the term diabetes melus describes diseases of abnormal carbohydrate metabolism that are characterized by hypoglycemia elevated blood glucose levels uncontrolled diabetes dramatically increases the risk of cardiovascular disease kidney disease and nerve damage normally when we eat carbohydrates such as bread the body breaks this down and absorbs it in circulation as glucose which is a type of sugar increased blood glucose levels will stimulate insulin secretion from the beta cells of the pancreas insulin promotes glucose storage in tissues by binding onto insulin receptors on the surface of these cells around our body this is to reduce blood sugar levels to normal range insulin can do this because insulin allows the uptake of glucose into the cells including liver cells heart cells kidney cells and nerves glucose is a main source of energy for these cells for example in this liver cell insulin binds onto insulin receptors which promote the expression of glucose channels allowing influx of glucose into the cell insulin also stimulates enzymes which promote glycolysis and therefore energy production in insulin also promotes enzymes for glucose storage as glycogen the net effect of insulin is to lower blood glucose levels to normal range diabetes occurs when there is a problem in insulin secretion or peripheral resistance to the action of insulin these problems lead to hypoglycemia and its Associated complications such such as cardiovascular disease chronic kidney disease and neuropathy diabetes is divided into two main types type one and type two diabetes melus type 1 diabetes is characterized by autoimmune destruction of the pancreatic beta cells leading to Absolute insulin deficiency no insulin production causes an increase in blood glucose levels type 1 diabetes is typically diagnosed in childhood and children often present with diabetic keto acidosis which is a medical emergency however 1/4 of cases are diagnosed in adults type 2 diabetes is by far the most common type of diabetes in adults and is characterized by hyperglycemia caused by a combination of insulin resistance and defective insulin secretion the underlying cause of insulin resistance has traditionally been attributed to predominantly environmental factors related to overeating sedentary lifestyle and resulting overweight and obesity with less prominent contributions from aging and genetics the majority of patients with type 2 diabetes melitus are asymptomatic at presentation meaning they don't have any symptoms with hypoglycemia noted on routine laboratory evaluation and this will prompt further testing diabetes melus is the number one cause of endstage renal disease blindness and non-traumatic lower extremity amputation chronic hypoglycemia is an important cause of complications of type 1 and type 2 diabetes meles which include microvascular and macrovascular complications these complications are thought to arise from the following mechanisms one formation of advanced glycosilated end products which really accelerates atherosclerosis and endothelial dysfunction two increased oxidative damage which causes cell injury and dysfunction three activation of polyol Pathways with accumulation of sorbitol which is toxic four platelet dysfunction associated with increased platelet aggregation let's first focus on microvascular complication which is a chronic complication of diabetes melus and this includes retinopathy and cataracts it also causes neuropathies including peripheral neuropathy where you get sensory loss in the peripheries more so than weakness sensory loss increases uh the risk of injury for example injury to the foot would not be noticed due to reduced pain sensation and this can then progress to a foot ulca patients with diabetes also have poor wound healing and the foot ulca can become gangrenous infected and this can lead to an amputation the other type of neuropathy is autonomic neuropathy which causes a dysfunction in the sympathetic and parasympathetic nervous system this Canad lead to things such as erectile dysfunction postural hypotension and gastroparesis the final type of microvascular complications is nephropathy where you get damage to the glomerulus of the nefron which leads to protein Uria diabetes is the number one cause of endstage renal failure macrovascular complications of diabetes Melius include peripheral vascular disease which can manifest as cation pain in the calf when walking cardiovascular disease which can present as a myocardial inunction as well as cerebral vascular disease such as a stroke given the significance of these micro and macrovascular complications in diabetes melus it is critical to manage these patients appropriately beginning with patient education aiming a hba1c less than seven hba1c is a reading of the blood glucose levels over 3 months you want to aim for normal blood pressure and cholesterol levels you want to stop smoking encourage exercising and appropriate diet management of diabetes melus also includes monitoring for the micro and macrovascular complications we discussed finally there's also pharmacological management which differs between type 1 and type 2 diabetes for example in type one the pharmacological management is insulin because in type 1 diabetes you have absolute deficiency of insulin whereas in type 2 diabetes the management can begin with oral or subcutaneous hypoglycemic agents and then later progress to insulin when there is some pancreatic dysfunction in summary we talked about type one and type two diabetes Melius and we talked about The Chronic complications of diabetes Melius the microvascular and macrovascular complications finally we talked about the general management of diabetes melus