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Diabetes Mellitus

Diabetes mellitus is the name given to a group of conditions linked by the patient's inability to produce and/or utilize insulin.

A chronic disease of absolute or relative insulin deficiency or resistance, diabetes mellitus is characterized by disturbances in carbohydrate, protein, and fat metabolism. This condition occurs in two forms: type 1, characterized by absolute insulin insufficiency, and type 2, characterized by insulin resistance with varying degrees of insulin secretory defects.

Onset of type 1 usually occurs before age 30 (although it may occur at any age); the patient is usually thin and requires exogenous insulin and dietary management to achieve control. Conversely, type 2 usually occurs in obese adults after age 40, although it's commonly seen in North American youths. It's most often treated with diet and exercise (in combination with anti-diabetic drugs), although treatment may include insulin therapy.

Diabetes mellitus is estimated to affect nearly 8% of the population of the United States (16 million people), about half of whom are undiagnosed. Incidence is equal in men and women and rises with age.

Nearly two-thirds of people with diabetes will die of cardiovascular disease. It's also the leading cause of renal failure and new blindness.


The effects of diabetes mellitus result from insulin deficiency. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency compromises the body tissues' access to essential nutrients for fuel and storage.

The etiology of both type 1 and type 2 diabetes remains unknown. Genetic factors may playa part in development of all types; autoimmune disease and viral infections may be risk factors in type 1.

Other risk factors include the following:

  • Obesity contributes to the resistance to endogenous insulin.
  • Physiologic or emotional stress can cause prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon, and growth hormone). This raises blood glucose levels, which, in turn, places increased demands on the pancreas.
  • Pregnancy causes weight gain and increases levels of estrogen and placental hormones, which antagonize insulin.
  • Some medications can antagonize the effects of insulin, including thiazide diuretics, adrenal corticosteroids, and oral contraceptives.

Signs and symptoms

Type 1

Symptoms for Type I don't really show up until the destruction of the beta cells is almost complete. The symptoms start to show when the insulin production is almost done, and then they appear rather suddenly. Symptoms include frequent urination, excessive thirst, especially for sweet drinks, extreme hunger along with sudden weight loss, weakness, extreme fatigue, visual changes especially blurred vision, and irritability. Severe cases may have no symptoms, then be diagnosed by a sudden onset of a diabetic coma caused by the extremely high levels of blood sugar.

Type II

Type II diabetes have very similar symptoms including the frequent urination, unusual thirst, fatigue, blurred vision and weight loss, but they tend to appear more slowly than with Type I. Women may also have frequent vaginal yeast infections, and fungal infections are common in the groin area or under the breasts.


The fasting plasma glucose test is the standard and preferred way to diagnose diabetes. Normal fasting plasma glucose levels are less than 110 milligrams per deciliter (mg/dl). If the overnight fasting blood glucose is greater than 126 mg/dl on two different tests on different days, the diagnosis of diabetes mellitus is made. Random blood glucose alone is seldom used because it is not reliable.

Other diagnostic and monitoring tests include urinalysis for acetone and blood testing for glycosylated hemoglobin, which reflects glucose control over the past 2 to 3 months.


Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.

Type 1 diabetes

Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump.

Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente), or a combination of rapid-acting and intermediate-acting (70/30 or 50/50 of NPH and Regular) mixed together.

Type 2 diabetes

Patients may require oral anti-diabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis,and delay GI absorption of carbohydrates.

Both types

Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight.

For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.


Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.

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