FAQ's on Internal Medicine

Q- What Is Diabetes Mellitus?

Ans- Diabetes Mellitus

Diabetes is a condition in which the body doesn't produce or properly use insulin or both. This causes sugars to build up too high in your blood.

types of diabetes

Type 1 diabetes usually occurs in children and young adults. In this the pancreas makes little or no insulin.

Type 2 diabetes is the most common form in adults. It develops when the body doesn’t make enough insulin and doesn’t efficiently use the insulin it makes (insulin resistance).

Symptoms

Frequent urination, excessive thirst, extreme hunger ,unusual weight loss, increased fatigue, irritability and blurring of vision.

What is the connection between diabetes, heart disease, and stroke?

If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people.

What doesn't cause diabetes (the myths)

1.       Eating sweets or the wrong kind of food does not cause diabetes. However, it may cause obesity and this is associated with people developing Type 2 diabetes.

2.       Stress does not cause diabetes, although it may be a trigger for the body turning on itself as in the case of Type 1 diabetes. It does, however, make the symptoms worse for those who already have diabetes.

3.       Diabetes is not contagious. Someone with diabetes cannot pass it on to anyone else.

Complications of diabetes (or sequelae of diabetes)

1.       Neuropathy (Nerve disease) --Pain is the chief symptom and tends to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold.

2.       Retinopathy (Eye disease)-It may lead to loss of vision.

3.       Arteriosclerosis (Vessel disease)-It is the leading cause of death among diabetics. There is absence of peripheral pulses in the lower legs and feet and gangrene, and ultimately lead to amputation of the extremity. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is precipitated by trauma, infection or extremes in temperature.

4.       Nephropathy (Kidney disease)

5.       Hypoglycemia- If there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls below normal levels, hypoglycemia occurs. If too much insulin is administered, or the person misses a meal or over-exercises, then also hypoglycemia may result. The brain is deprived of an essential energy source. The first sign is mild hunger, quickly followed by dizziness, sweating, palpitations, mental confusion and eventual loss of consciousness. Before the condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a sweet or drinking a glass of orange juice. In some cases, the only effective measure is an intravenous injection of glucose.

6.       Digestive Disorders-Like ulcers, diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhea and gallstones may occur.

7.       Oral Complications Periodontal disease, which can lead to tooth loss is common.

8.       Infections- Asymptomatic bacteriuria, lower extremity infections, reactivation tuberculosis, infections in surgical wounds and group B streptococcal infection etc.

9.       Complications of Pregnancy- Major congenital malformations in babies are common.

10.   Ketoacidosis- Ketone formation can directly cause an acute life threatening event, a diabetic coma.

Management of diabetes

Controlling your blood sugar is essential to feeling healthy and avoiding long term complications of diabetes

1.       Monitoring blood sugar The best range for you depends on your age and the type of diabetes you have. For younger adults who don't have complications of diabetes, a typical target range might be 80 to 120 mg/dL before meals and below 180 mg/dL after eating. Older adults who have complications from their disease may have a fasting target goal of 100 to 140 mg/dL and below 200 mg/dL after meals. That's because blood sugar that falls too low in older adults can be more dangerous than in younger people. How often you test your blood sugar depends on the type of diabetes you have. If you take insulin, test your blood sugar at least twice a day, and preferably three or four times a day. But if you have type 2 diabetes and don't use insulin, you may need to test your blood sugar levels only once a day or as little as twice a week. Factors that affect your blood sugar include:

·         Food

·         ]Exercise and physical activity. In general, the more active you are, the lower your blood sugar

·         Medications. Insulin and oral diabetes medications deliberately work to lower your blood sugar. Corticosteroids, in particular, may raise blood sugar levels. Medications such as thiazides, used to control high blood pressure, and niacin, used for high cholesterol, also may increase blood sugar

·         Illness.

·         Alcohol. Even a small amount of alcohol can cause your sugar levels to fall too low.

So a healthy diet, exercise and normal weight are important for you.

Medications/

Insulin is drug of choice which is injected using a syringe or an insulin pen injector or an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots. The most widely used form of insulin is synthetic human insulin, and newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body.

A number of oral drug options exist for treating type 2 diabetes, including:

·         Sulfonylurea drugs

·         Meglitinides

·         Biguanides

·         Alpha-glucosidase inhibitors

·         Thiazolidinediones

·         Drug combinations

In recent years, researchers have focused increasing attention on transplantation for people with type 1 diabetes. Current procedures include:

·         Pancreas transplantation

·         Islet cell transplantation

To summarize:

We, Indians are prone to Diabetes because of central / abdominal obesity. Even normal weight Indians may have large waist circumference making them more prone to become diabetic. Our motto should be..." To have healthy diet and healthy lifestyle so that we can manage diabetes well.”

Q- What Is Malarial Fever?

Ans- Malarial Fever

Malaria is a vector-borne infectious disease caused by protozoan parasites.

Cause

The disease is caused by protozoan parasites of the genus Plasmodium. The most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species (Plasmodium ovale, Plasmodium malariae, and sometimes Plasmodium knowlesi) can also infect humans. This group of humanpathogenic Plasmodium species is usually referred to as malaria parasites.

Transmission

·         Malaria parasites are transmitted by female Anopheles mosquitoes.

·         The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. Infection begins with a bite from an infected mosquito.

·         he parasite travels from the mosquito to your liver, where the parasite begins to reproduce. If another mosquito bites an infected person, that mosquito can then carry the infection to someone else.

Symptoms

High fever, body aches, headache, nausea, shaking chills (rigors), sweating, weakness, splenomegaly (enlarged spleen), cerebral ischemia, hepatomegaly (enlarged liver), hypoglycemia, and hemoglobinuria with renal failure may occur. Renal failure may cause blackwater fever, where hemoglobin from lysed red blood cells leaks into the urine.

Genetic effects of malaria

·         Sickle-cell disease

·         Thalassaemias

Prevention

·         Avoid exposure to mosquito’s during the early morning and early evening hours (the hours of greatest mosquito activity).

·         Wear appropriate clothing (long-sleeved shirts and long pants, for examples) especially when you are outdoors.

·         Apply insect repellent to the exposed skin.

Spray mosquito repellents on clothing to prevent mosquitoes from biting through thin clothing.

·         Use a mosquito net over your bed.

·         Have screens over windows and doors.

·         Spray insecticide in the bedroom before going to bed.

Treatment

·         Although some are under development, no vaccine is currently available for malaria; preventative drugs must be taken continuously to reduce the risk of infection.

·         Malaria infections are treated through the use of antimalarial drugs, such as quinine or artemisinin derivatives, although drug resistance is increasingly common.

Drink lots of fluids and do not become dehydrated.