Definition : This is a clinical syndrome characterised mainly by polyuria, polydipsia and polyphagia due to relative or absolute deficiency of insulin.
Aetiology: Age—middle age group, Sex—both sexes. The exact cause unknown. The associate factors are:
(1) Heredity. (2) Obesity. (3) Infection. (4) Hepatic disorders. (5) Stress & strain—both physical and mental. (6) Habits—overeating ( fats etc. ). (7) Various drugs, steroids, thiazide diuretics etc. (8) Destruction of insulin secreting tissue. (9) Endocrinal disorders— Acromegaly, pituitary basophilism, thyrotoxicosis etc. (10) Pregnancy—due to hormones antagonising insulin or due to lowering of senal threshold level of sugar.
(1) Juvenile onset type—insulin dependent.
(2)Adult or maturity onset type—usually not insulin dependent.
(3) Potential diabetics—hereditory.
(4) Latent diabetics— abnormal glucose tolerance persons.
(5) Brittle diabetics.
(6) Resistant diabetics.
Insulin is secreted by Beta-islets of Langerhans in the pancreas. Sufficient secretion of this hormone keeps the blood sugar level well below the renal threshold• so that little sugar is noriia1Iy excreted in the urine. In the deficiency of insulin the blood sugar level becomes higher, partly by conversion of fats and proteins into sugar and partly by hampered utilization at cellular level. When this raised level does not cross the renal threshold, no sugar is excreted. This state. is called latent diabetes. When the blood sugar level crosses the renal threshold, sugar appears in the. urine thus making the condition clinically existent. This state is known as manifest diabetes or clinical diabetes.
NOTE :—Normally more glucose in blood means more insulin and vice versa. Similarly fall in blood sugar liberates adrenalin which restores normal blood sugar level by glycogenolysis in the liver, ACTH and cortical steroids also help in the maintenance of normal blood sugar 4eel.
Clinical Features: Onset—usually gradual (rarely acute).
( 1) Lassitude, general weakness, progressive loss of weight, strength and energy and ready fatigue due to loss of glucose and tissue protein breakdown. (2) Polyuria— pale, clear large quantities of urine of high Sp. Gr. (I030 1050); nocturia. (3) Polydipsia due to dehydration. (4) Polyphagia—voracious appetite, particularly for sweets, feeling hungry within a short time of a full meal. (5) Pruritus vulvae or balanitis. (6) Constipation. (7) Pain in extremities.
(2) Failing vision, cataract formation. (9) Recurrent boils, carbuncles and other infections. (10) Amenorrhoea in women and impotency in males. (ii) Failing memory, inability to concentrate. (12) Coma, severe neuropathy or retinopathy may be the first symptoms. (13) Claudication. (14) Non-healing of wounds. ‘.
Signs—There may be absence of physical signs in cases of mild and moderate severity, otherwise—4 Patient appears debilitated and wasted or obese, (2) face—-pinched and pale,
(3) Skin—loose, shallow, often a yellow tint, specially on hands and face, (4) Tongue—dry (index of dehydration), later red and beefy, (5) Diminution or absence of tendon reflexes or vibration sense, (6) Complications—may provide the first sign.
(1) Confirmd by glucose tolerance test or more easily by post prandial blood sugar estimation.
Sign: Deep, sighing, breath smells of acetone. Dry, inelastic, Tongue dry & shrunken. Very low ; weak pulse. Diminished Usually flexor. Hyperglycaemia reduced plasma bicarbonate.
Bad. Sugar and acetone (ketonuria) Massive dose of insulin and associate measures to be taken.
Clinical Features: (Signs and symptoms ) —-(1) Firstly drowsiness with great thirst and polyuria, followed by unreadable coma. (2) Deep sighing respiration with breath smelling of acetone. (3) Cold extremities, sunken eyeballs, shrivelled tongue, dry skin, low blood pressure (due to dehydration). 4) Urine contains heavy amounts of sugar and ketones.
Diabetic Coma is a medical emergency and it is essential that all steps be taken as quickly as possible to
Restore the patient to consciousness. Principle of treatment —
Insulin in large doses and at frequent intervals. (2) I.V. saline drip. (3) Urine is tested for sugar and ketone bodies, (4) Blood sugar test. (5) Treatment of infection,