Diabetes mellitus types cause diagnosis and treatment

what is Diabetes mellitus

Diabetes mellitus is the most common of the endocrine disorders.
It is a chronic condition, characterised by hyperglycaemia
and due to impaired insulin secretion with or without
insulin resistance

types 

Type 1 (β-cell destruction, usually leading to absolute insulin
deficiency)
Type 2 (may range from predominantly insulin with relative insulin
deficiency to a predominantly secretory defect with or without
insulin resistance)

Definition of type 1

Type 1 diabetes mellitus is a chronic disorder of carbohydrate,
fat and protein metabolism with hyperglycaemia
resulting in most cases from autoimmune destruction of
pancreatic β cells.

Definition of type 2

Type 2 diabetes mellitus is a chronic disorder of carbohydrate,
fat and protein metabolism with hyperglycaemia
as its principal feature. It is characterised by impaired
insulin secretion and insulin resistance.

Pathophysiology of 2

Insulin resistance in the liver, skeletalmuscle and adipose
tissue secondary to a decrease
in the number of insulin receptors, decreased receptor
tyrosine kinase activity and post-receptor defects
causing impaired glucose transport.
Defective insulin secretion due to islet cell dysfunction
with increased secretion of proinsulin and cleavage
products. Amylin, an amyloid protein, is found in
increased amounts in the islets cells. It may disrupt
the normal insulin secretion.
Reduced effective insulin causes increased gluconeogenesis
by the liver and reduced peripheral uptake,
leading to hyperglycaemia.However, there is sufficient
insulin to suppress lipolysis and ketogenesis, so that
ketosis and ketoacidosis do not occur.

Clinical features

Patients may present with a history of polyuria, polydipsia
and weight loss often despite increased appetite.
Young patient often present acutely in diabetic ketoacidosis
Pathophysiology of type 1
In type 1 diabetes, there is hyperglycaemia due to failure
of glucose uptake and uncontrolled gluconeogenesis,
glycogenolysis, lipolysis and proteolysis:
Osmotic diuresis – there is a renal threshold for glucose
reabsorption, once the levels in the blood rise
above 10 mmol/L the kidney is no longer able to completely
reabsorb it from the proximal tubule resulting
in glycosuria and an osmotic diuresis.

Diagnosis

1. Diabetes symptoms (i.e. polyuria, polydipsia and
unexplained weight loss) plus:
• a fasting serum glucose concentration ≥7.0 mmol/L
• or serum glucose concentration ≥11.1 mmol/L 2 h after
75 g anhydrous glucose in an oral glucose tolerance test
(see later).
2. With no symptoms, diagnosis should not be based on a
single glucose determination but requires confirmatory
serum venous determination. At least one additional
glucose test result, on another day with the value in the
diabetic range, is essential, either fasting or from the 2-h
post-glucose load. If the fasting value is not diagnostic,
the 2-h value should be used.
Current recommendations are that the diagnosis is confirmed
by a glucose measurement performed in an accredited
laboratory on a venous serum sample. A diagnosis
should never be made on the basis of glycosuria or a stick
reading of a finger prick blood glucose alone, although such
tests are being examined for screening purposes. Glycated
haemoglobin (HbA1c) is also not currently recommended
for diagnostic purposes, although this is currently being
considered.

Treatment

the following medicines are helpful  in  Diabetes mellitus types 1 AND 2
Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. ...
Sulfonylureas. ...
Meglitinides. ...
Thiazolidinediones. ...
DPP-4 inhibitors. ...
GLP-1 receptor agonists. ...
SGLT2 inhibitors. ...
Insulin therapy.
Treatment for people with diabetes includes advice on nutrition,
physical activity, weight loss and smoking cessation if
appropriate. Drug therapy is prescribed where necessary
Fats
Since obesity is a major problem in type 2 diabetes and fats
contain more than twice the energy content per unit mass than
either carbohydrate or protein, consumption of fats should
be limited. Monounsaturated fats have a lower atherogenic
potential and are therefore recommended as the main source
of dietary fat. Intake of fat should be less than 35% of total
energy consumption, with saturated and trans-unsaturated
fats accounting for less than 10% of energy intake and monounsaturated
fats providing 10–20%.
Insulin therapy in type 1 diabetes
All patients with type 1 diabetes require treatment with insulin
in order to survive. Exogenous insulin is used to mimic the
normal physiological pattern of insulin secretion as closely
as possible for each individual patient. However, a balance is
required between tight glycaemic control and hypoglycaemia
risk. If the risk of hypoglycaemia is high, then it may be necessary
to aim for less tight glycaemic control. There is a wide
variety of insulin preparations available which differ in species
of origin, onset of action, time to peak effect and duration
of action
Protein
For adults without nephropathy, protein intake is recommended
as less than 1 g/kg of body weight, equivalent to
about 10–20% of total energy intake. For those with nephropathy,
protein intake may need to be further restricted, but this
requires expert dietetic advice and supervision
Fibre
There is no quantitative dietary recommendation for fibre
intake. Dietary fibre has useful properties in that it is physically
bulky, and it delays the digestion and absorption of
complex carbohydrates, thereby minimising hyperglycaemia.
For the average person with type 2 diabetes, 15 g of soluble
fibre from fruit, vegetables or pulses is likely to produce a 10%
improvement in fasting blood glucose, glycated haemoglobin
and low-density lipoprotein cholesterol (LDL-C). Insoluble
fibre from cereals, wholemeal bread, rice and pasta has no
direct effect on glycaemia or dyslipidemia, but it has an overall
benefit on gastrointestinal health and may help in weight
loss by promoting satiety
Salt
Sodium chloride should be limited to a maximum of 6 g/day.
A reduction in salt intake from 12 to 6 g/day has been shown
to produce a reduction in systolic blood pressure of 5 mmHg
and a reduction of 2–3 mmHg in diastolic pressure.

Alternative medicine

No treatments — alternative or conventional — can cure diabetes. So it's critical that people who are using insulin therapy for diabetes don't stop using insulin unless