Diabetes Mellitus
Also known as: diabetes, Type 1 or juvenile
onset 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.
Type 1, 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.
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.
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.
What are the symptoms?
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.
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
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.
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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