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Diabetes Mellitus ("sugar")

What is diabetes mellitus?

Diabetes is a disorder of the body that occurs when there is either an absolute or a relative lack of insulin, the hormone needed to control blood sugar. Blood sugars vary depending on whether you are fasting or have eaten. A normal fasting blood sugar is less than 110 mg/dl; however, as you grow older, fasting sugars can be higher and still be acceptable.

There are two types of diabetes mellitus:

Type I diabetes mellitus is known as "insulin-dependent diabetes". It occurs when the insulin-producing cells in the pancreas have been damaged or destroyed, usually by either a viral infection or an autoimmune disorder in which the body attacks itself. This type of diabetes usually develops in childhood or early adolescence and always requires injections of the hormone insulin.

Type II diabetes mellitus is referred to as "non-insulin dependent diabetes". It constitutes over 85% of diabetics and occurs mostly in adults over age 40 who are overweight. Unfortunately, with the massive increase in childhood obesity, many children and adolescents are developing type 2 diabetes. With type 2 diabetes, the body produces more than the normal amount of insulin; however, the body requires an excessive amount of insulin because of the extra fat tissue.  Hormonal-like substances (cytokines) produced in adipose (fat) tissue interfere with the cellular action of insulin and lead to diminished insulin action.

What are the symptoms of diabetes?

• Fatigue.
• Increased urination.
• Excessive thirst.
• Weight loss.
• Blurred vision.
• Skin infections.
• Bladder or vaginal infections.
• Coma, especially in undiagnosed diabetes.

Diagnosis and treatment

Type I diabetes requires lifelong insulin injections. This is necessary since there is an absolute lack of insulin and, at this time, no way to repair the damage to the insulin-producing cells (short of a pancreas transplant or islet cell transplant - both of which are "experimental").

Type 2 diabetes is treated very differently. Since the body is usually producing an abundance of insulin, the best treatment is to enhance the ability of the body to utilize the insulin it produces. The usual starting and most effective treatment is dietary intervention, as weight reduction is able to control many diabetics. If weight reduction is not feasible, your physician will probably place you on a pill that increases the amount of insulin the body produces. (Unfortunately, these medications do not work in type I diabetes). If there is an inadequate response, you may be placed on additional medications, such as metformin, that cause your liver to produce less glucose (sugar) or on a medications commonly referred to as "glitazones" that make your body more responsive to the insulin it produces. If these approaches fail, you may need insulin injections to control your blood sugars.

How can I prevent diabetes?

At this time, there is no reliable way to prevent type 1 diabetes. However, you can usually prevent type 2 diabetes by maintaining a normal weight, eating nutritious foods, avoiding excessive alcohol intake, and exercising regularly.

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