Understanding And Managing Diabetes Mellitus

Why is the disease given the name diabetes mellitus? How does diabetes mellitus differ from diabetes insipidus?

Questions:

Diabetes mellitus is a major world health problem. Treatment and management of diabetics is a very significant issue for governments, society and both pharmacists and pharmaceutical companies. Completing this assignment will help you to gain a deeper understanding of diabetes mellitus. 

The length of this assignment excluding graphs, figure legends and references should be no more than 1000 words. The % of marks allocated to each section is a guide to the word length for that section. Where appropriate references should be included using the Harvard System cited appropriately in the text with correct formatting in the reference list. As a guide a minimum of 4 but no more than about 12 references should be used. You are advised to use references from both primary and secondary sources. 

Assignments should be typed and submitted using learnonline via the Course Website. Graphs must be thoughtfully incorporated into the text. Due date/time is 6:00pm 9^th June. 

1. Why is the disease given the name diabetes mellitus? How does diabetes mellitus differ from diabetes insipidus?

2. Individuals with the diabetes mellitus are classified into two main groups. What are they and what is the basis of the classification system used? 

3. How are patients diagnosed as diabetics? What treatment options are most used to manage this condition?

4. What changes in the metabolism of glucose and fat (triglycerides) are observed in this disease? What symptoms might a diabetic show as a result of these metabolic changes and why do these occur?

5. Two overnight fasting patients, A & B, were each given a dose of 75g of glucose at time zero. Their blood glucose levels were measured at 0, 30, 60, 90, 120 and 240 minutes after ingestion of the glucose using a glucose specific assay. The brief procedure for this assay is:-

a. Add 5.0 ml of assay reagent to sufficient tubes for the assay

b. Add 0. 1 ml of each glucose standard to a tube of assay reagent

c. Add 0. 1 ml of each test serum to a tube of assay reagent.

d. Mix the contents of each tube and read the absorbance at 625 nm. 

The results obtained are shown in the two tables below. 

Table 1 – standards

Glucose standard (mmol/L)	Absorbance @ 625 nm
0	0.02
3	0.21
6	0.43
9	0.65
12	0.83

Table 2 – patient results 

Time (min)	Absorbance-Patient A	Absorbance-Patient B
0	0.26	0.47
30	0.51	0.63
60	0.25	0.82
90	0.23	0.81
120	0.24	0.71
240	0.30	0.68

Plot a standard graph of absorbance at 625 nm against glucose concentration You must use Excel. 

Determine the concentration of glucose in each patient serum sample and plot glucose concentration against the time over which the samples were obtained. Comment on the results for the two patients

6. What potential long term problems would a pharmacist need to be aware of when advising a diabetic client?  

Diabetes is a common metabolic disorder that is affecting people from the time of 1500 BCE. Diabetes Miletus got its name derived from two Greek words diabetes from ‘siphon’ means ‘that is to pass through’ and mellitus from ‘honeyed’ (Tattersall, 2010).

The DM and DI belong to the same category of metabolic disorder but are very different from each other. The difference is shown in table below 

Diabetes mellitus	Diabetes insipidus
Urine flow is high and diluted	Urine flow is normal but concentrated
No glucose in urine	High glucose in urine
Rise in blood cholesterol	No such rise in cholesterol
Ketogenesis occurs	No ketogenesis
Increase in appetite	No increase in appetite
Imbalance of insulin	Imbalance of ADH

Classification of diabetes mellitus

The diabetes mellitus is classified on the basis of peculiar characteristics classification system and is classfied in two types Diabetes mellitus type -1 and diabetes mellitus type -2. The individual with Type- 1 DM show absence of insulin hormone in the body due to pancreatic failure because beta cells in pancreas stop functioning whereas individual with Type – 2 DM have sufficient insulin present in body but there is insulin resistance development in the body leading to improper functioning of glucose metabolism (Patient, 2016). 

The determination of blood glucose level forms the baseline for diagnosis of the diabetic condition. There are different test employed to detect the presence of diabetes that is described below

This diagnosis is generally applied to identify the defect in sugar metabolism process in the body. This test is helpful to determine pre-diabetes condition, insulin resistance and reactive hypoglycaemia. The test is performed in two stages that are fasting glucose value and post two-hour glucose value. The OGTT results showing positive diabetic condition are described below: –

OGTT test	Normal level	Diabetic level
Fasting glucose value	6 mmol/L	Above 7 mmol/L
Post 2-hour glucose value	7.8 mmol/L	Above 11.0 mmol/L

There are more than eight classes of diabetic drugs that contain more than 50 medications performing function to control diabetes. Some of the most successful drug treatments are Insulatard, Metformin, Sulfonylureas, alpha-glucosidase inhibitors etc. (McPhee and Papadakis, 2010). Further, direct insulin hormone is the workable treatment to control the type-1 as well as type-2 (pills or insulin shots) DM condition. Some of the most successful CAM used to manage diabetes is aromatherapy, Chinese medicine acupuncture, biofeedback, dietary supplements, reflexology etc. (Lorig et al. 2010). 

Insulin hormone mediates the blood glucose conversion in stored form of fat in the liver. In DM conditions either insulin is absent or body develops insulin resistance, therefore, a condition of hyperglycaemia (high blood glucose) occurs due to low insulin, increased glucose production or decreased glucose utilisation. Further, the uptake of glucose by cells is also affected due to the absence of insulin. The glucose phosphorylation helps in cellular glucose uptake from blood but in the absence of insulin non-hepatic glucose utilisation minimises the glucose uptake showing an imbalance in glucose metabolic process leading to hyperglycaemia. 

The formation of glycogen (triglycerides) from glucose requires insulin as a mediating hormone. But, in DM condition insulin is not in proper state of activity leading to no glycogen storage in the liver and hyper glycerides in the blood indicating fat metabolism defect leading to the formation of hypertriglyceridemia in the body. The adipose as well as skeletal cells stop taking glucose from the blood in the insulin absence due to the disturbance in glucose transport proteins required for glucose uptake by cells. This protein gets disturbed because it requires insulin as a mediator for its formation. Hence, in this manner condition of diabetes disturbs the fat metabolism in the body (Staff.ncl.ac.uk, 2016). 

The most common symptoms of type-1 diabetes are increasing thirst, Excessive urination, dizziness and tiredness, loss of muscular bulk and weight, itching in the vaginal zone, nausea and vomiting as well as loss of appetite. Further, the symptoms arising due to metabolic changes in Type-2 diabetes are tiredness and dizziness specifically after meals, random hungry feelings (polyphagia), more often urination than normal (polyuria) and sudden weight loss (Diabetes.co.uk, 2016).

These symptoms occur due to high glucose concentration in the blood that is not been used as body fuel gets collected in blood. In the process of the body trying to reduce glucose concentration flushes excessive glucose out of the body in the form of urine creating urination imbalance. Further, as body is not getting enough energy because glucose is not getting converted to energy form results in excessive hunger, polyphagia, tiredness etc. symptoms in diabetes. In the absence of insulin, the body glucose is not getting stored in the form of glycogen leads to weight loss, muscle and appetite loss. Further, itching in the vaginal region occurs due to excessive sugar in the urinal secretion as a form of reaction (McPhee and Papadakis, 2010). 

Time (min)	Glucose concentration Patient – A	Glucose concentration Patient- B
0	3.71	6.71
30	7.23	9
60	3.57	11.7
90	3.28	11.5
120	3.42	10.1
240	4.28	9.71

As per above provided data on glucose concentrations of patient-A and B it is clear that Patient-B is suffering from diabetes because the glucose concentration is very high when compared with standard whereas patient-A shows normal glucose concentrations hence the absence of diabetes. 

When providing advice to a diabetic client the long-term problems that require the attention of therapist, as well as the patient, is high risk for cardiovascular diseases, heart attack risk, and blood vessels damages. There is also high risk for eye diseases like retinopathy, oedema, and cataract in diabetes. Further, kidney damages is another long-term risk due to ketogenesis in type-1 DM. alongside there are conditions like skin diseases, gum diseases and mental diseases common long-term risk factor for diabetes. The diabetic patient develops a high risk of cardiovascular diseases that commonly involves stroke, heart attack and heart valve failure as the blood becomes condensed due to high sugar level (Lorig et al. 2010).

Along with long-term risk diseases, there are certain long-term conditions that develop as a result of diabetes that is blurred vision, weight loss and weakness that a pharmacist need to keep in mind when advising diabetic patient (Staff.ncl.ac.uk, 2016). 

References

Books

Alwan, A., 2011. Global status report on non-communicable diseases 2010. World Health Organization. 

McPhee, S.J. and Papadakis, M.A. eds., 2010. Current Medical Diagnosis & Treatment 2012. New York:: McGraw-Hill Medical. 

Journals

Lorig, K., Ritter, P.L., Laurent, D.D., Plant, K., Green, M., Jernigan, V.B.B. and Case, S., 2010. Online diabetes self-management program A randomized study. Diabetes care, 33(6), pp.1275-1281. 

Tattersall, R.B., 2010. The history of diabetes mellitus. Textbook of Diabetes, Fourth Edition, pp.1-23. 

Wajchenberg, B.L., 2010. Clinical approaches to preserve β-cell function in diabetes. In The Islets of Langerhans (pp. 515-535). Springer Netherlands.