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CASE REPORT ON DIABETES MELLITUS

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I. INTRODUCTION

HISTORY OF THE DISEASE

1552 BC Written on a 3rd Dynasty Egyptian papyrs! p"ysi#ian $esy%Ra &entions

're(ent rination as a sy&pto&) T"is is t"e ear*iest +no,n re#ord o' dia-etes)

1500 BC. An#ient $ind ,ritings note t"at ants are attra#ted to t"e rine o' peop*e

,it" a &ysterios e&a#iating disease)

500 BC. T"e 'irst des#riptions o' sgar in t"e rine and its o##rren#e in o-ese

indi/ida*s)

250 BC. Apo**onis o' Me&p"is is #redited ,it" #oining t"e ter& 0dia-etes1! &eaning

to go t"rog"! or sip"on! 'or a disease t"at drains patients o' &ore '*id t"an t"ey #an

#ons&e)

1st Century AD T"e 2ree+s des#ri-e t"e disease as 0a &e*ting do,n o' t"e '*es" and

*i&-s into rine)1

164 AD 2ree+ p"ysi#ian! 2a*en o' Perga&&! diagnoses dia-etes as a +idney

ai*&ent)

Up t 11t! Century Sin#e t"e rine o' peop*e ,it" dia-etes is t"og"t to -e s,eet

tasting diagnosis is o'ten &ade -y 0,ater tasters1 ,"o drin+ t"e rine o' t"ose

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and! 'or ot"ers! is a #"roni# #ondition) T"is is t"e 'irst ti&e t"at a distin#tion -et,een

Type and Type 4 "as -een &ade)

1"#" Ro**o app*ies t"e 'irst signi'i#ant dietary approa#" to t"e treat&ent o' dia-etes)

$e s##ess'**y treats a patient sing a "ig" 'at and protein diet a'ter o-ser/ing t"at

sgar in t"e rine in#reases a'ter eating star#"y 'ood)

1"#$ Ro**o do#&ents e5#ess sgar in t"e -*ood! as ,e** as t"e rine)

E%r&y 1$00's Resear#"ers de/e*op t"e 'irst #"e&i#a* tests to indi#ate and &easre

t"e presen#e o' sgar in t"e rine)

1$4$ Bernard dis#o/ers t"at g*y#ogen is 'or&ed -y t"e *i/er and spe#*ates t"at t"is is

t"e sa&e sgar 'ond in t"e rine o' dia-eti#s) T"is is t"e 'irst *in+ing o' dia-etes and

g*y#ogen &eta-o*is&)

(%te 1$50s T"e 6ren#" p"ysi#ian! Priorry! ad/ises dia-etes patients to eat e5tra *arge

(antities o' sgar as a treat&ent)

1$6# Langer"ans! a 2er&an &edi#a* stdent! annon#es t"e pan#reas #ontains t,o

types o' #e**s one set se#retes t"e nor&a* pan#reati# '*ids! ,"i*e t"e 'n#tion o' t"e

ot"er is n+no,n) Later! t"ese #e**s are identi'ied as t"e 0is*ets o' Langer"ans1! ,"i#"

"e*p prod#e t"e "or&one ins*in)

1$"0s 6ren#" p"ysi#ian! Bo#"ardat! noti#es t"e disappearan#e o' sgar in t"e rine

o' "is dia-etes patients dring t"e 'ood rationing in Paris dring t"e 6ran#o%Prssian

War and 'or&*ates t"e idea o' indi/ida*i7ed diets

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1#0# de Meyer o' Be*gi& proposes t"e na&e 0ins*in1 :Latin; ins*a! is*and< 'or t"e

n+no,n pan#reati# s-stan#e)

1#11 Benedi#t de/ises a ne, &et"od to &easre rine sgar :Benedi#t=s So*tion

1#1* A**en=s -oo+! Stdies Con#erning 2*y#osria and Dia-etes! sti&*ates a

re/o*tion in dia-etes t"erapy)

1#10)1#20 A**en and >os*in are #onsidered t"e t,o *eading dia-etes spe#ia*ists in t"e

United States) >os*in -e*ie/es t"at dia-etes is 0t"e -est o' t"e #"roni# diseases1

-e#ase it ,as 0#*ean! se*do& nsig"t*y! not #ontagios! o'ten pain*ess and ss#epti-*e

to treat&ent1)

1#16 A**en pro&otes a stri#t diet regi&en! ,"i#" is soon ,ide*y adopted) A**en

-e*ie/es t"at t"e dia-eti#=s -ody #annot se 'ood! so "e *i&its t"e a&ont o' 'ood

a**o,ed patients) Patients ,ere ad&itted to t"e "ospita* and gi/en on*y ,"is+ey &i5ed

,it" -*a#+ #o''ee :or #*ear sop 'or teetota*ers< e/ery t,o "ors 'ro& ? a& to ? p&) T"is

diet is 'o**o,ed nti* t"ere is no sign o' sgar in t"e rine sa**y @ days or *ess) A

stri#t diet 'o**o,s Ot#o&es are -etter t"an e/er seen -e'ore 'or t"ose ,it" Type 4

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Best! Co**ip and Ma#*eod! Banting #ontines e5peri&enting ,it" di''erent pan#reati#

e5tra#ts on de%pan#reati7ed dogs)

1#21 Pa*es#! a distingis"ed Ro&anian s#ientist! p-*is"es an arti#*e des#ri-ing "is

s##ess'* iso*ation o' 0pan#reine1 ins*in)

1#21 Ins*in is 0dis#o/ered1) A de%pan#reati7ed dog is s##ess'**y treated ,it"

ins*in)

1#21 Banting presents T"e Bene'i#ia* In'*en#es o' Certain Pan#reati# E5tra#ts on

Pan#reati# Dia-etes! s&&ari7ing "is ,or+ at a session o' t"e A&eri#an P"ysio*ogi#a*

So#iety at a*e Uni/ersity)

1#22 In Toronto! one o' Co**ip=s ins*in e5tra#ts is tested on a "&an -eing! a %year%

o*d -oy na&ed Leonard T"o&pson) T"is test is #onsidered a s##ess -y t"e end o' t"e

'o**o,ing 6e-rary)

1#22 E*i Li**y and t"e Uni/ersity o' Toronto stri+e a dea* 'or t"e &ass prod#tion o'

ins*in in Nort" A&eri#a)

1#2* Banting and "is #o**eage! Ma#*eod! are a,arded t"e No-e* Pri7e in P"ysio*ogy

or Medi#ine) Banting s"ares "is a,ard ,it" Best Ma#*eod s"ares "is ,it" Co**ip)

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1#*0s Ins*in is 'rt"er re'ined) Prota&ine 7in# ins*in! a *ong a#ting ins*in t"at

pro/ides greater '*e5i-i*ity 'or dia-eti#s! is introd#ed) :It a#ta**y re&ained on t"e

&ar+et nti* se/era* years ago)os*in ,rites a-ot t"e 0n+no,n dia-eti#1 in Postgradate Medi#ine) A*t"og" a

&i**ion peop*e are +no,n to "a/e dia-etes! "e spe#*ates a &i**ion &ore "a/e it -t

don=t +no, it) $e is t"e 'irst e5pert to e&p"asi7e t"at ins*in a*one #annot so*/e a**

dia-etes%re*ated isses

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1#55 Ora* drgs t"at "e*p *o,er -*ood g*#ose *e/e*s are introd#ed)

1#5# T,o &a9or types o' dia-etes are re#ogni7ed; Type :ins*in%dependente+!t &ss% In peop*e ,it" dia-etes! ins''i#ient ins*in pre/ents t"e -ody 'ro&

getting g*#ose 'ro& t"e -*ood into t"e -odys #e**s to se as energy) W"en t"is

o##rs! t"e -ody starts -rning 'at and &s#*e 'or energy! #asing a red#tion in

o/era** -ody ,eig"t)o F%t+ue % W"en t"ere is not enog" ins*in! or t"e ins*in isn=t ,or+ing e''e#ti/e*y!

it &eans t"e sgar in or -*ood #annot get into or #e**s and t"ere'ore or #e**s

do not re#ei/e t"e energy t"ey need) As a res*t! ,e 'ee* 'atiged) $ig" -*ood

g*#ose s*o,s -*ood #ir#*ation so #e**s #an=t get t"e o5ygen and ntrients t"ey

need)o (%3 +nterest %n nentr%t+n A #onstant spp*y o' g*#ose to t"e -rain

is needed in order to &aintain nor&a* -rain 'n#tioning)o A t+n&+n sens%t+n r nu,ness +n t!e !%ns r 'eet T"e #ase is sa**y

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da&aged! yor digestion s*o,s do,n and 'ood stays in yor -ody *onger t"an it

s"o*d) T"is is a #ondition #a**ed gastroparesis) It #an &a+e yo 'ee* (easy and

/o&it)

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De#reased a-sorption o' g*#ose -y t"e #e**sF no g*#ose a-sorption

2*#ose is na-*e to enter t"e #e**s

2*#ose re&ains in t"e -*ood strea&

In#reased ser& g*#ose *e/e*

2*#ose inta+eo' #e**s

2*#ose#on#entration

in rine

Os&oti#ressre

Tisse per'siono' +idne

Q Ser& os&o*arityS*ggis" '*o,

I&pairedde*i/ery o' -*ood

#o& onents

Energy 'ornor&a* #e**

'n#tion

Rea-sorptiono' g*#ose inrena* t-*e

Water 'ro&

#e**to,ardst"e -*ood

I&paired re&o/a*o' ,aste 'ro&

-*ood

Q B*ood/is#osity

B*ood '*o, tot"e organsInade(ate

in'*a&&atory response

Ce**star/ation

o##rs

Os&oti#pressre

2*#ose *e/e*e5#eeds

rena*

De"ydration

I&pairedrena*

'n#tion

Tisse per'sion

Mi#roorganis&,o*d entert"e -ody atany rote

Sti&*ation o'"nger

&e#"anis&

Waterrea-sor tioSti&*ation o'

os&ore#eptorNer/e "ypo5ia

Po*yriaQ Per&ea-i*ity

o' t"e rena*** **

Ner/e da&a e

Po*yp"agiaPo*ydipsia

E5#essi/e g*#ose isIn'e#tion o##rs

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Hyp&ye+%

T"is is a sitation ,"ere t"ere are a-nor&a**y *o, *e/e*s o' g*#ose in t"e -*ood)It #an o##r ,"en e5#essi/e a&onts o' dia-eti# &edi#ations "a/e -een gi/en! ,"en

not enog" 'ood "as -een eaten! or ,"en too " e5er#ise "as -een nderta+en)

Be#ase #e**s re*y on g*#ose 'or 'e* in order to 'n#tion! "ypog*y#e&ia #an a''e#t t"e

proper 'n#tioning o' t"e #e**s % parti#*ar*y t"e #e**s in t"e ner/os syste&) T"is #an

*ead to initia* sy&pto&s s#" as ner/osness! di77iness! ,ea+ness! #on'sion! -*rred/ision and tre&ors) T"e 'irst signs o' "ypog*y#e&ia &st -e treated (i#+*y in order to

pre/ent sy&pto&s -e#o&ing se/ere) T"is in/o*/es eating or drin+ing so&et"ing sgary

e)g) orange 9i#e! and g*#ose ta-*ets) I' *e't ntreated! "ypog*y#e&ia #an #ase

sei7res and #o&a) T"is sitation re(ires rgent treat&ent in "ospita*)

/et%+s+s

So&e peop*e ,it" Type dia-etes #an de/e*op a #o&p*i#ation #a**ed dia-eti#

+etoa#idosis) Getoa#idosis de/e*ops ,"en t"e -ody doesnt "a/e enog" ins*in to

-rea+ do,n g*#ose and se it as 'e*! so it -rea+s do,n 'at to se 'or 'e* instead)

W"en 'at is -ro+en do,n a#ids #a**ed +etones are prod#ed) I' too " 'at is -ro+en

do,n at any one ti&e! e5#essi/e a&onts o' +etones &ay -e re*eased! #asing t"e

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/esse*s to "arden! narro, and -e#o&e -*o#+ed ,it" 'atty deposits :a pro#ess +no,n as

at"eros#*erosis

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Eye D+se%se; Ret+np%t!y

In peop*e ,it" dia-etes! t"e &any tiny -*ood /esse*s in t"e retina #an ,ea+en or-rea+) T"is #an a''e#t t"e retinas a-i*ity to ,or+ proper*y and #an #ase -*ood to *ea+

into t"e eye-a**! #*oding t"e /ision) T"is pro#ess is +no,n as dia-eti# retinopat"y)

Dia-eti# retinopat"y and #atara#ts do not tend to o##r nti* dia-etes "as -een present

'or &any years) It is t"ere'ore re#o&&ended t"at peop*e ,it" dia-etes are s#reened 'or

t"ese #onditions -y "a/ing t"eir eyes #"e#+ed e/ery % 4 years -y an eye spe#ia*ist:op"t"a*&o*ogist

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re*ated #onditions s#" as "ig" -*ood pressre) I' i&poten#e is e5perien#ed! it is

i&portant to dis#ss t"is ,it" a spe#ia*ist)

F. ANA-EENT

%@ EDICA( ANA-EENT

T"e goa* o' dia-etes &anage&ent is to +eep -*ood g*#ose *e/e*s as #*ose tonor&a* as sa'e*y possi-*e) Sin#e dia-etes &ay great*y in#rease ris+ 'or "eart

diseaseand perip"era* artery disease! &easres to #ontro* -*ood pressre and

#"o*estero* *e/e*s are an essentia* part o' dia-etes treat&ent as ,e**)

Peop*e ,it" dia-etes &st ta+e responsi-i*ity 'or t"eir day%to%day #are) T"is

in#*des &onitoring -*ood g*#ose *e/e*s! dietary &anage&ent! &aintaining p"ysi#a*a#ti/ity! +eeping ,eig"t and stress nder #ontro*! &onitoring ora* &edi#ations and! i'

re(ired! ins*in se /ia in9e#tions or p&p)

5harmacologic 6anagement7

Insu&+n T!er%py

Peop*e ,it" type dia-etes re(ire &*tip*e ins*in in9e#tions ea#" day to

&aintain sa'e ins*in *e/e*s) Ins*in is o'ten re(ired to treat type 4 dia-etes too) Using

https://www.ucsfhealth.org/conditions/heart_disease/index.htmlhttps://www.ucsfhealth.org/conditions/heart_disease/index.htmlhttps://www.ucsfhealth.org/conditions/peripheral_artery_disease/index.htmlhttps://www.ucsfhealth.org/conditions/heart_disease/index.htmlhttps://www.ucsfhealth.org/conditions/heart_disease/index.htmlhttps://www.ucsfhealth.org/conditions/peripheral_artery_disease/index.html

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Cn Types Hu%n Insu&+n

9rep%r%t+n Onset 7!r@ 9e%3 eet

7!r@

Dur%t+n Eet

7!r@Lispro :$&a*og< i&&ediate 3&ins% 3%Reg*ar :$&*in%R< 3&ins% 4% @%?Lants @ 4$&*in%N %4 %4 4$&*in%L %3 % 4

$&*in%U %J 3

or do#tor ,i** deter&ine yor dose and "o, o'ten yo need to ta+e ins*in)T"ere is no standard ins*in dose as it depends on 'a#tors s#" as yor -ody ,eig"t!

,"en yo eat! "o, o'ten yo e5er#ise and "o, " ins*in yor -ody prod#es)

Or%& Ant+)D+%,et+ e+%t+n

So&eti&es -*ood sgar *e/e*s re&ain "ig" in peop*e ,it" type 4 dia-etes e/en

t"og" t"ey eat in a "ea*t"y &anner and e5er#ise) W"en t"is "appens! &edi#ations

ta+en in pi** 'or& &ay -e pres#ri-ed) T"e &edi#ations ,or+ in se/era* di''erent ,ays)

T"ese in#*de i&pro/e t"e e''e#ti/eness o' t"e -odys natra* ins*in! red#e -*ood

sgar prod#tion! in#rease ins*in prod#tion and in"i-it -*ood sgar a-sorption) Ora*

dia-etes &edi#ations are so&eti&es ta+en in #o&-ination ,it" ins*in)

Ora* &edi#ation eit"er &a+es t"e pan#reas prod#e &ore ins*in! "e*ps de#rease

ins*in re(ire&ents -y t"e -ody or red#es g*#oneogenesis -y t"e *i/er

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To*a7a&ide :To*inase