (Primary stage).

02. Nausea and vomiting.

03. Abdominal Pain.

04. Legs cramps.

05. Acid smelling breath.

06. Kussmaul’s breathing.

NOTE:- If these symptoms are present, immediately Medical advise &Supervision  is Required.

MANAGEMENT OF DIABETES :-

01. Aware the patient about D.M  

02. Life style Modification.

03. Behavioral Therapy.

04. Nutritional Therapy.

05. Physical exercise therapy.

06. Pharmacological Treatment.

07. Pschycological counseling.

08. Family Counseling & Education.

Weight Gain with Insulin :-

Insulin decrease fat breakdown and increases fat formation. Therefore, weight gain is often associated with commencement or intensification of insulin therapy. Weight gain is related to :-

Absorption of calories that were previously lost  in the urine through glucosuria. When blood glucose levels are elevated, the body will excrete excess glucose through urine. If, once insulin is initiated, the person with diabetes continues to eat as usual, those calories will be absorbed and the person will gain weight.

Insulin tends to stimulate appetite, people will eat more because they are hungry. If the insulin dose is increased to compensate for the increased number of calories, then appetite is stimulated more and the blood glucose raises. This is called “Chasing blood sugar” . This may result in ‘Overinsulinisation’ or taking more insulin than needed.

Note:- Therefore, all the patients commencing  insulin therapy should meet with a Dietitian/Obesity consultant to develop a meal plan that will match the calories eaten to the insulin given.

1-3 unit-rapid acting insulin per 15gm Carbs. (60Kcal= 1-3Unit Insulin)

0.72-2 unite/ 10gm carbs. 

Related Complication with DM :-

01. Hypoglycaemia.

02. Hyperglycaemia.

03. Macrovascular Complication.

04. Diabetic Retinopathy.

05. Diabetic Nephropathy.

06. Diabetic Neuropathy.

AFTER TRANSFORMATION