Treatment guide for diabetes

Abstract

▶ Diabetes mellitus (DM) is a group of diseases characterized by chronic hyperglycemia due to deficiency of insulin action ✳ . In type 1 diabetes, deficiency of insulin action is mainly caused by the destruction and loss of β cells in the islets of Langerhans in the pancreas, which produce and secrete insulin (See p.5 : Table 2, Etiological classification of diabetes mellitus and glucose metabolism disorders). Type 2 diabetes arises as a result of genetic factors including those causing reduced insulin secretion and insulin resistance, and a number of environmental factors such as overeating (especially a high fat diet), lack of exercise, obesity and stress, to which may be added the factor of advancing age. ✳ Insulin is produced and secreted by the β cells of the pancreatic islets of Langerhans. After passing through the portal vein, insulin reaches the liver, and is carried via the hepatic vein to all the tissues of the body. It binds to the insulin receptors in the cell membrane of the liver, muscles, adipose tissue and other tissues that are insulin-sensitive, and promotes the uptake of glucose into the cells, energy usage and storage, protein synthesis, and cell proliferation. What is diabetes mellitus? A ▶ " Insulin action " is used to refer to the metabolic regulatory function exhibited by insulin in the tissues of the body. If a balance between the supply of insulin and the insulin requirement of the body is maintained, the metabolism as a whole remains normal, including the plasma glucose level. Decreased insulin secretion, or increased insulin resistance results in insufficient insulin action, and the plasma glucose level rises. ▶ Sustained hyperglycemia indicates insufficient insulin action. At the minimum degree of plasma glucose increase necessary for a case to be judged as " diabetic type " the patient experiences only mild subjective symptoms, and is frequently not aware of having the disease at all. If a moderately high level of hyperglycemia persists, characteristic symptoms (thirst, polydipsia, polyuria, weight loss and an easy fatigability) appear.