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Diff: Diabetes Mellitus

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	'''Diabetes mellitus''' is a group of long-term conditions in which the level of glucose in the blood becomes too high. This happens because the body does not make enough insulin, cannot use insulin properly, or both.

'''Diabetes mellitus''' is a chronic medical condition characterised by heightened levels of blood glucose ([[hyperglycaemia]]) stemming from deficiencies in insulin secretion, insulin action, or a confluence of both factors. Insulin, a hormone manufactured by the pancreas, assumes a pivotal role in regulating blood sugar levels. Diabetes may precipitate various complications that impact diverse organ systems. Effective management involves lifestyle modifications, pharmaceutical interventions, and, in certain instances, insulin therapy.
	Insulin is a hormone made by the pancreas. It helps glucose move from the blood into cells, where it can be used for energy. Without enough effective insulin, glucose remains in the blood and can damage blood vessels, nerves, eyes, kidneys, and other tissues over time.

== Classification ==	== Classification ==
	The main types of diabetes are:

=== Type 1 Diabetes: ===
	* '''Type 1 diabetes''', an autoimmune condition in which the body cannot make insulin. It often starts in childhood or adolescence, but it can develop at any age. Type 1 diabetes is treated with insulin.
	* '''Type 2 diabetes''', in which insulin does not work properly or the body does not make enough of it. It is more common than type 1 diabetes and is linked with factors such as age, weight, ethnicity, family history, and physical inactivity.
	* '''Gestational diabetes''', which develops during pregnancy and increases the chance of type 2 diabetes later in life.
	* '''Other forms of diabetes''', including monogenic diabetes, diabetes related to pancreatic disease, and diabetes caused or worsened by some medicines or endocrine conditions.

* Autoimmune Pathogenesis: The immune system orchestrates an assault on and subsequent destruction of insulin-producing beta cells within the pancreas.
* Insulin Dependency: Those afflicted with type 1 diabetes necessitate insulin for subsistence.
* Onset: Typically diagnosed during childhood or adolescence.
	== Symptoms ==
	Common symptoms of diabetes include:

=== Type 2 Diabetes: ===
	* Feeling very thirsty.
	* Urinating more often than usual, especially at night.
	* Feeling very tired.
	* Losing weight without trying.
	* Blurred vision.
	* Cuts or wounds taking longer to heal.
	* Recurrent infections or thrush.

* Insulin Resistance: Cells acquire resistance to insulin, while the pancreas may falter in producing an adequate insulin supply.
* Lifestyle Correlates: Obesity, sedentary habits, and genetic predisposition contribute to type 2 diabetes.
* Onset in Adulthood: Frequently diagnosed in adults, though an escalating incidence is observable in the youthful demographic.
	Type 1 diabetes can develop quickly and may become urgent. Type 2 diabetes can develop gradually and may not cause obvious symptoms at first.

=== Gestational Diabetes: ===
	== Diagnosis ==
	Diabetes is diagnosed with blood tests. These may include:

* Pregnancy-Related Morbidity: Manifests during pregnancy and heightens the risk of later-life type 2 diabetes.
* Glucose Intolerance: Elevation in blood glucose levels during gestation.
	* '''HbA1c''', which reflects average blood glucose over the previous two to three months.
	* '''Fasting glucose''', measured after not eating for a set period.
	* '''Oral glucose tolerance test''', sometimes used in pregnancy or where diagnosis is uncertain.
	* '''Random blood glucose''', especially when symptoms are present.

== Symptoms ==
	The correct test and threshold depend on the clinical situation. Diagnosis should be made by a qualified healthcare professional.

* Polyuria: Augmented frequency of urination.
* Polydipsia: Inordinate thirst.
* Polyphagia: Excessive hunger.
* Unexplained Weight Loss: Persists despite an increased appetite.
	== Complications ==
	Short-term complications can include:

== Diagnosis ==
	* '''Hypoglycaemia''', where blood glucose becomes too low. This is most often linked to insulin or some diabetes medicines.
	* '''Hyperglycaemia''', where blood glucose becomes too high.
	* '''Diabetic ketoacidosis''', a serious emergency that can occur when the body lacks insulin and produces high levels of ketones.
	* '''Hyperosmolar hyperglycaemic state''', a severe complication more often associated with type 2 diabetes.

* Fasting Blood Glucose Test: Measures blood glucose levels following an overnight fasting period.
* Oral Glucose Tolerance Test (OGTT): Assesses the body's capacity to manage a glucose load.
* Haemoglobin A1c Test: Reflects mean blood glucose levels over the preceding 2-3 months.
	Long-term complications can include:

== Complications ==
	* Heart disease and stroke.
	* Kidney disease.
	* Eye disease, including diabetic retinopathy.
	* Nerve damage, including peripheral neuropathy.
	* Foot ulcers and, in severe cases, amputation.
	* Gum disease and other infection risks.

=== Short-Term Complications: ===
	Good diabetes care aims to reduce these risks through glucose management, blood pressure control, cholesterol management, foot checks, eye screening, kidney monitoring, and support for lifestyle changes.

* Hypoglycaemia: Reduced blood sugar levels, precipitating symptoms like dizziness and cognitive confusion.
* Hyperglycaemia: Elevated blood sugar levels, potentially instigating diabetic ketoacidosis (DKA).
	== Management ==
	Diabetes management depends on the type of diabetes and the person's needs. It may include:

=== Long-Term Complications: ===
	* Education about glucose monitoring, food, activity, illness, and medicines.
	* Insulin therapy, especially for type 1 diabetes.
	* Tablets or injectable medicines for type 2 diabetes.
	* Weight management, balanced eating, and physical activity.
	* Blood pressure and cholesterol management.
	* Regular review by a GP, diabetes nurse, specialist diabetes team, or other appropriate clinician.

* Cardiovascular Morbidity: Escalates susceptibility to cardiovascular maladies and cerebrovascular incidents.
* Nephropathy: Induces kidney impairment.
* Retinopathy: Provokes ocular impairment, possibly culminating in blindness.
* Neuropathy: Incites nerve damage, signifying symptoms of paraesthesia.
* Foot Complications: Impaired circulation and neural damage amplify the vulnerability to infections and amputation risks.
	Some people with type 2 diabetes can reduce glucose levels through weight loss and lifestyle changes, while others need long-term medication or insulin. Type 1 diabetes requires insulin because the body cannot make enough of its own.

== Management ==
	== Related Conditions ==
	* [[Hyperglycaemia]]
	* [[Hypoglycemia\|Hypoglycaemia]]

* Lifestyle Interventions: Adoption of a wholesome diet, regular physical activity, and weight vigilance.
* Pharmacological Modalities: Administration of oral hypoglycaemic agents or insulin therapy as deemed clinically appropriate.
	== References ==
	* [https://www.nhs.uk/conditions/diabetes/ NHS: Diabetes]
	* [https://www.nhs.uk/conditions/type-1-diabetes/ NHS: Type 1 diabetes]
	* [https://www.nhs.uk/conditions/type-2-diabetes/ NHS: Type 2 diabetes]
	* [https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/ NHS: High blood sugar]
	* [https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/ NHS: Low blood sugar]

	[[Category:Health]]
	[[Category:Medicine]]