Diabetes Mellitus
Also known as: Type 1 diabetes,
Type 2 diabetes
What is it?
Diabetes Mellitus, more commonly known as just
diabetes, is a disease where your body doesn’t
make enough insulin, or isn’t able to
appropriately use the insulin being made by your
body. Insulin is a hormone made by the body to
regulate the amount of sugar in the blood. High
levels of sugar in the blood can seriously affect
other body systems, particularly over long periods
of time.
There are two types of
diabetes, Type I or juvenile onset, and Type II or
adult onset.
Type I
Commonly known as insulin
dependent diabetes since these patients require
insulin to control their blood sugars. In this
type of diabetes, the pancreas is damaged. This
is the organ which produces insulin in cells
called beta cells, and if they cannot produce
insulin because they are damaged, sugar levels in
the blood become elevated.
Type II
Non-insulin dependent
diabetes, is more common, almost 90 to 95% of all
diabetic cases. This type is a result of the
pancreas not being able to produce enough insulin
to control the blood sugar levels, or the
patient’s body not being able to utilize the
insulin correctly. Another form of Type II
diabetes is known as gestational diabetes. This
type develops during pregnancy, and usually
resolves when the pregnancy is over. It does,
however, put the woman at risk for developing the
more permanent disease later in life.
Who gets it, and what are its causes?
Recent reports in 1997 from the American
Diabetes Association and the Centers for Disease
Control report that there are now 15.7 million
Americans with diabetes. Although anyone can get
diabetes, there are several factors that can
increase the risk of developing the disease. Some
of these factors cannot be changed. These include
a family history of diabetes, age over 45, having
delivered a baby over nine pounds, and ethnicity.
It has been found that there is a higher incidence
of diabetes in African-Americans, Hispanics, and
Native Americans. There are a few risk factors
that can be reduced. These include being
overweight and not exercising regularly. By
adjusting their lifestyle, patients can reduce
their risk of developing the disease.
Type 1
The cause of diabetes is
dependent on the type of diabetes the patient
has. In Type I the beta cells in the pancreas,
the one’s responsible for producing the
body’s insulin, are gradually destroyed. This
is thought to be caused by the body’s own
immune system attacking the beta cells. The
immune system goes into overdrive, usually after
fighting an infection, and the starts to destroy
the body’s own tissues. In the case of
diabetes, the cells destroyed are the beta cells.
This is known as an autoimmune response. It is
not known what triggers the body into this
autoimmune response, but it seems to be that
there is a genetic disposition to it, as well as
influence from environmental factors. These
factors can include viral infections or
chemicals.
Type II
Type II diabetes results from
the body developing insulin resistance. Insulin
is being produced, but the body’s cells are not
able to use the insulin to take up the sugar in
the blood, known as glucose. It is thought that
there are three factors involved in the
development of obesity and insulin resistance
that lead to Type II diabetes. They are: free
fatty acids (acids in the blood produced by
breakdown of fat); leptin (a protein produced by
fat cells); and tumor-necrosis factor, or TNF (a
component of the immune system). It has still not
been completely determined how each of these
factors contribute to the development of Type II
diabetes. There are also genetic factors involved
in the development of type II diabetes.
Researchers are studying several genes thought to
be responsible to some degree for people getting
the disease.
What are the symptoms?
Type 1
Symptoms for Type I don’t
really show up until the destruction of the beta
cells is almost complete. The symptoms start to
show when the insulin production is almost done,
and then they appear rather suddenly. Symptoms
include frequent urination, excessive thirst,
especially for sweet drinks, extreme hunger along
with sudden weight loss, weakness, extreme
fatigue, visual changes especially blurred
vision, and irritability. Severe cases may have
no symptoms, then be diagnosed by a sudden onset
of a diabetic coma caused by the extremely high
levels of blood sugar.
Type II
Type II diabetes have very
similar symptoms including the frequent
urination, unusual thirst, fatigue, blurred
vision and weight loss, but they tend to appear
more slowly than with Type I. Women may also have
frequent vaginal yeast infections, and fungal
infections are common in the groin area or under
the breasts.
Diagnosis
Experts are recommending that
patients at risk be evaluated for Type I diabetes,
and that everyone over age 45 be tested regularly
for diabetes. Younger adults should be tested if
they have any of the risk factors. Pregnant women
should be tested between their 24th to
28th week routinely, and sooner if they
are at high risk. The tests that can be done to
diagnose diabetes are:
Fasting plasma glucose
testing-this has become the standard test. It is a
simple blood test drawn after the patient fasts
for 8 hours. Normal levels are up to 110 mg/dl.
The diagnosis of diabetes is made when this level
is 126 mg/dl or higher on two different days.
Levels between 110 mg/dl and 126 mg/dl are
considered to have impaired fasting glucose and
are at risk for later developing diabetes.
Glucose Tolerance Testing-this
test is more elaborate than the fasting glucose
testing. First a fasting glucose level is drawn,
then the patient drinks a special glucose
solution. Two hours later, another glucose level
is drawn. Normally, blood sugar increases
moderately after drinking the glucose solution,
and decreases after two hours. In diabetics, the
initial level is extremely high, and it doesn’t
decrease significantly after two hours.
Glycolated Hemoglobin-this test
examines the blood for levels of hemoglobin A1C or
glycolated hemoglobin. Hemoglobin is a protein
found in red blood cells, and it becomes modified
by having glucose bound to it. The degree of
modification depends on the average level of blood
sugar that the protein is exposed to over its life
span.
Treatment
Type 1
The medical treatment will
always involve insulin administration. Diet
modification as well as weight control are also
important. It has been found that by tightly
controlling the blood sugar level, many of the
major complications of diabetes can be delayed,
although not eliminated completely.
Type II
One third of the patients can
control their disease through diet and exercise
alone. The rest, however, need oral medications
that stimulate the pancreas to secrete additional
insulin, or increase the body’s sensitivity to
the insulin being made already. Eventually,
though, it is seen that the natural insulin
starts to fail, and insulin replacement is
necessary. Again, controlling the blood sugar
levels very closely will help to reduce the risk
for complications from diabetes.
Surgical treatment
For Type II diabetes, there is
no surgical treatment. Type I has only one
surgical treatment, pancreatic transplantation.
This doesn’t make a difference in Type II
diabetics since they still are making insulin, but
the body can’t manage it effectively. A new
pancreas would still be making insulin, but the
body still wouldn’t manage it. Type I diabetics
must not have other problems resulting from their
disease, such as severe heart disease, that would
make surgery difficult. They should also have
poorly controlled glucose levels despite following
a strict medical regimen.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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