Diabetes Mellitus is a most common disorders of a glucose metabolism. Glucose is a critical source of energy for the brain, muscles and tissue. When we eat, our body breaks down carbohydrates into glucose. This triggers the pancreas to release a hormone called insulin, which helps glucose to enter the cells from the blood. Diabetes Mellitus can occur due to the chronic hyperglycaemia (increase level of blood sugar/glucose) due to either absence/decrease of insulin, normal insulin secretion but inadequate to cope with blood glucose or decreased sensitivity of insulin receptors. It can often present with various musculoskeletal and neurological complaints; therefore, it is important to be aware of this common disorder.
There are two types of Diabetes Mellitus; Type 1 Diabetes mellitus and Type 2 Diabetes Mellitus. Type 1 DM is an autoimmune pancreatic beta-cell destruction due to little or no insulin production. It is common in Childhood or adolescence. It possibly triggered in the genetically suspectable by infectious stimulus and/or toxic environmental stimulus. It accounts for less than 10% of all cases of diabetes mellitus whereas Type 2 DM is due to tissue insensitivity to insulin. It is generally evident later in life, but these days, incidents are also increasing in young people. It accounts for 90-95% of all cases of diabetes mellitus. Type 2 diabetes are also lifestyle related where obese people are at higher risk. The other risk factors for Diabetes Mellitus type 2 include family history of diabetes, over the age of 45, overweight/obese, history of high cholesterol or triglyceride levels, sedentary lifestyle, common in ethnicities- American Indian, Hispanics & Asians as well as presence of gestational diabetes or giving birth to large baby. Gestational Diabetes occurs when a pregnant woman has high levels of glucose in her blood due to mother cannot produce enough insulin. Gestational diabetes is usually temporary and disappears after pregnancy, however gestational diabetes can increase the risk by 50% -60% of developing type 2 diabetes mellitus in the future.
Early symptoms of increase level of blood sugar (hyperglycaemia) includes polyuria (increased urination), polydipsia (increased thirst) and polyphagia (increased hunger). Later complications may include Peripheral neuropathy (weakness, numbness and pain, usually in the hands and feet), Nephropathy (deterioration of kidney function) and predisposition to infection. The symptoms that may occur when diabetes develops are loss of consciousness, cataracts and glaucoma, visual disturbance due to damaged blood vessels in the eyes; if left untreated it can lead to blindness. Risk of bacterial, fungal and yeast infections. High blood pressure. Gastroparesis due to poor blood sugar management causing delayed emptying of food from the stomach. This can cause bloating, heartburn and nausea. Protein in the urine due to the dysfunction in the kidney. Dry, cracked skin due to uncontrolled high blood sugar causing the body to lose fluids at a faster rate. Nerve damage causing ‘pins and needles’. Damaged nerves can also alter the perception of heat, cold, and pain sensation, increasing the risk of injuries. Foot problems increasing the risk of calluses, infections, or ulcers of the foot and a decrease in blood circulations to the feet. Excessive urination or frequent urination is also an early warning sign of diabetes. Pancreas malfunction due to less production of insulin and body’s inability to convert glucose into energy. Due to kidneys and pancreas problems, feeling tired and lack of energy causing harder for an individual to concentrate. Diabetes Mellitus can also increase the risk of stroke four times higher than someone without diabetes.
One of the emergency complications of DM include Acute diabetic ketoacidosis. It can lead to insulin deficiency causing the body to metabolise triglycerides & muscles for energy. As a result, it leads to hyperglycaemia, hyperketonaemia & metabolic acidosis. It is most common with type 1 DM. The symptoms of Diabetes Ketoacidosis include polyuria, polydipsia, polyphagia, fruity breath, nausea, vomiting, headaches, abdominal pain, lethargy, hypotensive, tachycardia, rapid & deep breathing and loss of consciousness.
To diagnose Diabetes Mellitus, lab tests such as Fasting plasma glucose where the value above 126mg/dL or higher include the presence of DM. Other tests may include renal function, urinalysis: glycosuria, proteinuria, ketonuria, yeast infection and cholesterol.
Diabetes mellitus can be effectively managed if it is diagnosed early. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney and/or nerve damage. There is no known prevention for type 1 diabetes, however the risk of type 2 diabetes can be lowered by lifestyle modification. It includes controlling the weight and managing the diet. Exercising regularly and avoiding smoking, high triglycerides; and low HDL cholesterol levels. Type 1 DM is treated with insulin replacement therapy usually by injection or insulin pump. Also, regular monitoring of blood glucose levels using glucose meters. Management of type 2 DM may include the usage of antidiuretic agents, blood sugar monitoring, transplant of pancreas or insulin, scrupulous foot care. In the early stage, hyperglycaemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce production by the liver. If the disease progresses or insulin secretion worsens, other therapeutic replacement of insulin can also be considered.
In terms of Chiropractic management or any allied health care provider, it is essential to be aware and recognise the signs/symptoms of diabetes mellitus. Acute diabetic ketoacidosis is a medical emergency which requires immediate actions. Monitoring patients for complications/clinical indicators for any micro/macro vascular disease, neuropathy and other associated disorders. Educating the patient in terms of prevention of further progression and development in other family members. Daily checking of feet for skin changes, cuts and sores. Nutritional support for Diabetes Mellitus such as vitamin C & E, biotin, Magnesium, Chromium, Aloe Vera juice, Inositol and Ginseng can be advised. Regular checking the spine by correcting any spinal dysfunction and joint misalignment which helps the individual with the musculoskeletal complaints as well as improving the overall function of the nervous system.
