Diabetes Mellitus: NDM

June 03, 2020

Diabetes Mellitus: NDM

Diabetes is quickly becoming a major and prevalent problem in all over the world. In India there are 7.7 crore diabetic patients out of 135 crore population (as per 2018) which is expected to grow 13.4 crore until 2045. There are 43.6 crore diabetic patients all over the world. Diabetes is a lifelong condition and can be maintained by self management. Type 2 diabetes is common among all others.

What is Diabetes Mellitus and role of Insulin Hormone ?

Insulin is a hormone which regulate blood sugar level and is produced by the pancreas. Insulin transports glucose from the blood into our body cells. If there is no or little insulin produced, body cells can not be able to take up glucose, as a result, there is increased sugar level in the blood, and not enough energy is able to produced, this condition is known as Diabetes, as described:

Diabetes is a chronic disease that occurs when blood glucose level is too high in the body. This condition of increased blood glucose level is called Hyperglycemia, which is caused due to:

Either no production of insulin by pancreas beta cells.
When the insulin is produced but in very little amount, leads to a phenomena called Insulin Resistance.

When the pancreas continues to make extra insulin to keep pace with increased blood glucose level, over years, the beta cells worn out and now cannot be able to cope up with the continued demand for excessive insulin production. Due to this, not enough glucose is carried to body cells for production of energy, this is known as Insulin Resistance.

There are 4 types of Diabetes Mellitus:

Type 1 Diabetes: It is an autoimmune disease in which no insulin is produced by the pancreas. The immune system of a person acts against it's own insulin making pancreatic cells, without which the blood glucose cannot enter body cells, then, excess amount of glucose left in the blood, which cannot be utilized, hence, no energy is produced for basic metabolic processes. It occurs primarily in young childrens at their peak age of 4-7 or 12-14 and in young adults under the age of 30.
Type 2 Diabetes: In this condition, insulin is produced by pancreas in very little amount, due to Family history and various acquired factors like Obesity, High Cholesterol Level, High Blood Pressure, which can be managed by self management with proper exercise, oral medications, healthy diet. It occurs mostly in middle aged and older people over the age of 45.
Gestation Diabetes: It occurs during pregnancy. During pregnancy, placenta produce Human Placental Lactogen Hormone, which makes the insulin less efficient, so, the excessive glucose is accumulated in the blood, hence, the blood sugar level rises, this condition is known as gestation diabetes mellitus.
Neonatal Diabetes Mellitus: Discussed below in next section:

Diabetes Mellitus can be categorized into two categories:

Polygenic diabetes: They are common form of diabetes which occurs due to polygenic defect i.e - defect/mutation in multiple genes of the suspect. Many environmental factors discussed above are also responsible which are acquired. Polygenic diabetes runs in families and can be controlled by self management. These are of two types: Type 1 and Type 2 diabetes mellitus.
Monogenic diabetes: They are rare form of diabetes, which occurs due to monogenic defect, i.e - defect/mutation in a single gene of suspect, that is responsible for normal development and function of pancreas beta cells, which are responsible for production and secretion of insulin hormone. Mostly the mutated gene is inherited from any one or both of the parents. Most of the monogenic diabetes are autosomal dominant disorders , which means one of the parent is affected while other is not, so, there are 50% chances that child will be affected. These are of 2 types:

MODY (Maturity Onset Diabetes of the Young): It is more common than NDM. It usually occurs in adolescence and young adults below 25. There are 14 responsible genes found in which 3 are used for diagnosis. i.e - HNF1α, HNF4α, glucokinase, if any of these defected.

NDM (Neonatal Diabetes Mellitus): Neonatal Diabetes Mellitus (NDM) also known as Congenital Diabetes is a disease which arise in new born babies at the initial 6 months of age, in which there is a constant increased level of blood glucose due to monogenic defect described above. There are 22 genes found to be responsible, among which anyone can be mutated. People compare NDM with type 1 diabetes as both of them are caused due defect in genes. But type 1 is not seen in initial 6 months of new born, however it arise later in life as dicussed. NDM is mainly of two types: 1. Transient Neonatal Diabetes Mellitus: It persist only in initial six months after that it disappears. 2. Permanent Neonatal Diabetes Mellitus (PNDM): It also appears in initial six moths. It persist for life !

Neonatal Diabetes is very rare, generally it arise around 1 in 3 crore to 1 in 4 crore of newborns. The Transient Neonatal Diabetes Mellitus is more common among two types.

What are the Symptoms of Diabetes Mellitus ?

Frequent Urination
Increased Thirst
Increased appetite
Fatigue/Dizziness
Unexplained weight loss

Symptoms of Type 2 diabetes generally occurs late in life, it's symptoms are very mild that the affected person don't even realize they have diabetes for a long time.

How NDM is diagnosed ?

If the child of age within six months is diagnosed with increased level of glucose in blood or urine, a technique called Genetic Testing is used. In this technique, DNA sequence of affected person is compared with that of a normal DNA sequence.

How NDM can be prevented ?

Monogenic diabetes currently do not have any cure or prevention. But it can be maintained by taking regular insulin in form of injection and oral medications regularly:

Diabport-C is a Polyherbal powder for controlling blood sugar level and preventing complications related to diabetes naturally, manufactured by Diabport Healthcare Pvt. Ltd. Kanpur.
It has various natural ingredient which helps to regulate complications like:

Curcumin - Slow down the various complications and improves Insulin Function.
Dalchini - Release of insulin from pancreatic cells and improve the activity of insulin receptors.
Karela seeds - Reduces Blood Sugar level in body.
Fenugreek - Hypoglycemic and Hypolipidemic effect.

These can be the Complications due to Diabetes Mellitus:

High level of blood glucose over period of time causes build up of harmful substances in our body, which then affect various small, medium and large blood vessels. The high glucose level causes the production of oxygen derived free radicals which are highly unstable and causes damage to the inner lining of blood vessels, i.e - Endothelium. In response to damage, blood vessel/artery form a plaque (atherosclerosis), because of which the oxygenated blood not able to reach to various organs and causes:

Diabetic Nephropathy: Diabetes can damage the glomerulus (network of small blood vessels) from which waste is being filtered out of blood. If left untreated, may leads to kidney failure which may require kidney transplant or dialysis.
Diabetic Retinopathy: Small blood vessels of retina can be damaged, which results in Blindness. If there are underlying eye problem, person can have cataracts and glaucoma.
Gangrene foot: If left untreated, occurs cuts and blisters, which can cause infection that are hard to healed, ultimately requires surgical removal.
Diabetic Neuropathy: Blood vessels that nourish the nerves can be damaged due to excess of glucose, specially in legs. If left untreated, in man can cause erectile dysfunction.
Cardiovascular diseases: Diabetes increases the risk of developing:

Coronary artery disease: Damage to coronary artery due to inadequate supply of blood due to plaque.
Heart attack: It caused due to coronary artery disease or arethrosclerosis.
Hear Failure: Weakening of heart cardiac muscle gradually, in this case, it occurs due to heart attack.
Angina Pectoris: Pain in the chest.
Stroke: If severe, blood vessel which supply blood to brain gets obstruct !