Team:UNAM-CU//medical considerations
Medical area
Definition
Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
Factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
Epidemiology:
The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 285 million in 2010. Based on current trends, the International Diabetes Federation forecasts that 438 million individuals will have diabetes by the year 2030.
Although the prevalence of both type 1 and type 2 DM is increasing worldwide, the prevalence of type 2 DM is rising much more rapidly, presumably because of increasing obesity rates , however type 1 DM, one of the most common chronic diseases in childhood.
Diagnosis:
The criteria for the Diagnosis of Diabetes Mellitus are:
• Symptoms of diabetes such as…
• random blood glucose concentration 11.1 mmol/L (200 mg/dL)a
• Fasting plasma glucose 7.0 mmol/L (126 mg/dL)b
• Glycated hemoglobin > 6.5%c
• Two-hour plasma glucose 11.1 mmol/L (200 mg/dL) during an oral glucose tolerance test
Random is defined as without regard to time since the last meal
Fasting is defined as no caloric intake for at least 8 h
The test should be performed in laboratory certified according to A1C standards of the Diabetes Control and Complications Trial
The test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water, not recommended for routine clinical use.
Note: In the absence of unequivocal hyperglycemia and acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day.
Source: American Diabetes Association
Complications
Acute, life-threatening consequences of diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome. The chronic hyperglycemia associated with DM causes secondary pathophysiologic changes in multiple organ systems. Complications are divided into:
Microvascular complications:
• Eyes: retinopathy with potential loss of vision
• Kidneys: nephropathy leading to renal failure
• Nerves: peripheral neuropathy with risk of foot ulcers amputation and Charcot joints and autonomic neuropathy causing gastrointestinal, genitourinary and sexual dysfunction.
Macrovascular complications:
• Cardiovascular Disease: Process of atherosclerosis, which leads to narrowing of arterial walls troght the body, it is also associated with atherosclerotic plaque.
The American Diabetes Association considers diabetes can be classified into the following general categories:
1. Type 1 diabetes (due to β-cell destruction, usually leading to absolute insulin deficiency)
2. Type 2 diabetes (due to a progressive insulin secretory defect on the background or insulin resistance)
3. Gestational diabetes mellitus (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes)
4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation)
Let’s study the major difference between tye 1diabetes and type 2diabetes
In one category, type 1 diabetes: The cause is an absolute deficiency of insulin secretion. It most commonly presents in childhood, but one-fourth of cases are diagnosed in adults
Most of the genetic susceptibility is accounted for by human leukocyte antigen (HLA) alleles. The most-common susceptibility haplotypes are located in chromosome number 6. The polymorphism of the HLA complex represents 40 – 50% of the risk.
DM2 is a term used for individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency
Obesity, particularly visceral or central (as evidenced by the hip-waist ratio), is very common in type 2 DM (80% or more are obese). In the early stages of the disorder, glucose tolerance remains near-normal, despite insulin resistance, because the pancreatic beta cells compensate by increasing insulin output.
As insulin resistance and compensatory hyperinsulinemia progress, the pancreatic islets in certain individuals are unable to sustain the hyperinsulinemic state. IGT, characterized by elevations in postprandial glucose, then develops. A further decline in insulin secretion and an increase in hepatic glucose production lead to overt diabetes with fasting hyperglycemia.
Ultimately, beta cell failure ensues.
Early manifestations include:
• Weakness
• Poliuria
• Polidipsia
• Altered vision
• Weight loss
• Mild dehydration
For prolonged or severed hyperglycemia (accompanied by metabolic acidosis or diabetic ketoacidosis), manifestations include:
• Kussmaul hyperventilation (Deep, rapid breathing)
• Stupor
• Coma
• Hypotension
• Cardiac arrhythmias
Patients with type 1 diabetes mellitus require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels.
Current options for insulin administration are:
• Insulin Injections:
Rapid, short, intermediate, and long-acting insulin preparations are available.
Both regular human insulin and rapid-acting insulin analogues are effective at lowering postprandial hyperglycemia in various basal bolus insulin regimens used in type 1 DM. These insulins are absorbed more quickly and have a rapid onset of action (5-10 minutes), a short interval to peak action (45-75 minutes), and a short duration of action (2-4 hours).
Short-acting insulin includes regular insulin. Regular insulin is administered subcutaneously, its onset of action occurs in 0.5 hours, its peak activity comes at 2.5-5 hours, and its duration of action is 4-12 hours
Intermediate-acting insulins include NPH insulin, which provides a slower onset of action and longer duration of action than regular insulin does. The onset of action usually occurs at 1-2 hours, the peak effect is noted at 4-12 hours, and the duration of action is normally 14–24 hours.
• External devices
A small battery-operated infusion pump that administers a continuous subcutaneous infusion of rapid-acting insulin can provide selected, programmed basal rates of insulin and a manually administered bolus dose before each meal. The patient self-monitors pre-prandial glucose levels to adjust the bolus dose.
Both options result uncomfortable and expensive for the patient. The risk of hypoglycemia may result from a change in insulin dose, a small or missed meal, or strenuous exercise.
Common symptoms of hypoglycemia are light-headedness, dizziness, confusion, shakiness, sweating, and headache. Patients should be made aware of these symptoms and educated to respond rapidly with sugar intake.
The engineering area was commissioned to modeling the external device, PROINSULITRON, with which perform a therapy could be possible.