The Effects Of Metformin And Diabinese On Female Sex Hormone Of Type 2 Diabetes Mellitus Patients
[UNIVERSITY OF ILORIN TEACHING HOSPITAL (UITH), ILORIN, KWARA STATE]

CHAPTER TWO
2.0                LITERATURE REVIEW
2.1    DIABETES MELLITUS
Diabetes mellitus is a complex, chronic disease. It is a condition characterised by an elevation of the level of glucose in the blood (IDF, 2012). Insulin, a hormone produced by the pancreas, controls the blood glucose level by regulating the production and storage of glucose (WHO, 2012). In diabetes there may be a decrease in the body’s ability to respond to insulin or a decrease in the insulin produced by the pancreas which leads to abnormalities in the metabolism of carbohydrates, proteins and fats (IDF, 2012).  The resulting hyperglycaemia may lead to acute metabolic complications including keto acidosis and in the long term contribute to chronic micro-vascular complications (Fauci et al., 2008). Fauci et al., (2008) define diabetes mellitus as a complex, chronic disorder characterised by disruption of normal carbohydrates, fat and protein metabolism and the development over time of micro-vascular and macro-vascular complications and neuropathies.
American Diabetes Association (2008) defines diabetes mellitus as a metabolic disorder characterised by glucose intolerance. It is a systemic disease caused by an imbalance between insulin supply and insulin demand. The onset is from 3 years in children and 25 years in adults. According to Fauci et al., (2008), the criteria for diagnosis of diabetes mellitus have been explained and include a causal plasma glucose of 11.1mmo1/L or higher, or fasting plasma glucose of 7.0mmo1/L or higher. According to Baumann et al., (2002), the prevalence of diabetes is higher in minority groups and among those who are socio-economically disadvantaged, but the reason for that has not been given.
2.1.1 TYPES OF DIABETES MELLITUS
There are four major classifications of diabetes mellitus, namely: type I, type II type III and gestational diabetes.
2.1.1.2     TYPE I
This is known as insulin dependent diabetes mellitus. About 5-10% of patients have type I diabetes mellitus. The pancreas produces inadequate amounts of insulin, resulting in the need for insulin injections to control the blood glucose. It is characterised by a sudden onset, usually before the age of 30 years. (Rothe et al., 2008).
According to Oster et al., (2016), in type I diabetes, also called IDDM, auto-immune B-cell destruction is attributed to a genetic predisposition coupled with viral agents and possibly chemical agents. Individuals susceptible to type I diabetes are linked to HLA (Human Leucocytes Antigen) DR3 and DR4 loci (DR3 and DR4 are just numbers used to identify the antigens).
2.1.1.3     TYPE II
This is also known as the non-insulin dependent diabetes mellitus (Garber, 2012). It results from a decrease in the sensitivity of the cells to insulin and a decrease in the amount of insulin produced. About 90-95% of patients have type II diabetes (Garber, 2012). This type II diabetes is treated with diet and exercise, and if elevated glucose levels persist, diet is supplemented with oral hypoglycaemic agents. During periods of illness or surgery, individuals who usually control their type II diabetes with diet, exercise and oral agents, may require insulin injections (Garber, 2012). In some individuals oral agents fail to control hyperglycaemia and insulin injection is required (Rothe et al., 2008).
Funnell (2012), indicate that type II diabetes accounts for 80-90% of all cases and is the significant cause of morbidity in the United States. The complications of type II result in disruption of lifestyle, psychosocial adjustment and health care expenses. It is often treated with diet, exercise, self-monitoring of blood glucose and hypoglycaemic agents/insulin. Funnell (2012), indicate that there are two subtypes of type II, obese and non-obese. Type II has a strong genetic influence but there is no correlation with HLA (Human Leucocytes Antigen) type. Individuals with type II diabetes have a 50% chance of transmitting the disease to their children.