Pathophysiology and Clinical Therapeutic Aspects of Diabetes

Diabetes mellitus is a long term and degenerative metabolic disorder that is characterized by the high levels of sugar in the blood as a result of either inappropriate insulin production or the failure of the body’s cells to respond adequately to insulin. It mainly manifests in two forms—Type 1 diabetes mellitus (T1DM) which is caused by an autoimmune destruction of pancreatic beta-cells, resulting in absolute insulin deficiency, and Type 2 diabetes (T2DM)—characterized by insulin resistance, which is frequently associated with obesity, lack of physical exercise, and genetic predisposition. This chapter discusses the basic pathophysiology of diabetes, with a focus on the normal control of glucose metabolism by insulin and glucagon. It describes the clinical presentations of diabetes, including polyuria, polydipsia, and weight loss, and covers both acute 188complications such as diabetic ketoacidosis and hypoglycemia, as well as chronic complications, including nephropathy, retinopathy, neuropathy, and cardiovascular diseases. Diagnostic methods of the disease such as fasting blood glucose, HbA1c and oral glucose tolerance tests are discussed. Treatment options are based on lifestyle changes, drug intervention, insulin treatment, and patient education. We also detail diabetes care by population group, including children, Type 1 and Type 2 diabetes, pregnant women, the elderly and people with diabetes in resource-poor regions of the world. In summary, the chapter gives a comprehensive overview of diabetes mellitus, and stresses the importance of early diagnosis, holistic management and prevention of complications to enhance patient care.