Diabetes Mellitus- Types, Causes, Symptoms and Treatment

Diabetes mellitus is the inability of the body to use glucose for energy due to inadequate amounts of, or loss of sensitivity to, the hormone insulin.

In diabetes mellitus the pancreas either produces insufficient amounts of insulin or body cells become resistant to the hormone’s effects. Diabetes mellitus is one of the most common long-term diseases occurring in the Western world, affecting more than 1 in 20 people. It sometimes runs in families.

Diabetes is a serious disorder and it’s among the six leading causes of death among individuals older than age 65 in America. Actually, the death rate from diabetes is likely greatly underestimated. Doctors say that death certificates in many cases are incomplete and incorrect and that the multiple metabolic abnormalities related to diabetes result in heart attack, stroke, kidney disease and kidney failure, and other vascular problems, which might be recorded as the cause of death on death certificates.

Types of Diabetes Mellitus

There are two main forms of diabetes mellitus, designated as type I diabetes and type II diabetes.

Type I Diabetes

This form of diabetes occurs when the pancreas produces too little insulin or none at all. It usually develops suddenly in childhood or adolescence. Although dietary measures are also important, it must be treated with insulin injections. About 60,000 people in the UK have this type of diabetes.

Type II Diabetes

Type II is by far the most common form of diabetes. The pancreas continues to secrete insulin but cells in the body become resistant to its effects. This form of diabetes mainly affects people over the age of 40 and is more common in overweight people. It develops slowly and often goes unnoticed for many years. Sometimes the condition may be treated with dietary measures alone, but oral drugs and sometimes insulin injections may become necessary. About 600,000 people in the UK have type II diabetes.
Diabetes mellitus can sometimes develop during pregnancy. This condition is called gestational diabetes and is usually treated with insulin to maintain the health of the mother and baby. Gestational diabetes usually disappears after childbirth; however, women who have had it are at increased risk of developing type II diabetes in later life.

Detection of Diabetes

Urine can be checked for sugar using a biochemical testing strip. If sugar is present then a blood test is taken to see whether blood sugar really is high. If there is still doubt then a glucose tolerance test might be required: you drink a very sweet drink and have half-hourly measurements of blood sugar for the next two hours.

A serious issue is that many seniors with diabetes haven’t been diagnosed, and therefore they’re not getting treatment. For example of the estimated 18 percent of girls ages 60-74 who have diabetes, about 4.5 percent stay undiagnosed. Of the estimated 20 percent of men ages 60-74 with diabetes, the issue of a deficiency of analysis is even greater: about 8 percent are undiagnosed.

This deficiency of identification continues among individuals older than age 74: about 5 percent of girls age 75 and older have undiagnosed diabetes, and about 8 percent of men age 75 and older are undiagnosed. Without analysis, these people aren’t treated and their health is endangered.

What are The Causes of Diabetes Mellitus?

• Type I diabetes is usually caused by an abnormal reaction in which the immune system destroys insulin-secreting cells in the pancreas. This kind of diabetes can be thought of as an autoimmune disorder.
• The trigger of the abnormal reaction is unknown, but it may be a viral infection.
• In some cases, destruction of the insulin- secreting tissues occurs after inflammation of the pancreas during acute pancreatitis.
• Genetics may also play a role, but the pattern of inheritance is complicated. The child of a person who has type I diabetes is at greater risk of developing the same type of diabetes. However, most affected children do not have a parent with diabetes.
• The causes of type II diabetes are less well understood, but genetics and obesity are important factors. About 1 in 3 diabetics has a relative with the same type of diabetes.
• Type II diabetes is a growing problem in societies that are becoming more affluent. In such societies, food intake increases, leading to a rise in the number of overweight people and the prevalence of this condition.
• Type II diabetes can also be caused by corticosteroid drugs by excess levels of
  natural corticosteroid hormones, as occurs in overactivity of the adrenal glands (Cushing’s syndrome), which oppose the action of insulin.

What Are The Symptoms of Diabetes Mellitus?

Although some of the symptoms of both forms of diabetes mellitus are similar, type I diabetes tends to develop more quickly and become more severe. The symptoms of type II may not be obvious or may go unnoticed until a routine medical check-up. The main symptoms of both forms may include:

1. Excess urine output/increased thirst: High sugar levels present the kidneys with too much sugar to be properly reabsorbed, so sugar leaks out with the urine. Large amounts of fluid leave with the sugar, thus one of the early symptoms of diabetes is passing a lot of urine. Because of the fluid loss,
   the diabetic feels thirsty and drinks much more than usual. In extreme cases the individual cannot keep pace with the fluid loss and becomes seriously dehydrated, with confusion and weakness, ultimately lapsing into a coma. Before insulin was discovered, this was how many young diabetics died.
2. Tiredness: Despite a superabundance of sugar in the blood stream, without adequate insulin the body cannot transport it into the cells where it is needed as fuel.
3. Weight loss: Unable to use sugar, the body turns to making its energy from fat and even protein from muscle, hence the weight loss. This presentation is especially dramatic in diabetics whose pancreas has failed – the younger diabetics. They become rapidly ill with weight loss and dehydration.
4. Infections: Bacteria feed on sugar. Diabetics have masses of the stuff in their urine and blood. This makes them walking banquets for bacteria, leading to thrush (a fungal infection of the groins, armpits and vagina), boils and abscesses.

In some people, the first sign of diabetes is ketoacidosis, a condition in which toxic chemicals called ketones build up in the blood. These chemicals are produced when body tissues are unable to take up glucose from the blood due to inadequate production of insulin, and have to use fats for energy. Ketoacidosis can also occur in people with type I diabetes who are taking insulin if they miss several doses or develop another illness (because any form of illness increases the body’s requirement for insulin). The main symptoms of ketoacidosis include:

• nausea and vomiting, sometimes with abdominal pain
• deep breathing
• acetone smell to the breath (like pear drops or nail polish remover)
• confusion.

These symptoms constitute a medical emergency because they can lead to severe dehydration and coma if not treated urgently. Emergency treatment for ketoacidosis includes:

• intravenous fluids to correct dehydration and restore the chemical balance in the blood
• insulin injections to enable cells to absorb glucose from the blood.

Are There Complications in Diabetes Mellitus?

Diabetes mellitus may give rise to both short¬term and long-term complications. Short-term problems are usually easy to remedy, but long-term complications are hard to control and can lead to shorter life expectancy.

Short-Term Complications

Poorly controlled or untreated type 1 diabetes may lead to ketoacidosis, the symptoms of which are described above.

Long-Term Complications

Certain long-standing problems pose the main health threat to people with diabetes and eventually affect even people with well- controlled diabetes. Close control of the blood sugar level reduces the risk of developing these problems, and early recognition of complications helps in their control. For these reasons, all affected people should see their doctor at least four times a year. Type II diabetes is often not diagnosed until years after its onset. As a result, complications may be evident at the time of initial diagnosis.

1. People with diabetes are at increased risk of cardiovascular disease. Large blood vessels may be damaged by atherosclerosis, which is a major cause of coronary artery disease and stroke.
2. Elevated levels oi cholesterol in the blood, which accelerates the development of atherosclerosis, is more common in people with diabetes.
3. Diabetes is also associated with high blood pressure, another risk factor for cardiovascular disease.
4. Other long-term complications result from damage to small blood vessels throughout the body. Damage to blood vessels in the light- sensitive retina at the back of the eye may cause diabetic retinopathy.
5. Diabetes also increases the risk of developing cataracts in the eyes. People with diabetes mellitus should have their eyes examined yearly by an ophthalmologist.
6. If diabetes affects blood vessels that supply
   nerves, it may cause nerve damage, so there may be a gradual loss of sensation, starting at the hands and feet and sometimes gradually extending up the limbs.
7. Symptoms may also include dizziness upon standing.
8. There may be impotence in men.
9. Later in life, loss of feeling combined with poor circulation makes the legs more susceptible to ulcers, even gangrene, so routine check-ups with your doctor are vital.
10. Damage to small blood vessels in the kidneys may lead to chronic kidney failure and end-stage kidney failure, which requires lifelong dialysis or a kidney transplant.

How Is Diabetes Mellitus Diagnosed?

Along with a patient having symptoms of diabetes, the sickness is supported with blood glucose levels. The Diagnosis is made with a fasting glucose level of greater than 126 mg/dl on two occasions or with a 2-hour glucose test that’s greater than 200 mg/dl. As an example, after fasting for 8-14 hours, plasma glucose levels are quantified, and amounts are taken again about a couple of hours later after the individual ingests 75 grams of glucose supplied by the person administering the test.

The amount for diabetes must be equivalent to or greater than 200 mg/dl two hours after taking the oral glucose. There’s also a test that quantifies how well the body handles glucose after a three-month period of time; it’s called the glycosylated hemoglobin level. This info could be very helpful in quantifying long term diabetes management.

What Is The Treatment of Diabetes Mellitus?

Diabetes is treated with a mix of exercise, drugs, and lifestyle recommendations. Additionally, the patient’s blood must be examined at least several times daily, at the very least. Glucose levels must be tracked with house glucose tests. For anyone with diabetes mellitus, the aim of treatment is to maintain the level of glucose in the blood within the normal range without marked fluctuations. This aim may be achieved with dietary measures, a combination of diet and insulin injections or of diet and pills that lower blood glucose levels. Treatment is usually lifelong and you will have to take responsibility for the daily adjustment of your diet and medication on the basis of daily blood sugar tests, which you perform yourself.

Treatment For Type I Diabetes

• This form of diabetes mellitus is nearly always treated with insulin injections. Oral drugs alone are ineffective.
• Insulin is available in various forms, including short-acting, long-acting and combinations of both forms.
• Treatment regimens need to be individually tailored and they may include combinations of insulin and oral drugs.
• Your doctor will talk to you about your needs and arrange for you to learn how to inject yourself.
• You will also have to control your diet and monitor your blood glucose as described below.
• If the diabetes is difficult to control you may be given an insulin pump, which dispenses insulin through a catheter that is inserted into your skin.
• Some commonly prescribed drugs for patients with Type 1 diabetes are the various types of insulin, including routine, lyspro, NPH, Aspart, lente, ultralente, semilente, and glargine.

Possible Transplant

The only way to cure type I diabetes is by a pancreas transplant, but this surgery is not routinely offered because the body may reject the new organ and because lifelong treatment with immunosuppressant drugs is needed afterwards. However, some people are given a pancreas transplant at the same time as a kidney transplant. A method is currently being devised to transplant insulin-secreting cells isolated from a normal pancreas, but this
Technique is still at an experimental stage.

Treatment For Type II Diabetes

Many people with this form of diabetes can control their blood glucose levels by exercising regularly and following a healthy diet to maintain ideal weight.

• You should follow general guidelines for a healthy diet and seek the guidance of a dietitian if necessary. Try to keep fat intake low, and obtain energy from complex carbohydrates (such as bread and rice) to minimize fluctuations in the blood glucose level. The diet should have a fixed calorie content. The proportions of protein, carbohydrate and fat must be consistent to keep a balance between food intake and medicine.
• You must also check your blood glucose regularly. If the glucose level is higher or lower than recommended, you may need to alter your diet or adjust your insulin or drug dose with the help of your doctor. Effective monitoring is especially important if you develop another illness, such as influenza, and in other situations, such as exercising or planning to eat a larger meal than usual.
• When diet is not sufficient to control your blood sugar, one or more drugs may be
  prescribed. You will probably begin with oral drugs, such as sulphonylureas, which stimulate the pancreas to release insulin, or metformin, which helps body tissues absorb glucose. You may also be given acarbose, which slows the absorption of glucose from the intestine and prevents fluctuations in the blood level. If oral drugs are ineffective, you may need insulin injections.
• Meglitinides signify a type of drugs prescribed for individuals with Type 2 diabetes to maintain glycemic control. Prandin (repaglinide) and Starlix (nateglinidol) are accessible “secretagogue” medicines, which means that these drugs cause a greater secretion of insulin. Sulfonylurea drugs also are secretatogues, but they’re not recommended for this use, and they behave otherwise on the body.
• One type of drug used to treat individuals with Type 2 diabetes is the biguanides.
• Thiazolidinediones (TZDs) are another type of drug used to treat individuals with Type 2 diabetes. TZDs make the body more sensitive to present insulin, letting it transfer glucose from the bloodstream into the cells more efficiently. The drug takes 12-16 weeks to achieve its maximal effects.

A Possible Medical Breakthrough

Islets Neogenesis Associated Protein (INGAP) refers to a naturally occurring protein that’s been synthesized in the lab and that can theoretically stimulate the development of the insulin-producing beta cells in the pancreas. In first animal studies, INGAP raised insulin levels and seemed to treat the diabetes in the creatures. INGAP is now being examined in human patients because it’s the possibility to treat Type 1 diabetes by stimulating the patient’s pancreas to create new beta cells which make insulin. This treatment might or might not be appropriate for individuals older than age 63 who have Type 1 diabetes.

Commonly Asked Questions

Who needs insulin?

Most young diabetics with disease of sudden severe onset require insulin. Otherwise, it is considered when diet and drugs hare failed to gain control and the individual is running into complications.

What are the risks from drugs or insulin?

An excessive dosage will send blood sugar below normal, called hypoglycaemia. This starts with light-headedness; severe hypoglycaemia causes confusion, sweating and that unconsciousness, including a risk of epileptic fits. Diabetics, especially those on insulin, and their companions should learn to recognize the early signs of hypoglycaemia. Treatment is to take a sweet drink or an injection of glucagon, a hormone which raises blood sugar rapidly.

Complementary Treatment of Diabetes

Diabetes becomes a medical emergency if it is not properly controlled, so do not abandon conventional treatment.

Autogenic training allows mind and body to rebalance themselves; hormone levels may rise and fall according to the system’s needs. Severe insulin-controlled diabetes will probably not respond but, in combination with dietary control, good results can be achieved for late-onset diabetes.

Diet — changing to a whole food, even vegan, diet can help all diabetics. Nutritional deficiencies can be implicated in adult-onset diabetes, for example zinc, chromium, magnesium and B vitamins. Consult a nutritional therapist about supplementation. Increased vitamin E may be needed.

Ayurveda can help if diabetes is linked to diet, when a number of preparations are available; yoga and manna puncture also help. Tai chi/chi kung is a gentle form of exercise which may benefit diabetics.

Injecting Insulin

If you need regular injections of insulin, you will be shown how to inject yourself. You can use a syringe and needle, but many people prefer insulin pens, which are easier to use and more discreet. Insulin can be injected into any fatty area, such as the upper arms, abdomen or thighs. Insert the needle quickly into a pinch of skin and then inject the insulin slowly. You should try not to use exactly the same site each time for the injection. After about age 10, children with diabetes can be taught how to inject themselves.

Insulin pen: This device for carrying and delivering insulin holds an insulin cartridge and has a dial that lets you set the required dose. Disposable needles attach to one end.

Test

Monitoring your blood glucose

You can monitor your blood glucose level using a digital meter. The method of use varies, depending on the type of meter, but usually involves applying a drop of blood to a test strip impregnated with a chemical that reacts with glucose. Checking your blood glucose at least once a day or as often as your doctor recommends allows you to monitor your treatment to confirm that it is effective and to alter it as necessary.

1. Before starting, wash your hands thoroughly and dry them. Once your hands
   are clean, obtain a drop of blood by using a spring-loaded pricking device on a fingertip.
2. Cover the chemically impregnated target area of the test strip with the drop of blood. Wait for one minute (or as long as is recommended by the instructions that come with the meter).
3. Finally, wipe or wash the excess blood from the strip and insert the strip into the digital glucose meter. The metre analyzes the blood and gives an instant reading of the glucose level.

What Is The Outlook?

If cardiovascular complications develop, diabetes mellitus can cause high blood pressure and heart attacks. However, advances in monitoring blood glucose levels, combined with a healthy lifestyle, have made diabetes easier to control, allowing people to lead a more normal life. Self-help groups exist for affected people.

Living with diabetes

People with diabetes mellitus can lead normal lives, and they can continue to exercise and to eat most foods. However, it is very important to eat a healthy diet, maintain fitness and, if necessary, lose weight. Following a healthy regime helps minimize the risk of developing complications over time, including heart disease, circulatory problems and kidney failure.

A healthy diet: For some people with diabetes, a healthy diet and weight loss are enough to keep blood glucose levels normal. Your diet should be high in complex carbohydrates, such as rice, pasta and legumes, and low in fats, particularly fats of animal origin.

Drinking and smoking: Alcohol in moderation is safe for most people, but in excess it may lower blood glucose levels. In addition, it is high in calories and may cause weight gain. Smoking is very harmful because it greatly increases the risk of long-term complications, such as heart disease and stroke.

Special care for your feet: Diabetes can increase the risk of skin infections and ulcers on the feet. You can reduce the risk by wearing shoes that fit comfortably, visiting a chiropodist regularly, not walking barefoot, and cutting your toenails straight across. You should inspect and clean your feet daily and consult a doctor promptly if you develop a sore on your foot.

Exercise and sports: Regular exercise makes you feel healthier, reduces the risk of heart disease, stroke and high blood pressure and can help if you need to lose weight. If you have type I diabetes, you may need to monitor your blood glucose before, during and after exercise to check how the activity affects your requirements for both insulin and food.

Strenuous exercise: Blood glucose levels usually drop during strenuous exercise. You may need to adjust your dose of insulin or eat more before strenuous activity.

Moderate exercise: Regular moderate exercise reduces the chance of developing coronary artery disease and may improve the control of your diabetes.

Your medical check-up: You should visit your doctor every few months so that she can detect problems related to diabetes at an early stage and treat them effectively. Management includes a neurological examination, measurement of your pulse and blood pressure, and a full physical examination at least once a year. Your levels of blood sugar and glycosylated haemoglobin will be tested. Your urine will be tested to check for kidney disease.

Eye examination: Inspection of the retina (the light-sensitive membrane at the back of the eye) can detect retinal damage caused by diabetes.

Blood pressure measurement: People with diabetes mellitus have an increased risk of high blood pressure, and regular monitoring is important.