First we need to understand, what is blood sugar, its origin and the causes of elevation of sugar level in blood stream.
What are the causes of elevation in blood sugar levels?
The pancreas of our body secretes two hormones from the islets of Langerhans. The one is Insulin and the other is glucagon. Insulin allows the body to use glucose (sugar) from carbohydrates in the food. Insulin regulates (maintains) the blood sugar level while Glucagon increases the blood sugar level. These both hormones works in opposite to each other. If blood sugar level lowers, Glucagon starts secreting and if it is high Insulin starts secreting. Persistent increase in the blood sugar level causes a biochemical abnormality known as diabetes mellitus. It could be temporary in condition, like pregnancy, severe illnesses, and usage of drugs like steroids. Sometimes the sugar level is high in urine but it is normal in blood, the reason is, kidney is not filtering the sugar properly. So in this case we rule out a renal problem rather to treat diabetes.
So the main causes of increase in the blood sugar levels are mainly two:
- Defective secretion of Insulin, that causes Diabetes Mellitus Type-1.
- Defective receptors of Insulin and due to that Glucose can’t get into the cells and the blood level of sugar increases. This causes Diabetes Mellitus Type-2.
Type 1, which is more common in people less than 40 years. The factors could be stress, dietary, genetically or immunological.
While type 2 diabetes is more common in people above 40 years of age, main cause genetic, environmental factors etc.
Symptoms of diabetes:
The patients with diabetes or high sugar levels in blood stream, complain of fatigue, dryness of mouth. This increases water intake and ;hence, increases urination, and increase hunger so increase intake of food by the patient. In medical terms it’s called as polydipsia, polyuria and polyphagia. As the sugar level in diabetics are high, and as the sugar is the favourite diet for micro organisms, the wounds inflicted on diabetics will infect again and again and ;hence, delayed healing of wounds.
Normal values of blood sugar:
The normal value of blood sugar level is 80-100 mg/dl for fasting and 120-140 mg/dl in random (Random test is conducted after 3 hours of taking meal). In diabetic patients, the fasting level is 120-126 mg/dl and random sugar level is 200 mg/dl.
Aims to control blood sugar level:
1) Abolishing the symptoms of diabetes while avoiding hyperglycemia
2) Correction of hyperglycemia and glycosuria.
3) Maintaining body weight with proper diet.
We can control blood sugar level through:
1) Daily exercise (walk)
2) Diet alone
3) Oral hypoglycemic drugs
By slowly reducing sugar in diet and if required it should be taken with the meal rather taking it alone. Whole grains, low calorie drinks, high fiber foods, raw cooked or roasted vegetables. Low energy diet for type 1 diabetes. In type 2 diabetes, weight loss is easier to control sugar level.
This is given in diabetes mellitus type 1.
Insulin is injected subcutaneous in the interior abdominal wall, upper arms, outer thighs and buttocks.
How to prepare Injectable Insulin:
1) Soluble: It is rapid in action but short duration, needs at-least 2 injections. It is advisable for young patients, new cases with severe dehydration, emergencies, operations, and infections.
2) Depot: It is used for elderly patients with mild diabetes as single dose.
Oral hypoglycemic drugs:
These are given for controlling sugar in diabetes mellitus type-2.
1) Sulphonylureas : Increase insulin activity by decreasing hepatic glucose. These drugs are indicated to non-obese type 2 diabetes
i)Tolbutamide: It’s the first generation of sulphonylunreas. It is a useful drug in elderly people, which are more risk to hypoglycemia. Administration is 8 -12 hourly.
- ii) Gliclazide and Glipizide: It’s a second generation of sulphonylunreas. It causes severe hypoglycemia, so avoided in elderly patients.
- Biguanids (Metaformin): Due to side effects its usage is lesser than sulphonylunreas. It mainly decreases absorption of glucose by the gut. It is prescribed 500 mg 12 hourly with food. It is a contra indicated in the patients with impaired renal and hepatic functions because it may cause a severe hypoxemia.
- Alpha-Glucosidase inhibitors: Acarbose or Miglitol both lowers post prandial blood glucose and improves glycemic control. They can be combined with Sulphonylunreas.
- Thiazolidinediones: Glitazones is given to patients with insulin sensitivity with no danger of hypoglycemia.
- Meglitinides: They are oral prandial blood glucose regulators.