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.