All About Diabetes

Diabetes Mellitus

Often referred to simply as diabetes, is a syndrome of diminished production of (type 1) or inappropriate response to (type 2 and gestational) hormone insulin produced by the beta cells of the pancreas.

Diabetes is characterized by disordered metabolism resulting in abnormally high level of sugar in blood (hyperglycemia).

The characteristic symptoms, which severity increases with that abnormality, are excessive urine production (polyuria) caused by sugar, resulting compensatory thirst and increased fluid intake (polydipsia), blurred vision caused by sugar effects on the eye's optics, unexplained weight loss, and lethargy.

Types

Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells.

Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand.

Gestational diabetes involves insulin resistance (similar to type 2) caused by hormones of pregnancy in genetically predisposed women. The gestational type usually resolves with delivery of the child.

Types 1 and 2 are chronic conditions

All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management.

Type 2 may be managed with a combination of dietary treatment, tablets and injections and, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.

Complications of Diabetes

Acute complications

1. Hypoglycemia.
2. Ketoacidosis, may occur if the disease is not adequately controlled.
Serious long-term complications include
1. Cardiovascular disease (doubled risk).
2. Chronic renal failure.
3. Retinal damage (which can lead to blindness).
4. Nerve damage (of several kinds).

Other Types

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autonomic or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.

Signs and symptoms

The classical triad of diabetes symptoms is Polyuria, Polydipsia and Polyphagia, which are, respectively, frequent urination; Increased thirst and consequent increased fluid intake; and increased appetite.

Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes the symptoms develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled.

When the glucose concentration in the blood is raised beyond the renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria).

ABC's of Diabetes

The National Diabetes Education Program (NDEP) developed a campaign entitled "Be Smart About Your Health, Control the ABCs of Diabetes." To help reduce diabetes related complications. The campaign focuses on three critical factors:
• Blood glucose - As reflected in your A1C
• Blood pressure
• Cholesterol

And recommends the following tests: