diabetes hyperinsulinism hypoglycemia
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DIABETES MELLITUS
A metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both
Signs And Symptoms
The diabetic syndrome is due to insulin deficiency combined with +ve actions of hormones antagonist to insulin ( glucagon, GH, adrenal glucocorticoids ) diabetes mellitus is characterized by :
Polyuria Polydipsia Weight loss in spite of polyphagia (increased appetite) Hyperglycemia Glycosuria Ketosis Acidosis Coma.
Causes
Lack of insulin due to: Destruction of β cells Surgical removal of pancreas Congenital absence of pancreas Genetical cause Auto-immune disorder Viral infections Chemicals and drugs
Types Of Diabetes Mellitus There are two general types of diabetes
mellitus: Type I diabetes OR insulin-dependent
diabetes mellitus (IDDM) caused by lack of insulin secretion.
Type II diabetes OR non-insulin-dependent diabetes mellitus (NIDDM) caused by decreased sensitivity of target tissues to the metabolic effect of insulin.
Type I Diabetes…Facts
It Is not contagious which means you can not give it to anyone, nor can it be caught.
Viruses like the mumps or German measles and apos may cause type I diabetes.
Different types of foods such as cow’s milk when fed early in life to 3 or 4 month olds can cause diabetes.
Scientist linked type I diabetes to genetics.Parents with diabetes that have children are more likely to develop diabetes then someone without a family history of diabetes.
Type I Diabetes
Signs and symptoms: Polydipsia Polyphagia Polyuria Weight loss Fatigue Blurred vision
Causes: Genetics Obesity – insulin resistance, Sedentary lifestyle Age – almost half of new
cases are in people over the age of 55
Treatment: Taking insulin Exercising regularly
and maintaining a healthy weight
Eating healthy foods
Change unhealthy eating habits.
Monitoring blood glucose levels.
Type II Diabetes…Facts
Most common form of diabetes. Most important triggers of diabetes is obesity.
Too much body fat makes it hard for the body to accommodate insulin resistance.Body fat promotes insulin resistance.
Also related to genetics.Inheritance of certain genes, obesity, age, and lifestyles.
The decrease in insulin sensitivity with menopause suggests that estrogen generally protects against insulin resistance in women. Loss of estrogen function, through changes in estrogen receptor, has been shown to cause insulin resistance and type 2 diabetes in a male patient.
Type II Diabetes
Signs and symptoms :
Polydipsia Polyphagia Polyuria Fatigue Blurred vision Achanthosis nigricans
– dark patches on skin slow healing of
wounds
Treatment Blood sugar monitoring Healthy eating Regular exercise Possibly, diabetes
medication or insulin therapy
No insulin shots unless sick or in need of more insulin.
Oral medications. Change to low-fat diet. Loosing weight.
Hyperinsulinism (CHI) is characterised by inappropriate and unregulated insulin secretion from the beta-cells of the pancreas.
HYPERINSULINISM
Congenital Hyperinsulinism (CHI)
In congenital hyperinsulinism the beta-cells release insulin inappropriately all the time and insulin secretion is not regulated by the blood glucose level (as occurs normally).
The action of insulin causes hyperinsulinaemic hypoglycaemia. High insulin levels prevent ketone bodies being made.
This means that the brain is not only deprived of its most important fuel (glucose), but also ketone bodies which are used as alternative fuels.
Primary Cause
At present, there are seven known genetic causes of CHI, which can be inherited in an autosomal recessive or dominant manner.
Abnormalities in the genes ABCC8 and KCNJ11 are the most common cause of severe CHI. Other rare causes are due to abnormalities in genes involved in regulating insulin secretion from the pancreas beta cells.
Secondary Causes
Secondary causes of hyperinsulinism can be subdivided into several categories. These categories can often be distinguished by the length of treatment required and the infant’s response to medical management. Transient hyperinsulinaemic hypoglycaemia means that the increased insulin production is only present for a short duration and is found in conditions such as:
Intrauterine growth retardation Infants of diabetic mothers Infants with perinatal asphyxia More research is needed to understand why transient
hyperinsulinism occurs. Some syndromes also present in the newborn period with hyperinsulinaemic hypoglycaemia. In infants with beckwith weidermann syndrome, an overgrowth syndrome, up to 50 per cent have been observed to develop hyperinsulinaemic hypoglycaemia.
Symptoms
As CHI is a congenital condition, a child usually starts to show symptoms within the first few days of life, although very occasionally symptoms may appear later in infancy.
Symptoms of hypoglycaemia can include floppiness, shakiness, poor feeding and sleepiness, all of which are due to the low blood glucose levels.
Seizures (fits or convulsions) can also occur, again due to low blood glucose levels. If the child’s blood glucose level is not corrected, it can lead to loss of consciousness and potential brain injury.
Treatment
During the transfer to the specialist centre, children are monitored closely and regularly to keep the blood glucose level as near normal as possible. If the level drops, the nurse and/or doctor in charge will be able to give glucose, either as a drip or an injection.
There are various drugs and each one will be tried in turn until the one that offers the best result is found. Drugs used to reduce insulin secretion include: diazoxide, chlorothiazide, nifedipine (this is rarely used as it is not as effective as the other medications), glucagon and octreotide.
Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels.Hypoglycemia may also be referred to as an insulin reaction, or insulin shock
HYPOGLYCEMIA
Symptoms
Mild Symptoms The typical signs of low
sugar levels: Trembling/shakiness Sweating Anxiety Irritability Pallor (face goes pale) Heart palpitations
(unregulated pattern) Tingling lips Loss of consciousness
(uncommon)
Severe Symptoms When the hypoglycemia
is more severe the following signs or symptoms are possible:
Concentration problems Confusion Irrational and disorderly
behavior (similar to somebody who is drunk)
Seizures (uncommon)
Causes
Hypoglycemia most commonly happens when a person with diabetes has taken too much insulin
Lack of glucagon (hormone that is secreted from the pancreas that raises blood glucose levels)
Excessive alcohol consumption: drinking heavily can block liver from releasing stored glucose
Tumor of pancreas known as an Insulinoma
Treatments
Check your blood sugar often, if below 70mg/dl (milligrams per deciliter) stabilize it by eating:
3-4 glucose tablets Half of cup of a non diet soft drink 1 cup of milk 5 or 6 pieces of hard candy Measurements may vary for children Doctor may also have a treatment plan, meal
plan, medications or physical activities
Importance Of Physical Therapy In Treatment Of Diseases
Exercise - make sure you have eaten some carbohydrate-rich food before you do any exercise.
References
Lippincott’s illustrated reviews: Biochemistry. Chapter 25 Diabetes Mellitus
Kiana Favours secretory at Cleveland Clinic (diabetes article) http://www.gosh.nhs.uk/medical-information/search-for-medical-conditi
ons/hyperinsulinism/hyperinsulinism-information/ Medical Author: Robert Ferry Jr., MD. Retrieved from
http://ww.emedicinehealth.com/low_blood_sugar_hypoglycemia/article_em.htm
Mathur , R. M. F., & Schiel Jr., W. C. (2008, 21 10). Medicinenet . Retrieved from http://www.medicinenet.com/hypoglycemia/article.htm
Robin, S. R. (1999). Hypoglycemic diabetes . Rydner. DOI: Farver, A. F. (2009, June 2). Hypoglycemic complications. Retrieved from http://www.mayoclinic.com/health/diabetic-
Farver, A. F. (2009, June 2). Hypoglycemic complications . Retrieved from http://www.mayoclinic.com/health/diabetic-
Rickers, F. (2008). National diabetes information clearinghouse . Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/
Davey, D. P. (16, February 20). Hypoglycemia (low blood glucose) in non-diabetic people . Retrieved from http://www.netdoctor.co.uk/diseases/facts/bloodsugarlow.htm