What is diabetes mellitus?
Diabetes is a group of metabolic diseases, caused by defects in insulin secretion and in action of pancreas. As a result, blood glucose level keeps rising over a prolonged period of time that cannot be recovered by the kidneys, thereby it leads to the excretion of glucose in the urine, causing diabetes. In diabetic patients, the fasting blood glucose level usually exceeds 126 mg/dl, and two hours after a meal the blood glucose level is higher than 200 mg/dl.
 
The classification of diabetes mellitus:
  1. Type 1 diabetes mellitus: Most patients affected with it are younger than that of type 2 diabetes mellitus. Pancreatic β-cells, which produce insulin in the pancreas, are destructed by auto- antibodies or by unknown etiologies. As a result, pancreas fails to secrete insulin. Fat is metabolized instead, and subsequently, breakdown of ketone bodies leads to ketoacidosis.
  2. Type 2 diabetes mellitus: Most patients are elderly. It is characterized by relative insulin deficiency or insulin resistance, which leads to hyperosmolar-hyperglycemic state.
  3. Others: Genetic mutations affecting the function of beta cells, genetic deficiency in insulin’s action, diseases of the exocrine pancreas (such as pancreatitis, pancreatectomy, tumor, and cystic fibrosis), endocrine disease, medications and chemical substance-induced, and infection.
  4. Gestational diabetes mellitus: Insulin resistance and pancreatic beta cells dysfunction occurs during pregnancy. Hormones produced by the placenta and other pregnancy-related factors contribute to insulin resistance, leading to glucose intolerance. These hormones usually return to normal value soon after giving birth. Gestational diabetes disappears in most women after delivery. However, it can often result in fetal giant baby, congenital malformations, premature birth, stillbirth and polyhydramnios.
 
What are the possible causes of diabetes?
  1. Family history of diabetes.
  2. Autoimmunity: Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the β-cells in the pancreas.
  3. Viral Infections: Exposure to certain viruses, such as the measles virus, coxsackie virus, mumps virus, cytomegalovirus, etc.
  4. Others: Obesity, emotional stress, malnutrition, pregnancy, drugs, etc.

The Symptoms of diabetes:
Polyuria, polydipsia, polyphagia, unexplained weight loss, fatigue, perineum itchy, numbness in limbs, blurred vision, slow-healing wounds, but some are asymptomatic. If you have these symptoms please make an appointment with “Endocrinology & Metabolism” outpatient medical department immediately. 

The treatment of diabetes:
See the instructions highlighted in [Notice for insulin therapy], [Home Care of Diabetes Mellitus- Oral Antidiabetic Drugs for Patient’s Use], [Care of patient with DM and Exercise] and [Principle of DM Diet].

Principle of self-care:
  1. Once you become familiar with the knowledge of diabetes, kindly cooperate with the medical staff. This will help us to lay the foundation of correct treatment concept.
  2. Diet control: keep a regular and balanced exercise and maintain a steady body weight, follow the prescription that doctor prescribed, as well as continue to take oral hypoglycemic agents or insulin injections regularly. Do not increase/decrease the frequency, or stop the medication without permission. To control blood sugar level, you have to be patient and persistent.
  3. Regularly monitor and record blood sugar level, blood pressure, blood lipid profile and HbA1c level, and also get your eyes, renal function and foot examined, as a reference for the treatment planning.
  4. Try to relieve any stress, and maintain your mental health.
  5. Become familiar with the symptoms and understand the treatment followed for hypoglycemia. For example, carry sugar powder, cookies and a medical identification card with you all the time.
  6. Understand the preventive approach of diabetic coma. Therefore, if you feel sick, you should check blood sugar level immediately, and contact the doctor.
  7. Maintain proper foot hygiene and inspect your foot daily (See “Care of Patient with DM foot”).
  8. Quit smoking and drinking alcohol, and maintain a good lifestyle.
 
Reference
  1. American Diabetes Association. (2020). Classification and diagnosis of diabetes: Standards of medical care in diabetes-2020. Diabetes Care, 43(suppl 1), S14-S31. https://doi.org/10.2337/dc20-S002
  2. American Diabetes Association. (2020). Standards of medical care in diabetes-2020 abridged for primary care providers. Clinical Diabetes, 38(1), 10-38. https://doi.org/10.2337/cd20-as01
  3. The Diabetes Association of the Republic of China. (2018). 2018 Diabetes clinical care guidelines. Taipei City, Taiwan, R.O.C.: The Diabetes Association of the Republic of China.
  4. Ou, J. M., Shang, Z. J., Liu, J. H., Chang, Y. J., Shih, K. C., Hu, L. S. (2019). Nursing care of clients with endocrine disorders. In Wang, K. Y., Liu, H. E., & Feng, R. F. (Ed.), Medical surgical nursing (6th ed., pp. 13-80~13-85). Taipei City, Taiwan, R.O.C.: Yeong Dah.
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