WHAT IS DIABETES MELLITUS?

A severe, chronic form of diabetes caused by insufficient production of insulin and resulting in abnormal metabolism of carbohydrates, fats, and proteins. The disease, which typically appears in childhood or adolescence, is characterized by increased sugar levels in the blood and urine, excessive thirst, frequent urination, acidosis, and wasting. Also called insulin-dependent diabetes, type 1 diabetes. A mild form of diabetes that typically appears first in adulthood and is exacerbated by obesity and an inactive lifestyle. This disease often has no symptoms, is usually diagnosed by tests that indicate glucose intolerance, and is treated with changes in diet and an exercise regimen. Also called non-insulin-dependent diabetes, type 2 diabetes.In Acupuncture, this disease is defined as 'xiao ke' which means diabetes.

CLINICAL DIAGNOSIS

1. The characteristics of a typical case of diabetes mellitus are often polyphagia, polydipsia, polyuria and loss of body weight. Early or asymptomatic patients only show abnormal release of cortical hormone and insuline inside the body. The level of fasting blood sugar is elevated with abnormal glucose tolerance test. Symptomatic patients are frequently complicated by other symptoms of dermal, neural and endocrinous disorders, besides polyphogia, polyuria and loss of body weight.

2. The main complications and concomitant diseases of diabetes mellitus are diabetic ketoacidosis, cardiovascular diseases, diabetic renopathy and peripheral neuropathy. Cardiovascular complications are the chief causes of death.

3. Diabetes mellitus is classified into juvenile and adult types according to the clinical features. The age of onset of the juvenile type is young and has a tendency to inheritance. Blood sugar fluctuates widely and is quite sensitive to insulin. Threatment is difficult and it is often named insulin-depending diabetes or unstable diabetes. The age of onset of adult type is above 40. This type is relatively mild and can be controlled by dietary restriction or oral antidiabetics. Therefore it is also named non- insulin depending diabetes or stable diabetes.

4. Accessory examination

a) Fasting blood-glucose is higher than 130 mg. Blood glucose after meal is more than 160-180 mg. Urine is positive for glucose. If complicated by ketosis, urine is positive for ketone bodies.

b) Glucose tolerance test can be used to diagnose early or suspected cases and is the principle test in diagnosis.

c) New diagnostic techniques such as testing blood insulin levels are quite helpful in understanding the pathological changes of pancreas and in obtaining information concerning treatment.

TYPES OF SYNDROMES

Diagnosing diabetes symptoms can be difficult in identifying at first, as manifestation of the disease is gradual. Sometimes, because symptoms can also be common to other illnesses, the real illness may be overlooked. Diabetes symptoms may vary, the list may go on and on but not everybody (diabetes patients) has them. There are even some cases that no symptoms may show on some patients.

Diabetes occurs when the body’s ability to react to insulin gets affected. The insulin is your body hormone that allows your blood sugar (glucose) to enter body cells. When too much glucose enters the blood, this leads to the elevated amount of blood glucose, which it can cause glucose spillage towards the urine. This is the primary reason why one of the most classic diabetes symptoms, frequent urination, plagues the patient.

Because elevated glucose level is beyond normal, your body cells are energy-starved and consequently leading to the damage in your nerves, kidneys, eyes, blood vessels and your heart. The increased amount of glucose appears when the sugar of your body falls too low. It then increases production of sugar. This process starts when the pancreas releases the hormone called glucagons. The stored glycogen will be converted back into the glucose by your liver and muscles.

Diagnosing diabetes patients may vary, and is based according to the duration and range of the high blood sugar levels. Patients with type 2 diabetes are often diagnosed relatively slowly as compared to people with type 1 diabetes, to which it may take only after weeks or some months. Symptoms may also progress slowly and mildly.

Some of the most specific and common early diabetes symptoms are:

- Skin irritation and diseases
- Skin infections
- Poor skin healing
- Athlete’s foot
- Sexual problem
- Unusual vaginal dryness
- Erectile failure (to male patients)
- Premature menopause (to female patients)
- Absence of menstrual periods
- Paresthesias
- Peripheral neuropathy
- Urinary tract infection
- Blurry vision
- Malaise
- Drowsiness
- Numbness of the hands
- Weight loss or weight gain

Other more extreme diabetes symptoms are:

- Excessive urination
- Excessive thirstiness
- Dehydration
- Weight loss even with an increased appetite
- Tiredness, fatigue, nausea, and vomiting
- Excessive hunger
- More bladder, skin and vaginal infections
- Serious blurry vision
- Headache
- Muscle aches, weakness and cramps
- Acne
- Increased sexual problems because of erectile failure for men, and vaginal dryness for women
- Cessation of menstrual periods

Other diabetes symptoms:

- Gums are bleeding
- Unusual noise or buzzing in the ear
- Feet numbness or tingling
- Skin itching
- Diarrhea
- Confusion
- Depression

Complications associated to diabetes symptoms:

- Kidney diseases
- Diabetic retinopathy
- Sciatica
- Heart diseases and
- Stroke

As those mentioned symptoms might occur at a later time for a patient, the usual situation is delayed scheduling of the check-up. This is not a good idea as complications may increase over time, making it even harder to treat and manage the disease. In this case, it is extremely important to check with the doctor in as early as possible to prevent more damage to the body. Another, it is important to note that diabetes is one of the lifelong diseases, and one that does not infect other people upon contact.

WHAT IS DIABETES INSIPIDUS?

Diabetes insipidus (DI) is an endocrine disorder involving deficient production or lack of effective action of an antidiuretic hormone (ADH or vasopressin). ADH is made in the hypothalamus (lower part of the brain), stored in and secreted by the pituitary gland (a small gland located below the hypothalamus), and works on the kidney to conserve fluid. Deficient production of ADH or lack of effective action of ADH causes large amount of urine output, increasing thirst, dehydration, and low blood pressure in advanced cases. Average urine volume for a normal adult is 1.5 liters daily. In diabetes insipidus, the urine volume can approach 18 liters daily!

Diseases of the hypothalamus/pituitary gland causing lack of ADH production is called central DI. Diseases of the kidney causing lack of response of the kidney to fluid conserving action of ADH is called nephrogenic DI.

Examples of central DI include surgical removal of the hypothalamus, tumors of the hypothalamus or the pituitary gland, infection of the pituitary gland, autoimmune (body's immune system attacking own organ) damage of the pituitary gland, and familial disease of the pituitary gland.

Examples of nephrogenic DI include certain kidney diseases. Low blood potassium level, protein starvation, high blood calcium level, sickle cell anemia, medications (such as lithium, demeclocycline,and methoxyflurane).The disease belongs to the category of 'xiao ke' in Acupuncture.

CLINICAL DIAGNOSIS

1. Polyuria, polydipsia and increased water intake are the principle features. If water intake is restricted, severe dehydration may occur.

2. The etiology of primary diabetes insipidus remains indeterminate. Secondary cases may be initiated by tumor, infection or trauma of the hypothalamus-pituitary system or the adjacent tissues.

3. Accessory examination

a) The specific gravity of urine is reduced and usually less than 1.006. The osmotic prnsipidus from psychogenic polydipsia and polyuria.

b) The osmotic pressure of plasma is elevated. There may appear dizziness, dysphoria, tachycardia or disorder of consciousness, the so-called hyperosmotic syndrome.

c) Water-deprivation test and hypertonic saline test are used to ditinguish diabetes insipidus from psychogenic polydipsia and polyuria. Water- deprivation test is dangererous, and now is rarely performed.

TYPES OF SYNDROMES

Deficiency of the Kidney-qi. Main Symptoms : Polydipsia, frequent and profuse urination, emaciation, aching pain in the lumbus, lassitude. The case exhibiting more symptoms and signs of deficiency of the kidney-yin is marked as feverish sensation in the palms and soles, restlessness, red tongue with little fur, deep, thready and rapid pulse; while the case presenting more symptoms and signs of deficiency of the kidney-yang is manifested as light colour urine, aversion to cold, impotence, pale tongue with whitish fur, and deep, thready and weak pulse.

Hypoglycaemia (low blood glucose) in diabetic patients

Regular blood sugar tests can help you identify when you need to pay extra attention to your blood sugar level.

Causes

Diabetic patients, hypoglycaemic episodes (also known as 'hypos') can be caused by too much insulin in the blood, or less insulin is needed.

Too much insulin in the blood

The dose of insulin or antidiabetic tablets is set too high.

The patient has accidentally overdosed or been given too many tablets.

Less insulin needed
1.If the patient has eaten less than usual.
2.If there has been physical activity.
If the patient has been drinking alcohol.

What happens during a hypoglycaemic episode?

paleness
shaking
perspiration
a feeling of weakness
rapid heartbeat
hunger
agitation
difficulty concentrating
irritability
fatigue
blurred vision
temporary loss of consciousness
confusion
convulsions
coma.

Hypoglycaemia does not cause any of the above symptoms in some diabetic patients. This is especially the case where long-standing diabetes is concerned. In these patients, convulsions and loss of consciousness can occur without warning. To avoid this, they are asked to maintain a higher level of glucose in the blood and to measure it more frequently than is normally required. This is very important.

Hypoglycaemic episodes can be categorised as:
1. Mild hypoglycaemia or hypoglycaemic episodes. The patient can manage these episodes alone. 2. Serious hypoglycaemia. The patient will need help from others, either a family member or a doctor.

Blood glucose levels

Blood glucose levels stay within narrow limits throughout the day (4 to 8mmol/l). But they are higher after food and usually lowest in the morning or when you are hungry.

When a person has diabetes, their blood glucose level usually moves outside these limits.

Controlling blood glucose levels:

Stable blood glucose significantly reduces the risk of developing late-stage diabetic complications. These may start to appear 10 to 15 years after diagnosis with Type 1 diabetes and often less than 10 years after diagnosis with Type 2 diabetes.

Complications

The best readings are:

 

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