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ENDOCRINE
DISORDERS

Diabetes Mellitus

Diabetes mellitus (DM) is a clinical syndrome characterised by hyperglycaemia due to absolute or relative deficiency of insulin, or both (i.e. defects in insulin secretion, insulin action or both).

Causes

Type 1 diabetes

  1. Type 1A (immune-mediated)

  2. Type 1B (idiopathic)

Type 2 diabetes


Other specific types of diabetes

  1. Genetic defects of β-cell function (maturity onset diabetes of the young, MODY)

  2. Genetic defects in insulin action (e.g. type A insulin resistance, lipoatrophic diabetes)

  3. Diseases of exocrine pancreas (pancreatitis, pancreatectomy, pancreatic neoplasm, haemochromatosis, fibrocalculus pancreatopathy)

  4. Other endocrine diseases (acromegaly, Cushing's syndrome, glucagonoma, phaeochromocytoma, hyperthyroidism)

  5. Infections (congenital rubella, cytomegalovirus)

  6. Drug/toxin-induced (vacor, glucocorticoids, pentamidine, diazoxide, T₄, β agonists, thiazides, protease inhibitors, α-interferon, nicotinic acid)

  7. Insulin receptors defects or insulin receptor antibodies

  8. Other genetic syndromes (Down's syndrome, Klinefelter's syndrome, Turner's syndrome, myotonic dystrophy, porphyria, Friedreich's ataxia)

  9. Gestational diabetes mellitus (GDM)

  • The two broad categories of DM are designated type 1 (Not type I) and type 2 (Not type II).

  • In type 1DM, there is absolute insulin deficiency. Type 1 is subdivided into two groups: type 1A due to autoimmune destruction of β-cells, and type1B wehere β-cell destruction occurs due to unknown cause. It most often occurs in younger patients but nearly 10% patients above the age of 30 years have this type of DM.

  • In type 2 DM, there are variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. It also occurs due to several genetic and metabolic syndromes. Some children have type 2 DM.

  • The terms insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) are no longer used because several patients with NIDDM eventually would require insulin.

  • Maturity onset of diabetes in the yound (MODY) is characterised by autosomal dominant inheritance, early onset of disabetes and impairment of insulin secretion.

Symptoms

Typically the clinical features of type 1 and type 2 DM are distinctive.


Type 1 DM

  • Usually begins before the age of 40

  • Body habitus is normal to wasted

  • The onset of symptoms may be abrupt, with polyuria, polyphagia and weight loss developing over days or weeks.

  • Some cases may present as ketocidosis during an intercurrent illness or following surgery.

  • Occasionally, an initial episode of ketoacidosis is followed by a symptom-free interval ("honeymoon period") during which no treatment is required.

  • Characteristically, the plasma insulin is low or unmeasurable. Glucogen levels are elevated but suppressible with insulin.


Type 2 DM

  • Usually begins after the age of 40.

  • The typical patient is obese.

  • The symptoms begin gradually, over a period of months to years. Frequently, hyperglycaemia is detected in an asymptomatic person on a routine examination. Many patients will present with one of the chronic complications of diabetes and on investigations are found to be diabetic.

  • These patients usually do not develop ketoacidosis. In the decompressed state, they are susceptible to the syndrome of hyperosmolar hyperglycaemic state (hyperosmolar non-ketotic coma).

  • The plasma insulin levels are normal to high. Glucagon levels are elevated, but resistant to insulin.


     Feature                                   Type 1 DM                       Type 2 DM

- Age of onset                              <40 years                       >40 years

- Duration of symptoms           Days or weeks              Months or years

- Body habitus                            Normal to wasted         Obese

- Plasma insulin                          Low to absent                Normal to high

- Plasma glucagon                    High, suppressible       High, resistant

- Acute complication                Ketoacidosis                  Hyperosmolar

                                                                                                       hyperglycaemic state

- Insulin therapy                         Responsive                     Responsive to resistant

- Sulphonylurea therapy          Unresponsive               Responsive

- Autoantibodies                        Yes                                     No

- Other autoimmune                Yes                                     No

 diseases 

- Family history of diabetes     No                                    Yes

Treatments

  • Diabetes Mellitus is a hormonal disorder mainly caused by lifestyle changes like lack of exercise, healthy diet and mental stress. To control sugar levels and prevent further progress of disease or its associated complications homeopathy is the best science. In all age groups homeopathy can easily control sugar levels. 

Few homoeopathic medications which help in such patients are pulsatilla nigricans, cephelandra, phosphorous etc. 

  • Diet and exercise is also important in managing diabetes  with medications.

Diabetes Mellitus
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