Diabetes Mellitus is a global epidemic and India is the second largest capital of the Diabetes world. Diabetes Mellitus is defined as fasting blood sugar >/ 126 mg/ dl, PP blood sugar >/ 200 mg/dl, HbA1C >/ 6.5%, with or without excessive thirst, excessive appetite, weight loss, etc.
95% of total Diabetes Mellitus cases are Type 2 patients where the clinical situations are characterized by Beta-cell secretory defect, Insulin resistance; whereas only 5% of Diabetes Mellitus patients are type 1, characterized by Insulinopenia as a result of pancreatic Beta cell destruction.
Management of Diabetes Mellitus is considered under two headings, one is prevention or delaying the onset of full-blown diabetes and aggressive intervention of the disease situation so that microvascular and macrovascular complications can be prevented. As far as diabetes prevention is concerned, the population at risk should be screened.
1. A BMI of more than 27 kg/ m2.
2. History of diabetes mellitus in either or both the parents, or siblings.
3. Hypertensive population.
4. Dyslipidemic population
5. History of coronary artery disease of father at less than 55 years of age or mother at less than 65 years of age.
There are entities like prediabetes; characterized by Fasting blood sugar ranging between 100-125 mg/dl, PP blood sugar ranging between 140-199 mg/dl, and HbA1C ranging between 5.7- 6.4 %. Aggressive diet and Exercise are extremely useful in these populations, so that onset of full-blown diabetes may be prevented.
The commonest comorbid disease of T2DM is high BP( Hypertension i.e BP greater than 140/90 Hg ).
Aggressive intervention in Type 2 DM means tight control of blood sugar, blood pressure, and serum lipids. It is needless to say that aggressive management of diabetes, soon after diagnosis offers long-lasting effects. Microvascular complications in diabetes mean the involvement of the Kidney and Retina. Macrovascular complication means coronary artery disease, cerebrovascular disease, Peripheral arterial disease, and atherosclerotic disease of the abdominal aorta.
Every one percent lowering of HbA1C decreases the incidence of both micro and macrovascular disease by approximately 30%. Uncontrolled diabetes and or Hypertension is the predisposing factor for stable angina, unstable angina, myocardial infarction, heart failure, cerebral stroke, kidney failure, and blindness.
Similarly, patients undergoing hemodialysis also have a similar background to the uncontrolled twin epidemic as mentioned above except for only a few cases of acute poisoning and snake bite. In short aggressive management of diabetes, hypertension, and dyslipidemia definitely aborts or delays the onset of micro and macrovascular complications as mentioned above.
While managing diabetes it has to be kept in mind that hypoglycemia and weight gain need to be avoided as far as possible. Hypoglycemia leads to a cardiac catastrophe like angina, cardiac arrhythmia along with Neurocognitive decline. Weight gain of a diabetes patient increases insulin resistance and as a result of which there is lesser efficacy of a particular diabetic treatment regime.
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