CHAPTER ONE

1.0 INTRODUCTION

1.1 DEFINITION

Diabetes is a clinically and genetically heterogeneous group of metabolic disorders manifested

by abnormally high levels of glucose in the blood. The disease often results from deficiency of

insulin secretion caused by pancreatic β-cell dysfunction or resistance to the action of insulin in

liver and muscles, or both (Maya et al., 2016).

It is viewed as a disorder of carbohydrate metabolic disorder characterized by impaired ability of

the body to produce or respond insulin to maintain proper levels of sugar (glucose) in blood.

Glucose: a sugar — is a main source of energy for the cells that make up muscles and other

tissues. Glucose comes from two major sources: food and your liver. Sugar is absorbed into the

bloodstream, where it enters cells with the help of insulin.

The liver stores and makes glucose. When glucose levels are low, such as when you haven't

eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level

within a normal range. Diabetes ensues when the glucose levels are high and not utilized by the

cell.

1.2 EPIDIOMIOLOGY

Globally, it has been estimated 422 million adults were living with DM in 2014, compared to

108 million in 1980. The prevalence (age- standardization) of diabetes nearly doubled since

1980, rising from 41% to 8.5% of the adult population. This reflects an increase in associated

risk factors such as being overweight. or obese (WHO 2016).

million deaths, by increasing the risk of cardiovascular and other disease. 43% of these

3.3million death occur at age < 70 yrs. The percentage of death attributed a high blood glucose

that occur prior to age 70 is higher in low-middle country than high class (WHO, 2016).

Although type 1 diabetes can be diagnosed at any age, it is one of the most common chronic

diseases of childhood (Gale EA. Type 1 diabetes in the young: Diabetologia, 2016.)

Globally, the incidence and prevalence of type 1 diabetes vary substantially. Type 1 diabetes is

most common in Finland (>60 cases per 100 000 people each year) and Sardinia (around 40

cases per 100 000 people each year). By contrast, the disorder is uncommon in China, India, and

Venezuela (around 0·1 case per 100 000 people each year).

1.3 TYPES OF DM

Type 1 diabetes mellitus is a chronic autoimmune disease that results from the destruction of

beta (β) cells in the pancreatic islets, leading to loss of insulin production and resultant

hyperglycemia (Dino J et al, 2017).

Type 1 diabetes is generally precipitated by an immune-associated, if not directly immune-

mediated, destruction of insulin-producing pancreatic β cells (Bluestone et al. 2010). Type II

diabetes is a long life disease that keeps your body from using insulin the way it should. People

with type 2 diabetes are said to have insulin resistance.

People who are middle-aged or older are most likely to get this kind of diabetes, so it used to be

called adult-onset diabetes. But type 2 diabetes also affects kids and teens, mainly because of

childhood obesity.
If you developed gestational diabetes when you were pregnant, your risk of developing type 2

diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms),

you're also at risk of type 2 diabetes.

Polycystic ovarian syndrome. For women, having polycystic ovarian syndrome — a common

condition characterized by irregular menstrual periods, excess hair growth and obesity —

increases the risk of diabetes.

1.4. MORBIDITY AND COMPLICATIONS

Diabetes is a major cause of morbidity and mortality though the outcome are not due to the

immediate effect of the disorder. They are instead related to the disease development as a result

of chronic DM. These include disease of large blood vessels (macro vascular disease including

Coronary heart disease and peripheral arterial disease) and small blood vessels (macro vascular

disease, including retinal (adrenal vascular disease) as well as disease of the nerve. Having type

1 diabetes means the body doesn’t make insulin. This hormone moves sugar (glucose) from the

bloodstream into the cells, where it’s used for energy.

Without insulin, too much sugar builds up in your blood. That can damage your nerves and blood

vessels, leading to serious health problems. Although long-term complications of diabetes

develop gradually, they can eventually be disabling or even life-threatening. Diabetes

dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of

blood vessels (atherosclerosis).

Excess sugar can cause tingling, numbness, burning or pain that usually begins at the tips of the

toes or fingers and gradually spreads upward. Eventually, you may lose all sense of feeling in the
affected limbs. Damage to the nerves that control digestion can cause problems with nausea,

vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

Diabetes can sometimes lead to kidney failure or irreversible end-stage kidney disease, which

may require dialysis or a kidney transplant. Diabetes increases the risk of serious eye diseases,

such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially

leading to blindness.

Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe

damage might require toe, foot or leg amputation. Hearing problems are more common in people

with diabetes. Diabetes may leave you more susceptible to skin problems, including bacterial and

fungal infections. Obstructive sleep apnea is common in people with type 2 diabetes. Obesity

may be the main contributing factor to both conditions. Treating sleep apnea may lower your

blood pressure and make you feel more rested, but it's not clear whether it helps improve blood

sugar control. Type 2 diabetes seems to increase the risk of Alzheimer's disease, though it's not

clear why. The worse your blood sugar control, the greater the risk appears to be.

Symptoms of DM

The symptoms of type 2 diabetes can be so mild that you don't notice them. About 8 million

people who have it don't know it. Symptoms include classical signs are polyuria, polydipsia and

polyphagia. Others are blurry vision, being cranky, tingling or numbness in hands and feet,

fatigue, slow wound healing and hunger.

1.5 RISK FACTORS

Factors that may increase your risk of type 2 diabetes include:

overweight to develop type 2 diabetes. Excess fats distribution in the abdomen have a greater

risk of type 2 diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk

of type 2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6

centimeters) or a woman with a waist that's greater than 35 inches (88.9 centimeters).

Inactivity increases the risk of type 2 diabetes. Physical activity helps control weight, uses up

glucose as energy and makes the cells more sensitive to insulin. The risk of type 2 diabetes

increases from the family history. Although it's unclear why, people of certain races —

including black, Hispanic, American Indian and Asian-American people — are more likely to

develop type 2 diabetes than white people are. The risk of type 2 diabetes increases with age,

especially after age 45. That's probably because people tend to exercise less, lose muscle mass

and gain weight as they age. But type 2 diabetes is also increasing dramatically among children,

adolescents and younger adults.

1.6 STATEMENT OF THE PROBLEM

Diabetes mellitus is a chronic disorder that causes a major health problem which increases the

rate of mortality, morbidity and adverse effects as a result of treatment. Hypoglycemia is a

complication of Diabetic mellitus as a result of treatment of hyperglycemia in patient treated

patients in the hospital setting and the society.

Symptoms and effects can be mild, moderate or severe, depending on how low the glucose falls

and a variety of other factors. It is rare but possible for diabetic hypoglycemia to result in brain

damage or death. Indeed, an estimated 2–4% of deaths of people with type 1 diabetes mellitus

have been attributed to hypoglycemia.

1.7 AIMS AND OBJECTIVES

To evaluate the incidence and complications of hypoglycemia in patients treated with both oral

and parenteral anti diabetic agents.

To assess risk factors associated with moderate to severe hypoglycemia

To assess the clinical manifestations of moderate to severe hypoglycemia.

To evaluate the relative incidence of hypoglycemic manifestation of both Oral and Parenteral

Anti-Diabetic agents.

1.8 SPECIFIC OBJECTIVES

To identify the Anti-diabetic agent associated with prevalence of moderate to severe

hypoglycemia.

To determine the manifestation of hypoglycemia associated with mild to moderate

hypoglycemia.