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Diabetes Mellitus
Medical Questions » Diabetes Mellitus
| Name: Diabetes Mellitus |
| Also known as: Sugar Diabetes |
| Excessive levels of glucose in the blood. Glucose is used as fuel by every cell in the body. When glucose is eaten, it is absorbed into the blood from the small intestine. Once it reaches a cell, it must cross the fine membrane that forms its outer skin. This is normally impermeable to all substances, but insulin has the ability to combine with glucose and transport it across the membrane from the blood into the interior of the cell. Insulin is made in the pancreas, which sits in the center of the abdomen. There are two totally different types of diabetes juvenile diabetes (type 1 or insulin dependent diabetes mellitus (IDDM)) and maturity onset diabetes (type 2 or non-insulin dependent diabetes mellitus (NIDDM)). Diabetes affects approximately 2% of the population, with 90% of diabetics suffering from the maturity onset form. The cause and treatment of the two types is quite different. |
Causes of Diabetes Mellitus
Juvenile diabetes: a lack of insulin production by the pancreas. Most people develop this type as a child or in early adult life. Maturity onset diabetes: far more common in obese patients. There is adequate insulin production, but cells throughout the body fail to respond to the insulin. |
Symptoms of Diabetes Mellitus
Juvenile diabetes: excessive tiredness, thirst, excess passing of urine, weight loss despite a large food intake, itchy rashes, recurrent vaginal thrush infections, pins and needles and blurred vision. Patients become steadily weaker because their muscles and other organs cannot work properly. Maturity onset diabetes: similar symptoms, but less thirst and urinary frequency, and more visual problems, skin infections and sensory nerve problems than those with the juvenile form. Many patients are totally without symptoms when the diagnosis is discovered on a routine blood or urine test. |
Tests for Diabetes Mellitus
Blood and urine glucose levels are high in untreated or inadequately treated patients.
A blood glucose tolerance test (GTT) is performed to determine the severity of both types of diabetes. After fasting for 12 hours, a blood sample is taken, then a sweet drink is then swallowed, and further blood samples are taken at regular intervals for two or three hours. The pattern of absorption and elimination of blood glucose will give the diagnosis.
By measuring the amount of glucose in certain blood cells, the average blood glucose level over the past three months can also be determined.
The level of insulin can also be measured in blood.
Juvenile diabetes: daily self-testing is necessary to ensure that disease control is adequate. Both blood and urine tests for glucose are available, but the blood tests are far superior.
Maturity onset diabetes: regular blood testing of glucose levels is also necessary, but normally on a weekly rather than daily basis. Urine tests are often inaccurate in the elderly, as their kidney function may be reduced to the point where glucose cannot enter the urine. |
Treatment for Diabetes Mellitus
Diet is essential in both forms because the amount of glucose eaten is not normally constant, and diabetics lack the means of adjusting the amount of glucose in their blood with insulin. The diet must restrict the number of kilojoules (calories) being eaten, and sugar in all its forms should be eaten only with great caution. Fat should not account for more than a third of the total calories, and cholesterol intake should be restricted. Protein should be obtained more from poultry and fish than red meats. Carbohydrates other than sugar can be consumed freely. Grains and cereals with a high fiber content should be the main part of the diet. Artificial sweeteners such as aspartame (NutraSweet) can be used to flavor food and drinks. Fat cells can react abnormally to insulin very easily, and so overweight diabetics must lose weight. Exercise is encouraged on a regular daily basis. Patients should carry glucose sweets with them at all times to use if their blood sugar levels drop too low.
Juvenile diabetes: when first diagnosed, patients are often quite ill, and most are hospitalized for a few days to stabilize their condition. Insulin injections must be given regularly several times a day for the rest of their life. Initially derived from pigs and cattle, human insulin has now been produced by genetic engineering techniques. Insulin cannot be taken by mouth as it is destroyed by acid in the stomach, but can be injected into any part of the body covered by loose skin, although the same site should not be used repeatedly. The newer pen-style delivery systems enable diabetics to easily dial the required dose and inject as necessary with minimal inconvenience. There are many different types of insulin that vary in their speed of onset and duration of action.
Maturity onset diabetes: education of patients with this type of diabetes is very important, so that they understand what they can and cannot eat and drink. Older people who develop diabetes can often have the disease controlled by diet alone or a combination of tablets and diet. Tablets (eg. tolbutamide, chlorpropamide, glibenclamide, glipizide) make the cell membrane respond to insulin again. Weight loss is a vital part of treatment because if normal weight levels can be maintained, the disease may disappear.
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Complications of Diabetes Mellitus of its treatment
Juvenile diabetes: an increased risk of both bacterial and fungal skin and vaginal infections, the premature development of cataracts in the eye, microscopic hemorrhages and exudate that destroy the retina at the back of the eye, damage to the kidneys that prevents them from filtering blood effectively, poor circulation to the extremities (hands and feet) that may cause chronic ulcers and even gangrene to the feet, the development of brown skin spots on the shins, and sensory nerve damage (diabetic neuropathy) that alters the patient' s perception of vibration, pain and temperature. There are also complications associated with treatment such as a ' hypo' in which too much insulin is given, excess exercise undertaken or not enough food is eaten, and blood glucose levels drop (hypoglycemia) to an unacceptably low level. The patient becomes light-headed, sweats, develops a rapid heart beat and tremor, becomes hungry, then nauseated before finally collapsing unconscious. Glucose drinks or sweets given before collapse can reverse the process, but after collapse, an injection of glucose is essential. In an emergency, a sugary syrup or honey introduced through the anus into the rectum may allow a diabetic to recover sufficiently to take further sugar by mouth. Rarer complications of treatment are adverse reactions to pork or beef insulin, and damage to the fat under the skin if the same injection site is used too frequently. Diabetic ketoacidosis (see separate entry) is the most severe complication. Maturity onset diabetes: the elderly are very susceptible to all the complications listed above, particularly foot damage and eye damage. High blood pressure is more common than in the average person of their age. |
Likely Outcome of Diabetes Mellitus
With the correct treatment and careful control, patients with both types of diabetes should live a near-normal life, with a near-normal life span. |
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