Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.
The blood delivers glucose to provide the body with energy to perform all of a person’s daily activities.
- The liver converts the food a person eats into glucose. The glucose is then released into the bloodstream.
- In a healthy person, the blood glucose level is regulated by several hormones, primarliy insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas also makes other important enzymes released directly into the gut that helps digest food.
- Insulin allows glucose to move out of the blood into cells throughout the body where it is used for fuel.
- People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
- In diabetes, glucose in the blood cannot move efficiently into cells, so blood glucose levels remain high. This not only starves all the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.
Types of Diabetes?
Type 1 diabetes (T1D): The body stops producing insulin or produces too little insulin to regulate blood glucose level.
- Type 1 diabetes involves about 10% of all people with diabetes in the United States.
- Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus.
- Type 1 diabetes can occur in an older individual due to destruction of the pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin.
- People with type 1 diabetes require insulin treatment daily to sustain life.
Type 2 diabetes (T2D): Although the pancreas still secretes insulin, the body of someone with type 2 diabetes is partially or completely unable to use this insulin. This is sometimes referred to as insulin resistance. The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands.
- At least 90% of adult individuals with diabetes have type 2 diabetes.
- Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes require insulin therapy.
- Type 2 diabetes is usually controlled withdiet, weight loss, exercise, and oral medications. However, more than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.
Gestational diabetes (GDM) is a form of diabetes that occurs during the second half of pregnancy.
- Although gestational diabetes typically resolves after delivery of the baby, a woman who develop gestational diabetes is more likely than other women to develop type 2 diabetes later in life.
- Women with gestational diabetes are more likely to have large babies.
Metabolic syndrome (also referred to as syndrome X) is a set of abnormalities in which insulin-resistant diabetes (type 2 diabetes) is almost always present along with hypertension (high blood pressure), high fat levels in the blood (increased serum lipids, predominant elevation of LDL cholesterol, decreased HDL cholesterol, and elevated triglycerides), central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with metabolic syndrome.
Prediabetes is a common condition related to diabetes. In people with prediabetes, the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes.
- Prediabetes increases a person’s risk of developing type 2 diabetes, heart disease, or stroke.
- Prediabetes can typically be reversed (without insulin or medication) with lifestyle changes such as losing a modest amount of weight and increasing physical activity levels. Weight loss can prevent, or at least delay, the onset of type 2 diabetes.
- An international expert committee of the American Diabetes Association redefined the criteria for prediabetes, lowering the blood sugar level cut-off point for prediabetes. Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years if they do make lifestyle changes such as exercising more and maintaining a healthy weight.
About 17 million Americans (6.2% of adults in North America) are believed to have diabetes. AIt has been estimated that about one third of adults with diabetes do not know they have diabetes.
- About 1 million new cases of diabetes is diagnosed occur each year, and diabetes is the direct or indirect cause of at least 200,000 deaths each year.
- The incidence of diabetes is increasing rapidly. This increase is due to many factors, but the most significant are the increasing incidence of obesity associated with the prevalence of a sedentary lifestyle.
Complications of Diabetes
Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition calledhyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the blood vessels of the kidneys, the nerves, and other blood vessels.
- Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
- Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause ofkidney failure.
- Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations.
- Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.
- Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).
- Diabetes predisposes people to elevated blood pressure, high levels of cholesterol and triglycerides. These conditions both independently and together with hyperglycemia, increase the risk of heart disease, kidney disease, and other blood vessel complications.
Diabetes can contribute to a number of acute (short-lived) medical problems.
- Many infections are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body’s normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.
- Hypoglycemia or low blood sugar, occurs intermittently in most people with diabetes. It can result from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, exercising more than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremor of the hands, and sweating are common symptoms of hypoglycemia. A person can faint or have a seizure if blood sugar level become too low.
- Diabetic ketoacidosis (DKA) is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup of ketones (acidic waste products ) in the blood. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies such as a stroke and heart attack.
- Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly, and often leads to dehydration so severe that it can cause seizures, coma, and even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated, or who have stress, injury, stroke, or are taking certain medications, like steroids.
Type 1 diabetes: Type 1 diabetes is believed to be an autoimmune disease. The body’s immune system specifically attacks the cells in the pancreas that produce insulin.
- A predisposition to develop type 1 diabetes may run in families, but genetic causes (a postitive family history) are much more common for type 2 diabetes.
- Environmental factors, including common unavoidable viral infections, may also contribute to type 1 diabetes.
- Type 1 diabetes is most common in people of non-Hispanic, Northern European descent (especially Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare in those of Asian descent.
- Type 1 diabetes is slightly more common in men than in women.
Type 2 diabetes: Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families. Several genes have been identified, and more are under study which may relate to the causes of type 2 diabetes. Risk factors for developing type 2 diabetes include the following:
- High blood pressure
- High blood triglyceride (fat) levels
- Gestational diabetes or giving birth to a baby weighing more than 9 pounds
- High-fat diet
- High alcohol intake
- Sedentary lifestyle
- Obesity or being overweight
- Ethnicity, particularly when a close relative had type 2 diabetes or gestational diabetes: certain groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans, have a greater risk of developing type 2 diabetes than non-Hispanic whites.
- Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years.
Symptoms of type 1 diabetes are often dramatic and come on very suddenly.
- Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus or urinary tract infection) or injury.
- The extra stress can cause diabetic ketoacidosis.
- Symptoms of ketoacidosis includenausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium follow.
- Without treatment, ketoacidosis can lead to coma and death.
Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.
- A person may have type 2 diabetes for many years without knowing it.
- People with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome.
- Type 2 diabetes can be precipitated by steroids and stress.
- If not properly treated, type 2 diabetes can lead to complications such as blindness,kidney failure, heart disease, and nerve damage.
- Fatigue, constantly tired: In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
- Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even an excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
- Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels, which overwhelms the kidney’s ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.
- Excessive urination (polyuria): Another way the body tries to rid the body of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because a large amount of water is necessary to excrete the sugar.
- Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to manage the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger. Despite increased caloric intake, the person may gain very little weight and may even lose weight.
- Poor wound healing: High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Long-standing diabetes also is associated with thickening of blood vessels, which prevents good circulation, including the delivery of enough oxygen and other nutrients to body tissues.
- Infections: Certain infections, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow. These infections can also be an indicator of poor blood sugar control in a person known to have diabetes.
- Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional. Call your health care professional or 911.
- Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels.
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