Diabetes Update

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What is diabetes?

Diabetes mellitus is a chronic health condition in which the body is unable to produce adequate insulin to properly break down sugar (glucose) in the blood. Symptoms include hunger, thirst, excessive urination, dehydration and weight loss. Over time, diabetes can lead to heart and blood vessel disease, blindness, kidney failure, and foot ulcers, among other conditions.

Diabetes is a disease of the endocrine system, specifically, the pancreas, and of glucose metabolism. Insulin is normally produced in the pancreas in response to high blood glucose levels; for example, after a meal. The Islets of Langerhan are small areas of tissue within the pancreas that contain beta cells, which produce insulin. In Type 1 diabetes, the beta cells are destroyed, leading to an absolute lack of insulin. In Type 2 diabetes, there is resistance peripherally to the inherent insulin. This leads to a relative lack of insulin and therefore hyperglycemia.

Type 1 diabetes occurs at a very early age, caused, as mentioned above, by a destruction of beta cells in the pancreas. People with Type 1 diabetes have little or no ability to produce insulin and are entirely dependent on injections of insulin for survival.

The cause of Type 1 diabetes is unknown, although childhood infections and a genetic tendency are two possibilities. The pancreas undergoes a change, and cells that normally produce insulin are destroyed. This may be a result of the body’s own immune system believing the pancreas to be a foreign organ. Patients with Type 1 diabetes tend to be very slim people.

Type 2 diabetes tends to be of adult onset, although more and more young people are now being diagnosed with this insulin-resistance syndrome.

In Type 2 diabetes , the pancreas retains its ability to produce insulin , but either the quantity is inadequate for the body’s needs, or insulin cannot be used to its full extent by the tissues. Most people who have this condition suffer from being overweight, and require a strict weight-reducing diet and exercise program, as well as possible treatment with drugs, sometimes including insulin.

Definition of diabetes

•  Random plasma glucose of >200mg/dL

•  Fasting plasma glucose >=126mg/dL on 2 separate occasions

•  Fasting plasma glucose 110-125mg/dL is considered Impaired Glucose Tolerance

•  Fasting plasma glucose <110mg/dL is considered normal

•  HbA1c <6.5% indicates good glucose control

Signs/symptoms

At onset, the two types of diabetes present with distinction:

Type 1 – weight loss, polyuria, polydypsia

Type 2 – polyuria, polydypsia, recurrent infections

Prevalence of diabetes

It is estimated that 20.8 million people in the United States –7 percent of the population-have diabetes, including 6.2 million who are undiagnosed. Ninety-five percent of people with diabetes have Type 2. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. Diabetes is also likely to be underreported as a cause of death. Overall, the risk of death among people with diabetes is about twice that of people without diabetes of similar age.

Complications of diabetes

Diabetes is a systemic disease which can have devastating effects on the body as a whole. Diabetes has numerous serious complications.

Heart and blood vessel disease

Heart disease is the leading cause of death for people with diabetes. Heart disease and stroke account for about 65 percent of deaths in people with diabetes.

People with diabetes are 2-4 times more likely to have heart disease than persons without diabetes. Even people with Type 2 diabetes who do not have heart disease have an increased risk of having a heart attack. People with diabetes also tend to have other risk factors for heart disease, including obesity, high blood pressure, and hardening of the arteries (atherosclerosis).

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