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A look at Diabetes Mellitus

Adult diabetes is a significant concern for both health authorities and the public. Not only because the incidence rate in adults is steadily growing, but because this disease is striking down its victims at younger and younger ages; from an average age of 52 in the USA between 1988 and 1994, to 46 between 1999 and 2000. In fact, its common name of adult or adult-onset diabetes has become a misnomer. Where once it only occurred in people over the age of 40, it has now been diagnosed in children as young as two.

Adult-onset diabetes is known medically as diabetes mellitus type 2, and as that name implies, there is a type 1 people may develop. Both diabetes mellitus type 1 and type 2 relate to the hormone insulin, with type 1 sometimes called insulin dependent diabetes mellitus (IDDM) because it requires daily injections of insulin. A temporary form of type 2 DM called gestational diabetes can occur during pregnancy.

Diabetes Symptoms

Both types have similar symptoms, including:

Polydipsia: frequently thirsty.
Polyuria: needing to urinate often.
Polyphagia with weight loss: losing weight despite eating more due to an increased appetite.
Lethargy and weakness: feeling constantly tired and having reduced muscle strength.
Blurred vision.

More serious symptoms, such as retinopathy leading to blindness and nephropathy leading to kidney failure, can occur if medical treatment is not received.

Diagnosis of Diabetes

Diabetes occurs when insufficient insulin is being produced or the body’s cells are resistant to its influence. This results in difficulty processing glucose ingested in meals. Therefore, diagnosis is based on measuring glucose in blood samples, commonly called the blood sugar level. High levels are hyperglycemia, indicative of diabetes. There are several possible tests:

The Fasting Plasma Glucose (FPG) test. This is the standard test for diagnosing diabetes. A blood sample is taken from the patient 8 hours after they last ate. If the glucose level is above 125 mg/dl, or 1.25 grams per liter, diabetes is probable. Additional tests are recommended for confirmation or if the level is near.

The Oral Glucose Tolerance test (OGTT). The patient is given a standard glucose solution to drink after fasting for 8 hours. A blood sample is taken two hours later and the glucose level determined. If it is over 200 mg/dl, diabetes is likely.

Glycolated Hemoglobin test. This blood test does not require the patient to fast beforehand. Normally levels should be below 7%, above 8% indicates diabetes in 98% of patients. Levels above 11% indicate that complications are likely.

Autoantibody test. This is a test to determine whether a patient’s diabetes is type 1. A blood sample is tested for autoantibodies, a type of antibody that attacks the islet cells of the pancreas that produce insulin. A positive result indicates type 1 DM, but a negative does not rule it out.

Additional tests on patients diagnosed with diabetes screen for possible complications. These detect heart disease, kidney damage and thyroid abnormalities.

Diabetes Mellitus Type 1

Any physical damage, infection or autoimmune response in the pancreas may result in the destruction of islet beta cells. Destroyed cells are replaced by connective tissue, which cannot make insulin. If the damaged pancreas is unable to produce sufficient insulin to meet the body’s needs, the patient is deemed to have diabetes mellitus type 1 or IDDM.

Currently, sufferers will have to administer additional insulin by injection for the rest of their lives. Medical research is experimenting with replacing pancreatic cells by donation, either from deceased human donors or pigs.

Diabetes Mellitus Type 2

This starts with insulin resistance, the body’s cells have a reduced response to the presence of insulin even though the pancreas is producing normal amounts. Exact causes are still unknown, but genetic factors, obesity and stress may all increase its likelihood. With the insulin less effective, the glucose level stays high causing the pancreas to work overtime producing insulin. This can lead to beta cell exhaustion, damaging the pancreas and leaving it unable to produce normal amounts of insulin.

If the pancreas is damaged, patients will need to take insulin injections to top up the level being produced. If detected before the pancreas becomes irreparably damaged, changing the diet and a suitable exercise regimen can get the disease under control. This may require the assistance of drugs, hypoglycemics may be particularly helpful in the early stages. The types that might be used, starting with the hypoglycemics, are:

Alpha-glucosidase inhibitors lower the blood sugar level by blocking the breakdown of starch and complex sugars into glucose.

Biguanides and Thiazolidinediones reduce glucose production by the liver, with the 2nd group also reducing insulin resistance in muscle and fat cells.
DPP-4 inhibitors maintain GLP-1, an otherwise short-lived organic compound your body produces. GLP-1 reduces glucose levels only when they are high, keeping it in the normal range.

Meglitinides and Sulfonylureas increase insulin production. Amaryl, a sulfonlyureas, also reduces insulin resistance.

When caught early enough and the patient keeps to their new diet and exercise regimen, the prognosis for DM type 2 is good. The patient may reach the point where drugs are no longer required and they can lead a long and healthy life. If too late or the patient is unable to modify their lifestyle sufficiently, they may reach the point where daily insulin shots are needed and may suffer serious complications.