Clinical Diagnosis of Diabetes Mellitus

Clinical diagnosis of diabetes mellitus is suspected from the symptoms and signs like:



Frequent urination
Excessive thirst.
Craving for sweets and starches
Weakness.
Unexplained weight loss
Blurred vision
Itching of the skin
Drowsiness
Tingling or numbness in feet,
Nausea
Vomiting
Slow and poor healing of cuts and wounds
Infections, Diabetes greatly reduces ones ability to resist infections
Vaginal infections



The laboratory confirmation of diabetes mellitus is based on the following tests:



1. Fasting and random blood glucose estimation
2. 2 hour glucose level after food
3. Urine test for glucose
4. Oral glucose tolerance test.



The interpretation of the above test states that a high fasting blood sugar associated with detection of glucose in urine in conjunction with symptoms suggestive of diabetes mellitus should confirm this disease.



Every suspected cases of diabetes, therefore, is strongly advised to see a qualified medical practitioner for proper investigation and diagnosis of this disease.



There can be long term complications of diabetes mellitus and these complications can be in terms of health effects. From narrowing of the large arteries, leading to heart attacks, strokes and gangerene. Sometimes, there are problems in the blood vessels behind the eye, leading to retinopathy and sometimes blindness. And the kidney where it may progress to renal failure.



Health experts have observed that the debilitating effects of diabetes mellitus are many and reported that epidemiology studies are involved in the disease and obesity are the risk factors for atherosclerosis. Atherosclerosis has been identified as the most common complication of diabetes and responsible for the death of 75 percent of diabetic Americans. Available results also show that atherosclerosis leads to heart attacks, strokes and gangrene.



Diabetic patients have always been bothered by possible easy diabetes control measures that will enable them get on with their life.



Below are few sure diabetes control, prevention and management tips that will help you put the problem of diabetes to a reasonable level, if not cured entirely:



- Dietary management. In general principle, dietary measures are required in the treatment of all diabetic patients in order to achieve the overall therapeutic goal.



- Endeavor to exercise yourself as much as possible.

Clinical manifestation of diabetes mellitus

The symptoms of diabetes is more easily recognized in children than in adults, so it's surprising that the diagnosis can be missed/delayed sometimes, diabetes is a great imitator: influenza, gastroenteritis and appendicitis are most frequently diagnosed conditions, only to find that the disease was diabetes. Families with a strong family history of diabetes should suspect diabetes, especially if there is a child in the family with diabetes. Major events are:



• • • Temporary Polyuria Polydipsia Cachexia • Polyphagia • Progressive • Glucosuria Hyperglycemia • increased urine specific gravity



The sequence of chemical events described above results in hyperglycemia and acidosis, which in turn produce three "polys" Diabetes polifagia, polydipsia and polyuria-Cardinal symptoms of the disease. In non-insulin-dependent diabetes (which was also found in older children), insulin values are found to be overweight, and often there is fatigue and frequent infections (such as monilial infections in females).



The insulin-dependent diabetic is significantly decreased insulin levels and, as diabetes becomes complete, there is no demonstrable, insulin. Your baby may begin to wet the bed, became surly and "non-self" or act too tired. Abdominal discomfort is common. Weight loss, although quite observable in the rankings, perhaps less frequently presents complaint due to the fact that the family may not have noticed the change. Another feature of diabetes is thirsty. A couple reported that their son, during a voyage from California to Kensas, drank the contents of a gallon jug of water between each gas station. At one point the child's illness may actually refuse liquids and food, adding to the growing state of dehydration and malnutrition. Other symptoms include dry skin, blurred vision and sores that are slow to heal. More commonly in children, fatigue, bed-wetting and are the main complaints that encourage parents to take their child to the doctor. The child may be Hyperglycemic, with very high blood levels of glucose and glucose in the Urine; can be in diabetic ketosis, ketones and urine glucose but not severely dehydrated; can be in diabetic Keto-acidosis, dehydration, electrolyte imbalance and acidosis.



EvaluationObservation Diagnostics and testing are important in the diagnosis of diabetes in children. If children show glycosuria, are overweight or have symptoms of hypoglycemia, are candidates for the glucose tolerance test. The Urine test will show positive glucose only when the disease is actually occur. The urine test does not necessarily negative our early diabetes, nor a positive test necessarily indicate diabetes. Renal glycosuria, do not related to diabetes, may cause glucose in urine.



The fasting blood glucose test may miss the early diagnosis of diabetes and has been known to lose as 85% of children who have an abnormal glucose tolerance test with asymptomatic disease. The glucose tolerance test 4 hours was found to be the most successful tests for the early diagnosis of diabetes, whereas the glucose tolerance test-6--now is more beneficial for hypoglycemia diagnosis os. According to the rules established for normal children, diabetic or not of various ages, the criteria for early diagnosis of diabetes is two or more abnormal range. However, the standardization of food intake before testing can be critical, and those preparing for the test should emphasize the importance of following directions to the diet provided by your doctor or the laboratory. It's hard to do glucose tolerance test in children younger than 3 years of age, since standards have not been established for children in this age group.



Problem diagnosisSigns tests, and chemical symptoms can lead to the conclusion that your child has diabetes, when in fact another condition can appear, this is true in salicylate intoxication, which can be excluded our easily by boiling urine. Acetone, if present, boil out the urine, leaving a negative test if related to diabetes, and a positive test if related to salicylate intoxication. Temporary hyperalimentation, pancreatitis and encephalitis. Blood glucose testing usually return to normal after the stress is reversed; However, insulin may be needed for a short time stress diseases, especially when the child is at the stage of hyperalimentation. Other abnormal conditions that may cause glucose to appear in the Urine are some kidney disease, some other endocrine disorders as hypercortisolism and lead encephalopathy.

Clinical Manifestation of Diabetes Mellitus

The symptomatology of diabetes is more readily recognizable in children than in adults, so it is surprising that the diagnosis may sometimes be missed or delayed, Diabetes is a great imitator: influenza, gastroenteritis, and appendicitis are the conditions more often diagnosed, only to find that the disease was really diabetes. Those families with a strong family history of diabetes should suspect diabetes, especially if there is one child in the family with diabetes. Main manifestations are:



• Polyuria• Polydipsia• Polyphagia• Progressive cachexia• Glucosuria• Hyperglycemia• Increasing of specific gravity of urine



The sequence of chemical events described previously results in hyperglycemia and acidosis, which in turn produce the three "polys" of diabetes- polyphagia, polydipsia, and polyuria- the cardinal symptoms of the disease. In non-insulin-dependent diabetes (which has also been found in older children), the insulin values are found to be overweight, and there is often tiredness and frequent infections (such as monilial infections in females).



The insulin-dependent diabetic has markedly decreased insulin levels and, as diabetes becomes complete, there is no demonstrable, insulin at all. The child may start wetting the bed, become grouchy and "not himself" or act overly tired. Abdominal discomfort is common. Weight loss, though quite observable on the charts, maybe a less frequent presenting complaint because of the fact that the family might not have noticed the change. Another outstanding feature of diabetes is thirst. One couple reported that their child, during a trip from California to Kensas, drank the contents of a gallon jug of water between each gas station stop. At a certain point in the illness the child may actually refuse fluid and food, adding to the increasing state of dehydration and malnutrition. Other symptoms include dry skin, blurred vision, and sores that are slow to heal. More commonly in children, tiredness and bed-wetting are the chief complaints that prompt parents to take their child to the physician. The child may be hyperglycemic, with elevated blood glucose levels and glucose in the Urine; may be in diabetic ketosis, with ketones as well as glucose in the urine but not noticeably dehydrated; may be in diabetic keto-acidosis, with dehydration, electrolyte imbalance and acidosis.



Diagnostic evaluationObservation and testing are important to the diagnosis of diabetes in children. If children demonstrate glycosuria, are overweight, or exhibit symptoms of hypoglycemia, they are candidates for glucose tolerance testing. The Urine test will show positive glucose only when the disease is actually manifest. The negative urine test does not necessarily rule our early diabetes, nor does a positive test necessarily indicate diabetes. Renal glycosuria, unrelated to diabetes, can result in glucose in the urine.



The fasting blood glucose test may miss the diagnosis of early diabetes and has been known to miss as many as 85% of children who has an abnormal glucose tolerance test with asymptomatic disease. The 4-hour glucose tolerance test has been found to be the most successful test for the diagnosis of early diabetes, whereas the 6-hour glucose tolerance test is more helpful for the diagnosis os hypoglycemia. Based on norms established for normal, non-diabetic children or various ages, the criteria for the diagnosis of early diabetes is two or more abnormal range. However, standardization of food intake before the test may be important and those preparing for the test should emphasize the importance of following the directions for diet supplied by the physician or laboratory. It is difficult to do glucose tolerance testing in children younger than 3 years of age, since norms for children in this age-group have not been established.



Problem of diagnosisSigns, symptoms and chemical tests may lead to the conclusion that the child has diabetes, when in reality another condition may be present, this is true in salicylate intoxication, which can be ruled our easily by boiling the urine. The acetone, if present, will boil out of the urine, leaving a negative Acetest if related to diabetes and a positive Acetest if related to salicylate intoxication. Temporary hyperalimentation, pancreatitis, and encephalitis. The glucose tests usually return to normal once the stress is reversed; however, insulin may be needed for a short period in the stress illnesses, especially when the child is undergoing hyperalimentation. Other abnormal conditions that may cause glucose to appear in the Urine are certain renal diseases, some other endocrine disorders such as hypercortisolism, and lead encephalopathy.