Diabetes mellitus main causes: Symptoms-Types-Drugs | MPO training 23

1. Insulin Deficiency – When your pancreas fails to produce enough insulin. This condition is commonly seen in Type 1 diabetes.
2. Insulin Resistance – When your body’s cells do not respond properly to insulin. This is more common in Type 2 diabetes.

• Over 537 million adults (aged 20–79) are living with diabetes worldwide.
• By 2045, this number is expected to reach 783 million, if no major actions are taken.
• About 1 in 10 adults globally now has diabetes, and nearly half of them don’t even know they have it.
• Type 2 diabetes accounts for around 90% of all diabetes cases, and it’s mostly linked to poor lifestyle, obesity, and aging.
• In low- and middle-income countries, diabetes is rising at a much faster rate compared to high-income countries.

• Polyuria (Frequent urination): You feel the need to urinate more often than usual.
• Polydipsia (Excessive thirst): You become very thirsty and want to drink a lot of water.
• Polyphagia (Increased hunger): You feel hungry more often and eat more than usual.
• Hyperglycemia (High blood sugar): Your blood contains too much sugar.
• Glycosuria (Sugar in urine): Extra sugar leaves your body through urine.
• Asthenia (Weakness): You feel tired and weak.
• Weight loss: You may lose weight even if you eat well.
• Fatigue: You feel very tired during the day.
• Blurred vision: Your eyesight may become unclear or fuzzy.
• Slow healing wounds: Cuts or sores take a long time to heal.
• Frequent infections: You get infections often, especially skin or urinary tract infections.
• Tingling or numbness: You may feel pins and needles or numbness in your hands or feet.
• Dry and itchy skin: Your skin may become dry and itchy.
• Dark patches on the skin: You might notice dark, thickened skin patches, usually on the neck or underarms.
• Mood changes: You might feel irritated or moody at times.
• Nausea or vomiting: Sometimes, especially in Type 1 diabetes, you may feel sick or vomit.

1. Type 1 diabetes (IDDM)
2. Type 2 diabetes (NIDDM)
3. Gestational diabetes

What is Insulin and How does insulin work?

Pathological Terms

Diabetes Management and Treatment

How does diabetes mellitus affect daily life and work?

People with diabetes need to monitor blood sugar, eat regularly, and take medicines. With proper care, most can live a normal life, but ignoring the condition may reduce energy and focus at work.

A) Management:

Unfortunately, there is currently no permanent cure for diabetes. However, it can be effectively managed through a combination of healthy lifestyle choices, regular monitoring, and medical treatment. The goal is to maintain blood glucose levels within the target range and prevent or delay complications.

Core Principles of Diabetes Management – The 5 D’s:

1. Discipline:

• Regular monitoring of blood sugar.
• Adherence to lifestyle changes.
• Consistency in daily routine.
• Stress reduction and mental well-being.

2. Diet:

• Balanced meals with controlled carbohydrates.
• High fiber, low sugar, and low saturated fats.
• Regular meal times and portion control.
• Avoidance of processed and sugary foods.

3. Drugs:

• Oral hypoglycemic agents (OHAs) for Type 2 diabetes.
• Insulin therapy (especially for Type 1 diabetes or advanced cases).
• Medication compliance is critical to long-term success.

4. Daily Exercise:

• At least 30 minutes of moderate physical activity (e.g., walking, cycling) most days of the week.

5. Doctor Visits:

• Regular checkups
• Monitoring of HbA1c, kidney function, eyes, and feet to catch complications early.

B) Treatment of Diabetes

Treatment of diabetes depends on the type of diabetes, the severity, and the individual’s health condition. The primary goal is to control blood sugar levels and prevent complications.

1. Type 1 Diabetes Treatment:

• Requires daily insulin therapy (injections or insulin pump).
• Blood glucose monitoring multiple times a day.
• May include carbohydrate counting and meal planning.

2. Type 2 Diabetes Treatment:

• Begins with lifestyle changes: healthy eating, physical activity, and weight management.
• If lifestyle alone is not sufficient, oral medications (oral hypoglycemic agents) are prescribed.
• In advanced stages or if oral drugs fail, insulin may be added.
• Other medications may also be used to protect the heart, kidneys, or lower cholesterol and blood pressure.

3. Gestational Diabetes Treatment:

• Focuses on healthy diet and physical activity during pregnancy.
• If blood sugar remains high, insulin or oral medications may be recommended.
• Careful monitoring of mother and baby is essential.

Common Medications Used in Treatment:

• Metformin – First-line drug for type 2 diabetes.
• Sulfonylureas (e.g., glipizide, glyburide) – Stimulate insulin release.
• DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors – Newer classes for better control and heart/kidney protection.
• Insulin – Various types: rapid, short, intermediate, and long-acting.

Important Notes: Always follow your doctor's advice for medication and dosing. Never stop or change medication without medical consultation. Self-monitoring of blood glucose (SMBG) is vital to ensure treatment effectiveness. Treatment must be individualized—there is no one-size-fits-all approach.

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What lifestyle changes help manage diabetes mellitus effectively?

Eating a balanced diet, regular exercise, reducing stress, maintaining weight, quitting smoking, and routine blood sugar checks are key lifestyle changes that improve diabetes control.

DPP-4 inhibitors Mode of Action

Step-by-Step Explanation of the Diagram: This diagram illustrates how DPP-4 inhibitors (a type of diabetes medication) work in the body.

Step 1: Food intake

• When we eat food, our body produces incretin hormones.

Step 2: Incretin hormones

• These hormones perform two main functions:
• Stimulate insulin release → Increases insulin secretion.
• Inhibit glucagon release → Decreases glucagon (a hormone that raises blood sugar levels).

Step 3: Result – Lowering of blood glucose

• The combined effect of increased insulin and decreased glucagon leads to reduced blood glucose levels.

Step 4: The Problem – DPP-4 enzyme

• The body naturally produces an enzyme called DPP-4, which inactivates incretin hormones.
• This reduces the beneficial effects of increments.

Step 5: The Solution – DPP-4 Inhibitors

• DPP-4 inhibitors are medications that block the DPP-4 enzyme.
• As a result, incretin hormones remain active for a longer time.
• This leads to increased insulin release, decreased glucagon levels, and ultimately lower blood sugar.

In Summary: DPP-4 inhibitors are drugs that keep incretin hormones active longer, thereby boosting insulin, reducing glucagon, and lowering blood glucose levels.

What are GLP-1 and GIP?

GLP-1 (Glucagon-Like Peptide-1): GLP-1 is a natural hormone released from the intestines after we eat.

What it does:

• Stimulates the body to release insulin (which lowers blood sugar).
• Reduces glucagon, a hormone that increases blood sugar.
• Slows down stomach emptying, which helps to reduce appetite.

GIP (Glucose-dependent Insulinotropic Polypeptide): GIP is another incretin hormone also released after eating.

What it does:

• Increases insulin release only when blood sugar is high (this is why it's called glucose-dependent).
• Helps reduce glucose production in the liver.

In Summary: GLP-1 and GIP are both hormones that help increase insulin release after eating and lower blood sugar. Keeping these hormones active helps the body control blood sugar better. That’s why DPP-4 inhibitor medicines are useful — they prevent these hormones from being broken down, allowing them to work longer.

Comparison Table: GLP-1 vs GIP – Incretin Hormones

Feature/Function	GLP-1 (Glucagon-Like Peptide-1)	GIP (Glucose-dependent Insulinotropic Polypeptide)
Where it is released from	Small intestine (after eating)	Small intestine (after eating)
Stimulates insulin release?	✅ Yes	✅ Yes (only when blood glucose is high)
Suppresses glucagon?	✅ Yes (reduces blood sugar further)	❌ No major effect
Slows down stomach emptying?	✅ Yes (helps control appetite)	❌ No
Effect on liver glucose production	Indirectly reduced (via insulin action)	✅ Helps reduce liver glucose output
Short lifespan in body?	Yes – quickly broken down by DPP-4 enzyme	Yes – also broken down by DPP-4
Supported by DPP-4 Inhibitors?	✅ Yes – works longer when DPP-4 is blocked	✅ Yes – works longer when DPP-4 is blocked

Summary (Easy to Remember):

• GLP-1 helps with insulin release, lowers glucagon, and reduces appetite.
• GIP helps with insulin release and reducing liver glucose, but only when sugar is high.
• Both are broken down by the DPP-4 enzyme, so using DPP-4 inhibitors keeps them active longer and helps control diabetes.

Mode of Action of DPP-4 inhibitors + Biguanides

DPP-4 Inhibitors work by inhibiting the DPP-4 enzyme which in turn increases the incretin hormone levels (GLP-1 & GIP) by preventing the breakdown of GLP-1 & GIP & Biguanides increase insulin sensitivity and decreases hepatic glucose overproduction.

What the Image Explains – Step-by-Step Explanation:

Step 1: Metformin (a type of Biguanide medicine)

• Metformin helps keep GLP-1 and GIP (incretin hormones) active in the body.

Step 2: DPP-4 Inhibitors (DPP-4i)

• These medicines block the DPP-4 enzyme, so incretin hormones stay active longer.
• As a result, the body releases more insulin.

Step 3: Insulin Sensitivity

• Metformin also improves insulin sensitivity, which helps the liver produce less glucose (this is called reducing hepatic glucose output).

Step 4: Combined Effect

• Together, Metformin and DPP-4 inhibitors help control blood sugar better by reducing glucose levels and increasing insulin — which leads to better control of HbA1c (a long-term marker of blood sugar control).

Summary: This image clearly shows how Metformin + DPP-4 inhibitors work together to control blood sugar levels and help maintain a healthy HbA1c.

Classification of Anti-Diabetic Drugs (Generic Names)

Therapeutic Class-> 1. Insulin (Injectable)

Sub-Class / Group	Generic Names
-	Short-acting: Regular Insulin Intermediate-acting: NPH Insulin Long-acting: Insulin Glargine, Insulin Detemir, Insulin Degludec Rapid-acting: Insulin Lispro, Insulin Aspart, Insulin Glulisine

Therapeutic Class-> 2. Oral Anti-Diabetic Drugs

Sub-Class / Group	Generic Names
1. Biguanides	Metformin
2. Sulfonylureas	Glimepiride, Gliclazide, Glibenclamide (Glyburide), Glipizide
3. Meglitinides	Repaglinide, Nateglinide
4. Thiazolidinediones (TZDs)	Pioglitazone, Rosiglitazone
5. DPP-4 Inhibitors	Sitagliptin, Vildagliptin, Linagliptin, Alogliptin, Saxagliptin, Teneligliptin
6. SGLT-2 Inhibitors	Empagliflozin, Dapagliflozin, Canagliflozin, Ertugliflozin
7. Alpha-glucosidase inhibitors	Acarbose, Miglitol
8. GLP-1 Receptor Agonists	Semaglutide, Liraglutide, Dulaglutide, Exenatide
9. Amylin analogs	Pramlintide
10. Dual GIP/GLP-1 Agonists	Tirzepatide

In this chart, it is shown that Metformin (one of the most common diabetes medications) works better when used in combination with other drugs.

These mixed-use medications are called "Combination Therapy."

1. DPP-4 Inhibitor + Metformin: DPP-4 inhibitors are drugs that keep the body's incretin hormones active for longer, which increases insulin secretion and reduces blood glucose levels.

The following combinations are commonly used with Metformin:

• Sitagliptin + Metformin
• Vildagliptin + Metformin
• Linagliptin + Metformin

These combinations are often made by pharmaceutical companies as single tablets containing both drugs.

2. SGLT-2 Inhibitor + Metformin: SGLT-2 inhibitors are drugs that remove excess glucose from the body through urine, thus lowering blood sugar levels.

The combination mentioned:

• Empagliflozin + Metformin

This combination is also available as a single tablet.

Summary in Table Format (Only Generic Names):

Summary in Table Format (Only Generic Names)

Combination Type	Generic Combination	Function
DPP-4 Inhibitor + Biguanide	Sitagliptin + Metformin Vildagliptin + Metformin Linagliptin + Metformin	Increases insulin secretion, lowers blood glucose
SGLT-2 Inhibitor + Biguanide	Empagliflozin + Metformin	Removes glucose through urine, lowers blood glucose

FAQs

1. What causes diabetes mellitus in adults and children?

In adults, poor lifestyle choices, obesity, and genetic factors often lead to Type 2 diabetes. In children, Type 1 diabetes is usually caused by an autoimmune reaction where the body attacks its own insulin-producing cells.

2. How is diabetes mellitus different from diabetes insipidus?

Diabetes mellitus is related to blood sugar problems, while diabetes insipidus is a rare condition involving water balance and kidney function. They share the name "diabetes" but are completely different diseases.

3. What are the early warning signs of diabetes mellitus?

Early symptoms include frequent urination, excessive thirst, tiredness, blurry vision, slow wound healing, and unexpected weight loss. These signs should not be ignored and need medical attention.

4. How is diabetes mellitus diagnosed by doctors?

Doctors usually perform blood tests such as fasting blood glucose, HbA1c, and oral glucose tolerance tests to diagnose diabetes mellitus. These tests help check your blood sugar levels over time.

5. What are the long-term complications of uncontrolled diabetes mellitus?

If not managed well, diabetes can lead to serious complications like heart disease, stroke, kidney failure, blindness, nerve damage, and foot ulcers that may require amputation.

6. Can diabetes mellitus be reversed or cured?

Type 1 diabetes cannot be cured. Type 2 diabetes may go into remission with lifestyle changes, weight loss, and proper treatment, but it’s not considered a permanent cure.

Conclusion: Diabetes mellitus main causes

To sum up, understanding the diabetes mellitus main causes: symptoms and types gives you a strong base as a future MPO. This knowledge helps you speak confidently with healthcare professionals. Whether it’s Type 1 or Type 2, knowing what triggers the condition can guide your approach. As a Medical Promotion Officer, such insights can shape your daily activities. Keep learning to make your role more meaningful. This knowledge isn’t just medical—it’s your tool for building trust.