Diagnosis and management of diabetes mellitus

Diagnosis and Management of Diabetes Mellitus

Definition of Diabetes Mellitus

Diabetes mellitus is a metabolic disorder characterized by high levels of blood glucose, which results from defects in the insulin secretion or its action or both. Early diagnosis and management of diabetes mellitus will help prevent complications.

Diabetes mellitus commonly known as diabetes was first identified as a disease associated with ‘sweet urine’ and excessive muscle loss in the past. Elevated levels of blood glucose (hyperglycaemia) lead to spillage of glucose into the urine, hence the tern sweet urine.

Types of diabetes mellitus

Type 1 diabetes

Type 1 diabetes is an autoimmune disease. This means that the body produces antibodies against its own healthy tissues. These antibodies destroy the insulin-producing cells of the pancreas (called beta cells). This deterioration usually begins at a young age. If all the beta cells are destroyed, the body can no longer produce insulin. After all, type 1 diabetes is accompanied by insulin deficiency.

Type 2 diabetes

In type 2 diabetes, several factors can cause blood sugar levels to be too high. Unlike the type 1 where there is little or no insulin production. In type 2, the effect of insulin is reduced, so cells in various tissues cannot optimally use the available insulin. This is also called insulin resistance. Type 2 diabetes is sometimes referred to as “age-related diabetes”. However, the name is misleading because young people can also develop type 2 diabetes.


Causes and Risk factors

Type 1 diabetes

In this type of diabetes, there is an inflammatory process in the islets of Langerhans of the pancreas. This eventually leads to the destruction of the insulin-producing cells. As a result, the body is no longer able to produce insulin independently. Insulin should always be administered using a syringe or pump.

Type 2 diabetes

Type 2 diabetes is often associated with obesity. In type 2 diabetes, there is almost always a lack of insulin production and reduced sensitivity to insulin (insulin resistance).


Symptom of Diabetes

Diabetes symptoms vary according to blood sugar levels.  Most people with prediabetes or type 2 diabetes usually have no symptoms.

Symptoms of type 1 diabetes tend to appear quickly and become more severe. Some symptoms of type 1 and type 2 diabetes include:


  • Feeling more thirsty than usual.
  • Frequent urination.
  • Lose weight without trying.
  • There are ketones in the urine. Ketones are a by-product of muscle and fat breakdown that occur when there is not enough insulin.
  • Feeling tired and weak or other mood swings
  • Blurry vision
  • Wounds heal slowly.
  • Get various infections such as gum, skin, and vaginal infections.

Type 1 diabetes can start at any age. However, it usually begins in childhood or adolescence. Type 2 diabetes is the most common type and can develop at any age. It is more likely for people over 40 to develop type 2 diabetes



Diagnosis of Diabetes Mellitus

Some forms of diabetes may be partially or fully inherited. In such cases, genetic studies will be required. Your DNA will be screened for any abnormalities that may be responsible for your condition.

Diabetes is sometimes discovered by chance during blood tests that you or your doctor have done for other diseases or conditions. After the diabetes detection, additional blood and urine tests will be done to check for any complications.


Recommended target blood glucose level ranges

The National Institute for Health and Care Excellence (NICE) recommended target blood sugar levels for adults with type 1 diabetes and children with type 2 and type 1 diabetes are as follows. In addition, the International Diabetes Federation has set blood sugar goals for people without diabetes. This table provides general guidance. The personal goals set by your healthcare team are the ones you should aim for.



Target Levels
by Type
Upon wakingBefore meals
(pre prandial)
At least 90 minutes after meals
(post prandial)
Non-diabetic*4.0 to 5.9 mmol/Lunder 7.8 mmol/L
Type 2 diabetes4 to 7 mmol/Lunder 8.5 mmol/L
Type 1 diabetes5 to 7 mmol/L4 to 7 mmol/L5 to 9 mmol/L
Children w/ type 1 diabetes4 to 7 mmol/L4 to 7 mmol/L5 to 9 mmol/L
NICE recommended target blood glucose level ranges



Normal blood sugar ranges

Normal blood sugar levels for most healthy people are:


4.0 to 5.4 mmol/L (72 to 99 mg/dL) fasting

Up to 7.8 mmol/L (140 mg/dL) 2 hours after a meal


Blood sugar ranges for people with diabetes include:

Before meals: 4 to 7 mmol/L in patients with type 1 or type 2 diabetes

After a meal: less than 9 mmol/l in type 1 diabetes and 8.5 mmol/l in type 2 diabetes.

In order to diagnose diabetes, the following tests are performed:

Random plasma glucose determination

Blood samples can be taken at any time for random determination of plasma glucose. It does not require much planning and therefore can be used to diagnose type 1 diabetes where time is of the essence.

Fasting blood sugar

Fasting blood sugar is measured at least eight hours after fasting, so it is usually done in the morning.

NICE guidelines say that a fasting glucose level between 5.5 and 6.9 mmol/L increases a person’s chance of developing type 2 diabetes, especially when combined with other risk factors for type 2 diabetes.

Oral Glucose Tolerance Test (OGTT)

The oral glucose tolerance test involves first taking a blood sample on an empty stomach and then drinking a very sweet drink containing 75 grams of glucose.

After drinking this drink, you should rest until another blood sample is taken two hours later.

The HbA1c test can diagnose diabetes

The HbA1c test does not measure blood sugar directly, but the test results can be affected by how high and low blood sugar levels are over a two to three month period.

Indications for diabetes or pre-diabetes are indicated in the following conditions:

Normal: less than 42 mmol/mol (6.0%)

Prediabetes: 42 to 47 mmol/mol (6.0 to 6.4%)

Diabetes: 48 mmol/mol (6.5% or more)


Treatment of Diabetes Mellitus

Treatment of diabetes mellitus involves lifestyle modification in addition to use of drugs. The following lifestyle interventions are necessary to treat diabetes mellitus:

  1. Regular exercise. Everyone needs regular cardio. This includes people with diabetes. Physical activity lowers blood sugar by transporting sugar into cells for energy. Insulin sensitivity is also increased by physical activity. This means your body needs less insulin to move sugar into your cells.

Get approval from your provider to exercise. Then choose an activity you enjoy, such as walking, swimming, or cycling. The most important thing is to make physical activity a part of your daily routine.

Try to get at least 30 minutes or more of moderate physical activity most days of the week, or at least 150 minutes of moderate physical activity each week. Daily activities can take a few minutes. If you’ve been inactive for a while, start slow and build muscle slowly. Spending too much time sitting is also bad for your health.

  1. Healthy food. There is no special diet for diabetes. Fruits, vegetables, and lean proteins should form the foundation of your diet. These foods are rich in nutrients, high in fibre and low in fat and calories.

You will also reduce your intake of saturated fat, refined carbohydrates, and sweets.

It can be difficult to understand the type and amount of food. A registered dietitian can help you create a meal plan that fits your health goals, nutritional preferences, and lifestyle. Portion control is also essential, especially if you have type 1 diabetes or use insulin as part of your treatment.

  1. Drug treatment. Drug treatment of type 1 diabetes involves mainly the use of insulin. People with type 1 diabetes may also benefit from Islet cell transplant. For type 2 diabetes, treatment involves the use of insulin in combination with oral medications.

People who are overweight may need to go for weight loss surgery.


More about insulin

There are four basic forms of insulin, categorised by effectiveness and duration of action:

Rapid-acting insulins contain insulin lispro, insulin aspart, and glulicine insulin. It is the fastest, reaching peak activity in about 1 hour and working for 3 to 5 hours. Rapid-acting insulin is injected at the beginning of a meal.

Short-acting insulin. Like regular insulin, short-acting insulin starts working a little slower and lasts longer than rapid-acting insulin. Regular insulin reaches peak activity within 2-4 hours and lasts for 6-8 hours. Inject thirty minutes before eating.

Intermediate-acting insulins, such as neutral protamine Hagedorn (NPH) or insulin U-500, begin to act in 0.5 to 2 hours, reach peak activity in 4 to 12 hours, and last for 13 to 26 hours, depending on conditions. about insulin. This type of insulin can be taken in the morning to provide coverage for the first half of the day, or in the evening to provide overnight coverage.

Long-acting insulins such as insulin glargine, insulin detemir, U-300 insulin glargine, or insulin degludec are less effective in the first few hours, but may provide protection for 20 to 40 hours, depending on which insulin is used.

Rapid-acting and short-acting insulins are commonly used by people who inject several times a day and need extra insulin with meals.

Some insulin combinations are already available in mixed form. In addition, people who need a large dose of insulin can use concentrated insulin.

In some cases, inhaled insulin is available for people who cannot or do not want to receive insulin injections. Inhaled insulin works like an inhaler (similar to an asthma inhaler) where people breathe insulin into their lungs to absorb it.

Inhaled insulin works as a short-acting insulin and must be taken several times a day. People should also receive long-acting insulin injections. With inhaled insulin, your doctor checks your lung function every 6 to 12 months.

Complications of Diabetes

Long-term complications of diabetes develop gradually. The longer you have diabetes and the less your blood sugar is controlled, the higher your risk of complications. As a result, diabetes complications can be debilitating and even life-threatening. In fact, prediabetes can lead to type 2 diabetes. Possible complications are:

Nerve damage (neuropathy). Eating too much sugar can damage the walls of the small blood vessels (capillaries) that supply the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually starts in the feet or toes and moves upwards.

Damage to the digestive nerves can cause problems such as nausea, vomiting, diarrhoea, or constipation. It can cause erectile dysfunction in men.

Foot injury. Damage to the nerves in the foot or poor blood flow to the foot increases the risk of many foot complications such as numbness, slow wound healing and in severe cases amputation.

Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessels (glomeruli) that filter the blood from waste. Diabetes can damage this microfiltration system.

Cardiovascular diseases. Heart disease is significantly more likely to occur in people with diabetes. This can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of the arteries (atherosclerosis). If you have diabetes, your risk of heart attack or stroke is higher.

Eye damage (retinopathy). Diabetes can damage the blood vessels in the eye (diabetic retinopathy). It can cause blindness.

Skin and mouth diseases; Diabetes can make you more prone to skin problems, including bacterial and fungal infections.


Complications of gestational diabetes

Most women with gestational diabetes give birth to healthy babies. But untreated or uncontrolled blood sugar can cause problems for both mother and baby.

Gestational diabetes can cause complications for your baby, including:


Overgrowth. Excess glucose can cross the placenta. Excess glucose stimulates the child’s pancreas to produce additional insulin. This can cause your child to grow too big. This can lead to a difficult birth, sometimes requiring a caesarean section.

Hypoglycaemia. Sometimes babies of mothers with gestational diabetes have hypoglycaemia (low blood sugar) shortly after birth. This is because insulin production is high. Babies born to mothers with gestational diabetes are at risk of obesity and type 2 diabetes later in life. Untreated gestational diabetes can cause the baby to die before or shortly after birth.

Gestational diabetes complications for the mother, includes:


Eclampsia. Symptoms of this condition include high blood pressure, excessive protein in the urine, and swelling of the legs and feet.

If you had gestational diabetes during one pregnancy, you are more likely to have it again during the next pregnancy.


Diabetes mellitus results when there is a problem with the pancreas, an organ that produces insulin. When the body makes little or no insulin, sugar builds up in the blood and can cause serious complications.

Eating a healthy diet and regular exercise can help you manage your diabetes.

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