Diabetes

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Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs.

• Urination and thirst are increased, and people lose weight when they are not trying to
• Diabetes damages the nerves and causes problems with sensation
• Diabetes damages blood vessels and increases the risk of heart attack, stroke, and kidney failure
• Doctors diagnose diabetes by measuring blood sugar levels
• People with diabetes need to follow a low-sugar, low-fat diet, exercise, and usually take drugs.

Insulin, a hormone released from the pancreas, controls the amount of sugar in the blood. When people eat or drink, food is broken down into materials, including the simple sugar glucose, that the body needs to function. Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, it is converted to energy, which is either used immediately or stored as fat or glycogen until it is needed.

The levels of sugar in the blood vary normally throughout the day. They rise after a meal and return to normal within about 2 hours after eating. Once the levels of sugar in the blood return to normal, insulin production decreases. The variation in blood sugar levels is usually within a narrow range, about 70 to 110 milligrams per deciliter (mg/dL) of blood. If people eat a large amount of carbohydrates, the levels may increase more. People older than 65 years tend to have slightly higher levels, especially after eating.

If the body does not produce enough insulin to move the sugar into the cells, the resulting high levels of sugar in the blood and the inadequate amount of sugar in the cells together produce the symptoms and complications of diabetes.

Doctors often use the full name diabetes mellitus, rather than diabetes alone, to distinguish this disorder from diabetes insipidus, a relatively rare disorder that does not affect blood sugar levels.

Types

Prediabetes: Prediabetes is a condition in which blood sugar levels are too high to be considered normal but not high enough to be labeled diabetes. People have prediabetes if their fasting blood sugar level is between 101 mg/dL and 126 mg/dL or if their blood sugar level 2 hours after a glucose tolerance test is between 140 mg/dL and 200 mg/dL. Identifying people with prediabetes is important because the condition carries a higher risk for future diabetes as well as heart disease. Decreasing body weight by 5 to 10 % through diet and exercise can significantly reduce the risk of developing future diabetes.

Type 1: In type 1 diabetes (formerly called insulin-dependent diabetes or juvenile-onset diabetes), more than 90% of the insulin-producing cells of the pancreas are permanently destroyed. The pancreas, therefore, produces little or no insulin. Only about 10% of all people with diabetes have type 1 disease. Most people who have type 1 diabetes develop the disease before age 30.

Scientists believe that an environmental factor—possibly a viral infection or a nutritional factor in childhood or early adulthood—causes the immune system to destroy the insulin-producing cells of the pancreas. A genetic predisposition may make some people more susceptible to the environmental factor.

Type 2: In type 2 diabetes (formerly called non-insulin-dependent diabetes or adult-onset diabetes), the pancreas continues to produce insulin, sometimes even at higher-than-normal levels. However, the body develops resistance to the effects of insulin, so there is not enough insulin to meet the body's needs.

Type 2 diabetes was once rare in children and adolescents but has recently become more common. However, it usually begins in people older than 30 and becomes progressively more common with age. About 15% of people older than 70 have type 2 diabetes. People of certain racial and ethnic backgrounds are at increased risk of developing type 2 diabetes: blacks, Native Americans, and Hispanics who live in the United States have a twofold to threefold increased risk. Type 2 diabetes also tends to run in families.

Obesity is the chief risk factor for developing type 2 diabetes, and 80 to 90% of people with this disorder are overweight or obese. Because obesity causes insulin resistance, obese people need very large amounts of insulin to maintain normal blood sugar levels.

Certain disorders and drugs can affect the way the body uses insulin and can lead to type 2 diabetes. High levels of corticosteroids (from Cushing's disease or from taking corticosteroid drugs) and pregnancy (gestational diabetes) are the most common causes of altered insulin use. Diabetes also may occur in people with excess production of growth hormone (acromegaly) and in people with certain hormone-secreting tumors. Severe or recurring pancreatitis and other disorders that directly damage the pancreas can lead to diabetes.

Symptoms

The two types of diabetes have very similar symptoms. The first diabetes symptoms are related to the direct effects of high blood sugar levels. When the blood sugar level rises above 160 to 180 mg/dL, sugar spills into the urine. When the level of sugar in the urine rises even higher, the kidneys excrete additional water to dilute the large amount of sugar. Because the kidneys produce excessive urine, people with diabetes urinate large volumes frequently (polyuria). The excessive urination creates abnormal thirst (polydipsia). Because excessive calories are lost in the urine, people lose weight. To compensate, people often feel excessively hungry. Other symptoms include blurred vision, drowsiness, nausea, and decreased endurance during exercise.

Type 1: In people with type 1 diabetes, the symptoms often begin abruptly and dramatically. A condition called diabetic ketoacidosis may quickly develop. Without insulin, most cells cannot use the sugar that is in the blood. Cells still need energy to survive, and they switch to a back-up mechanism to obtain energy. Fat cells begin to break down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). The initial symptoms of diabetic ketoacidosis include excessive thirst and urination, weight loss, nausea, vomiting, fatigue, and—particularly in children—abdominal pain. Breathing tends to become deep and rapid as the body attempts to correct the blood's acidity. The breath smells like nail polish remover, the smell of the ketones escaping into the breath. Without treatment, diabetic ketoacidosis can progress to coma and death, sometimes within a few hours.

Type 2: People with type 2 diabetes may not have any symptoms for years or decades before they are diagnosed. Symptoms may be subtle. Increased urination and thirst are mild at first and gradually worsen over weeks or months. Eventually, people feel extremely fatigued, are likely to develop blurred vision, and may become dehydrated.

Sometimes during the early stages of diabetes, the blood sugar level is abnormally low, a condition called hypoglycemia.

Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop. However, the blood sugar levels can become extremely high (often exceeding 1,000 mg/dL). Such high levels often happen as the result of some superimposed stress, such as an infection or drug use. When the blood sugar levels get very high, people may develop severe dehydration, which may lead to mental confusion, drowsiness, and seizures, a condition called nonketotic hyperglycemic-hyperosmolar coma.

Complications

People with diabetes may experience many serious, long-term complications. Some of these complications begin within months of the onset of diabetes, although most tend to develop after a few years. Most of the complications are progressive. The more strictly people with diabetes are able to control the levels of sugar in the blood, the less likely it is that these complications will develop or become worse.

Most complications are the result of problems with blood vessels. High sugar levels over a long time cause narrowing of both the small and large blood vessels. The narrowing reduces blood flow to many parts of the body, leading to problems. There are several causes of blood vessel narrowing. Complex sugar-based substances build up in the walls of small blood vessels, causing them to thicken and leak. Poor control of blood sugar levels also tends to cause the levels of fatty substances in the blood to rise, resulting in atherosclerosis and decreased blood flow in the larger blood vessels. Atherosclerosis is between 2 and 6 times more common in people with diabetes than in people who do not have diabetes and tends to occur at younger ages.

Over time, elevated levels of sugar in the blood and poor circulation can harm the heart, brain, legs, eyes, kidneys, nerves, and skin, resulting in angina, heart failure, strokes, leg cramps on walking (claudication), poor vision, kidney failure, damage to nerves (neuropathy), and skin breakdown. Heart attacks and strokes are more common among people with diabetes. Poor circulation to the skin can lead to ulcers and infections and causes wounds to heal slowly. People with diabetes are particularly likely to have ulcers and infections of the feet and legs. Too often, these wounds heal slowly or not at all, and amputation of the foot or part of the leg may be needed.

People with diabetes often develop bacterial and fungal infections, typically of the skin. When the levels of sugar in the blood are high, white blood cells cannot effectively fight infections. Any infection that develops tends to be more severe.

Damage to the blood vessels of the eye can cause loss of vision (diabetic retinopathy. Laser surgery can seal the leaking blood vessels of the eye and prevent permanent damage to the retina. Therefore, people with diabetes should have yearly eye examinations to check for damage.

The kidneys can malfunction, resulting in kidney failure that may require dialysis or kidney transplantation. Doctors usually check the urine of people with diabetes for abnormally high levels of protein (albumin), which is an early sign of kidney damage. At the earliest sign of kidney complications, people are often given angiotensin-converting enzyme (ACE) inhibitors, drugs that slow the progression of kidney damage.

Damage to nerves can manifest in several ways. If a single nerve malfunctions, an arm or leg may suddenly become weak. If the nerves to the hands, legs, and feet become damaged (diabetic polyneuropathy), sensation may become abnormal, and tingling or burning pain and weakness in the arms and legs may develop. Damage to the nerves of the skin makes repeated injuries more likely because people cannot sense changes in pressure or temperature.

Diagnosis

The diagnosis of diabetes is made when people have abnormally high levels of sugar in the blood. Blood sugar levels are often checked during a routine physical examination. Checking the levels of sugar in the blood annually is particularly important in older people, because diabetes is so common in later life. People may have diabetes, particularly type 2 diabetes, and not know it. Doctors may also check blood sugar levels in people who have symptoms of diabetes such as increased thirst, urination, or hunger. Doctors may also check blood sugar levels in people who have disorders that can be complications of diabetes, such as frequent infections, foot ulcers, and yeast infections.

To measure the blood sugar levels, a blood sample is usually taken after people have fasted overnight. However, it is possible to take blood samples after people have eaten. Some elevation of blood sugar levels after eating is normal, but even after a meal the levels should not be very high. Fasting blood sugar levels should never be higher than 126 mg/dL. Even after eating, blood sugar levels should not be higher than 200 mg/dL.

Doctors can also measure the level of a protein in the blood, hemoglobin A1C (also called glycosylated or glycolated or hemoglobin). Glycosylated hemoglobin forms when the blood has been exposed to high blood sugar levels over a period of time. Doctors do not usually use this test to diagnose diabetes, but the test can help confirm the diagnosis when blood sugar levels are not extremely high. The test demonstrates long-term trends in blood sugar levels.

Another kind of blood test, an oral glucose tolerance test, may be done in certain situations, such as in routine screening of pregnant women for gestational diabetes or in older people who have symptoms of diabetes but normal glucose levels when fasting. However, it is not routinely used for testing for diabetes, including in pregnant women at very low risk. In this test, people fast, have a blood sample taken to determine the fasting blood sugar level, and then drink a special solution containing a large, standard amount of glucose. More blood samples are then taken over the next 2 to 3 hours and are tested to determine whether the level of sugar in the blood rises abnormally high.

Treatment

Individual diabetes treatment may vary depending upon the patient and their desire to receive tradition treatment, alternative treatment or integrative treatment for the disease.  It is vital that persons diagnosed with, or suspected of having diabetes consult with their health care provider to assure proper evaluation, treatment and interpretation of information contained on this site.

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