Diabetes mellitus is a chronic disease in which patients present with absolute or relative insulin deficiency. It effects about 6% of western populations and is a major contributing factor for heart attacks, strokes, kidney failure and peripheral vascular disease. Diabetes mellitus is also the leading cause of new blindness.

1. Types of Diabetes

There are four forms of the disease, classified as: types 1 and 2, gestational and other specific types.

a. Type 1 Diabetes

In people with type 1 diabetes the pancreas is not producing insulin, so blood glucose levels are higher than normal. People with this form of diabetes require daily insulin therapy to survive. This form is further split into idiopathic diabetes and immune mediated diabetes.

Type 1 accounts for around 10% to 15% of all people with diabetes. It is one of the most serious and common chronic diseases of childhood, with about half of the people with this form of diabetes developing the disease before age 18. It is also known as insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes.

b. Type 2 Diabetes

Type 2 diabetes is marked by reduced levels of insulin (insulin deficiency) and/or the inability of the body to use insulin properly (insulin resistance). This form of the disease is most common among people aged 40 years and over and accounts for 85% to 90% of all people with diabetes. Most people with type 2 diabetes are obese.

c. Gestational Diabetes

Gestational diabetes occurs during pregnancy in about 3% to 8% of females not previously diagnosed with diabetes. It is a temporary form of diabetes and usually disappears after the baby is born. However, it is a marker of much greater risk of developing Type 2 diabetes later in life. Screening tests for gestational diabetes are usually performed around the 24th-28th week of pregnancy.

d. Other Specific Diabetes Types

This includes people who have diabetes as a result of a genetic defect, or exposure to certain drugs or chemicals.

2. Causes of Diabetes Mellitus

Diabetes is caused by resistance to, or deficient production of, the hormone insulin, which helps glucose move from the blood into the cells.

In type 1 immune mediated diabetes, pancreatic beta cell destruction results in failure to release insulin and ineffective transport of glucose. There is no known cause for idiopathic diabetes.

In type 2 diabetes, the beta cells release insulin but, receptors are insulin resistant and glucose transport is variable and inefficient. Some people may have conditions that can cause diabetes, such as Cushing's syndrome, pancreatitis or liver disease.

Risk factors for type 2 diabetes include;

a. Obesity

b. History of Gestational diabetes

c. Lack of physical activity

d. Hypertension

e. Age 45+

f. Ethnic groupings other than anglo-saxon

g. Low HDL cholesterol levels

h. Impaired glucose tolerance

i. Family history

3. Signs and Symptoms of Diabetes

Symptoms of diabetes include; dehydration, unexplained weight loss, excessive thirst, frequent need to urinate, fatigue, lethargy, severe irritation and itching, excessive hunger, blurred vision, skin and urinary infections and vaginitis.

4. Diagnosis

Diabetes or impaired glucose tolerance may be detected on routine blood tests as part of a general health check up or investigation for other symptoms or diseases. Diabetes tests check blood glucose levels.

Fasting blood glucose levels are classified as:

Normal: less than 100 mg/dl

Prediabetes: 100 to 125 mg/dl

Diabetes: greater than 125mg/dl

Because symptoms can be mild, diabetes is often detected when a person suffers a problem that is caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.

5. Diabetes Treatment

Effective treatment endeavors to normalize blood glucose and reduce complications using insulin replacement, diet and exercise. For those with very mild diabetes, diet plus weight loss plus exercise may be enough to keep blood glucose within reasonable levels.

Dietary changes should focus on the ideas of weight loss and blood sugar regulation by keeping the blood sugar levels relatively stable throughout the day, avoiding big peaks or troughs.

The principal treatment of type 1 diabetes, even from its earliest stages, is replacement of insulin combined with careful monitoring of blood glucose levels using blood testing monitors.

Type 2 diabetes may require oral anti-diabetic drugs to stimulate body insulin production and increase insulin sensitivity. Various forms of natural supplements for diabetes treatment have also been postulated as effective.

People with unstable diabetes, or those requiring many injections a day, may benefit from an insulin pump which is worn on the body and delivers a continuous infusion of insulin via a needle implanted into the body.

Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or the mother.

Treatment for all forms of diabetes need not significantly impair normal activities, if sufficient patient training, awareness, appropriate care, discipline in testing and dosing of insulin is taken

6. Complications

Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world. If undetected or poorly controlled, diabetes can lead to blindness, kidney failure, lower limb amputation, heart attack, stroke and impotence.

Types Of Diabetes

In medical parlance, this disease is known as "diabetes mellitus" - diabetes from the Greek word for siphon, to illustrate the excessive thirst and urination, which is characteristic of this condition, and mellitus from the Latin word for honey - as urine of a diabetic person contains sugar and is sweet.

Commonly, this disease is called diabetes.

There are many types of diabetes, but the three most common are:

« Type 1 diabetes

« Type 2 diabetes

« Gestational diabetes

1. Type 1 diabetes (also known as insulin dependent diabetes):

This is an autoimmune disease where the body's own immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. It can appear at any age, although mostly under 30 (very often in childhood or during teens), and is caused by environmental factors such as viruses, diet or people genetically predisposed. This type of diabetes, is also known as juvenile-onset diabetes.

It is not really known what causes type 1 diabetes and it is not caused by eating too much sugar or sweets.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin much earlier. Common symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme weakness. If not timely diagnosed and treated with insulin, a person with type 1 diabetes can go into life-threatening diabetic coma, also known as diabetic ketoacidosis.

2. Type 2 diabetes (non-insulin dependent diabetes):

This is the most common form of diabetes, affecting 85-90% of all diagnosed people. It is also known as late-onset diabetes, and is characterised by insulin resistance and relative insulin deficiency.

Type 2 diabetes is genetic in origin, but other factors such as excess weight, sedentary lifestyle, high blood pressure, ethnicity and faulty diet are its major risk factors. Symptoms may not show up for many years, and by the time they crop up, considerable harm may have been done to the body.

In this condition, the pancreas is usually producing enough insulin, but for reasons unknown, the body cannot use the insulin effectively - termed as insulin resistance. As a result, glucose builds up in the blood and the body cannot make proficient use of its main source of energy.

The symptoms of type 2 diabetes develop gradually. Symptoms include weakness, nausea, frequent urination, excess thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds. Some people may show no symptoms.

Type 2 diabetes is a progressive, lifetime condition; and over time, it may be difficult to keep the blood glucose level in the target range. However, good diabetes care and management can prevent or delay the onset of complications.

One can do this by:

« Eating healthy meals and snacks

« Following regular physical activity

« Taking diabetes medications (including insulin), if prescribed.

3. Gestational diabetes:

Gestational diabetes develops only during pregnancy. In most cases, all diabetic symptoms disappear following delivery. Women who have had gestational diabetes have a 20 to 50 % chance of developing type 2 diabetes within 5 to 10 years, especially if they were overweight before the pregnancy.

Gestational diabetes is not caused by a lack of insulin, but by blocking effects of other hormones (estrogen, cortisol, and human placental lactogen) on the insulin that is produced, a condition referred to as insulin resistance. Normally, the pancreas is able to make additional insulin to overcome insulin resistance. However, when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

Carbohydrate intolerance is diagnosed during pregnancy through an oral glucose tolerance test (OGTT). While the carbohydrate intolerance usually returns to normal level after delivery, the mother has a significant risk of developing permanent diabetes later on; while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life.

Risk factors include a family history of diabetes, increasing maternal age, obesity and being a member of a ethnic group with a high risk of developing type 2 diabetes.

The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels as soon as the diagnosis of gestational diabetes is made.

Other types of diabetes -

4. Diabetes insipidus:

Diabetes insipidus is an uncommon condition, that occurs when the kidneys are unable to conserve water as they perform their function of filtering blood. The anti-diuretic hormone (ADH, also called vasopressin) controls the amount of water conserved. Diseases of the kidney (for example, polycystic kidney disease) and the effects of certain drugs may also cause nephrogenic diabetes insipidus.

The common symptoms are excessive ********* and extreme thirst.

5. Syndrome X:

Syndrome X, also known as the "metabolic syndrome" or "Insulin Resistance Syndrome", is a condition that is linked to an increased risk of diabetes and heart disease.

It is characterised by abdominal obesity, elevated levels of triglycerides, low levels of HDL (good) cholesterol, high blood pressure and high blood sugar levels. Other symptoms include smoking, high fat and calorie diet, pre-diabetes or Type 2 diabetes, polycystic ovary syndrome.

This is more common in older people than in younger people. In addition, women were more likely to have the syndrome than men.

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