Diabetes

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, which result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes, was first identified as a disease associated with “sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning although it can be controlled, it lasts a lifetime

• Type 1—Also known as insulin-dependent diabetes mellitus (IDDM), type 1 diabetes is an autoimmune disease (a condition arising from and directed against a person's own tissues) in which the pancreas produces little or no insulin. Individuals with type 1 diabetes must take insulin throughout their lives to manage their condition.
• Type 2—The most common form of diabetes (accounting for 90% of all cases), type 2 diabetes is a metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It occurs most frequently in people who are overweight, inactive, and older than 40 years of age (although the rates in children are rising). Most people with type 2 diabetes—about 60% to 70%—do not need to take insulin to manage their condition, however. For this reason, type 2 diabetes is also called noninsulin-dependent diabetes mellitus (NIDDM).
  

Signs and Symptoms

• Excessive urination
• Excessive intake of water and/or food
• Loss of bladder control in children after they had already been trained
• Unintended weight loss over several days (people with type 1 diabetes tend to be thin)
• High levels of glucose in the blood and urine
• Nausea and vomiting
• Abdominal pain or discomfort
• Weakness and excessive fatigue
• Increased susceptibility to infection, such as vaginitis and other yeast infections
• Dehydration
• Blurred vision
• Irritability, restlessness, and/or apathy
• Ketoacidosis —a potentially fatal condition marked by an accumulation of ketones (chemicals that build up in the bloodstream when the body is forced to burn fat instead of glucose) and increased acidity of the blood
• Numbness or burning sensation of the feet, ankles, and legs.
• Excessive urination and thirst
• Yeast infections
• Whole body itching

More about Diabetes

Causes

Both types of diabetes are caused by the absence, insufficient production, or lack of response by cells in the body to the hormone insulin.
People with type 1 diabetes produce little or no insulin at all because their immune systems attack and destroy the insulin-producing beta cells in the pancreas. Although it is not clear what specifically causes type 1 diabetes, it is believed that exposure to a toxin or viral infection may trigger this autoimmune attack in genetically susceptible individuals. In type 1 diabetes, beta cells are destroyed gradually, but symptoms do not appear until at least 80% of the cells are affected.

Type 2 diabetes usually develops in older, overweight individuals who become resistant to the effects of insulin over time. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin but, for unknown reasons, the body cannot use the insulin effectively (a condition called insulin resistance). In people with type 2 diabetes, production of insulin by the pancreas also tends to diminish.

As mentioned above, other types of diabetes can occur as a result of pregnancy (gestational diabetes), genetic disorders, surgery, medications such as steroids, malnutrition, infections, and other illnesses. In addition, physical stress can cause a temporary rise in blood sugar or even uncover "hidden" diabetes.

Risk Factors

• Family history of diabetes
• Low activity level
• Poor diet
• Excess body weight (especially around the waist)
• Age greater than 45 years
• High blood pressure
• High blood levels of triglycerides (a type of fat molecule)
• HDL cholesterol of less than 35
• Impaired glucose tolerance (identified by your doctor)
• Habitually inactive
• History of vascular disease (such as stroke)
• Mother who had preeclampsia (a condition characterized by a sharp increase in blood pressure during the third trimester of pregnancy)
• Family history of autoimmune diseases, including Hashimoto's thyroiditis, Graves' disease, myasthenia gravis, Addison's disease, or pernicious anemia
• Viral infections during infancy including mumps, rubella, and coxsackie
• Child of an older mother
• Northern European or Mediterranean descent
• Cow's milk in babies may cause diabetes type I

Diagnosis

Different types of tests are used to diagnose diabetes—random plasma glucose, fasting plasma glucose, and oral glucose tolerance tests.

If the blood sugar is elevated (as detected by a random measurement in the middle of the day), a fasting plasma glucose test will likely be ordered. This means that, after an individual has fasted overnight (at least 8 hours), a sample of blood is drawn and sent to the laboratory for analysis.

Normal fasting plasma glucose levels are less than 110 milligrams per deciliter (mg/dL). People with fasting plasma glucose levels of more than 140 mg/dL (on two or more tests on different days) definitely have diabetes. If results from the fasting plasma glucose test are questionable (meaning glucose levels are between 120 and 140 mg/dL) and diabetes is still suspected, a glucose tolerance test will be ordered. In this test, three measurements of blood glucose are taken over 2 hours after a large amount of sugar is ingested. If two of the measurements (or more) are at least 200 mg/dL, diabetes is diagnosed.

Treatment Approach

There is no cure for diabetes. The immediate goals are to stabilize your blood sugar and eliminate the symptoms of high blood sugar.

Type 1:

• Intensive Insulin therapy
• Meal planning
• Exercise

Type 2 - Different groups of oral medications may be combined, or insulin and oral medications may be used together.

• Medications
• Diet
• Exercise

Based on what is known, medications for type 2 diabetes are designed to:

• Increase the insulin output by the pancreas.
• Decrease the amount of glucose released from the liver.
• Increase the sensitivity (response) of cells to insulin
• Decrease the absorption of carbohydrates from the intestine.
• Slow gastric emptying to delay the presentation of carbohydrates for absorption in the small intestine

Pregnancy

Oral hypoglycemic agents are not known to be safe for use in pregnancy; women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breast-feeding.

Consequences of Uncontrolled Diabetes

• Retinopathy - Medical conditions such as good control of sugars, management of hypertension and regulation of blood lipids are important to prevent retinopathy. Fortunately, the vision loss isn't significant in most people with the condition.
• Kidney damage - The risk for kidney disease increases over time and becomes evident 15 to 25 years after the onset of the disease. This complication carries significant risk of serious illness -such as kidney failure and heart disease.
• Poor blood circulation - Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased risk of injury and decreased ability to heal open sores and wounds, which in turn significantly raises the risk of amputation.
• Damage to nerves - may also lead to digestive problems such as nausea, vomiting and diarrhea.

Medications

Diabetes Medications

• Actos
• Avandia
• Glimepiride
• Glipizide Xl
• Glyburide
• metformin