diabetes mellitus (redirected from Hypoinsulinaemia)

Diabetes Mellitus 

Definition

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin.

Description

Diabetes mellitus is a chronic disease that causes serious health complications including renal (kidney) failure, heart disease, stroke, and blindness. Approximately 17 million Americans have diabetes. Unfortunately, as many as one-half are unaware they have it.

Background

Every cell in the human body needs energy in order to function. The body's primary energy source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway into the cell through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. When there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells.

The body will attempt to dilute the high level of glucose in the blood, a condition called hyperglycemia, by drawing water out of the cells and into the bloodstream in an effort to dilute the sugar and excrete it in the urine. It is not unusual for people with undiagnosed diabetes to be constantly thirsty, drink large quantities of water, and urinate frequently as their bodies try to get rid of the extra glucose. This creates high levels of glucose in the urine.

At the same time that the body is trying to get rid of glucose from the blood, the cells are starving for glucose and sending signals to the body to eat more food, thus making patients extremely hungry. To provide energy for the starving cells, the body also tries to convert fats and proteins to glucose. The breakdown of fats and proteins for energy causes acid compounds called ketones to form in the blood. Ketones also will be excreted in the urine. As ketones build up in the blood, a condition called ketoacidosis can occur. This condition can be life threatening if left untreated, leading to coma and death.

Types of diabetes mellitus

Type I diabetes, sometimes called juvenile diabetes, begins most commonly in childhood or adolescence. In this form of diabetes, the body produces little or no insulin. It is characterized by a sudden onset and occurs more frequently in populations descended from Northern European countries (Finland, Scotland, Scandinavia) than in those from Southern European countries, the Middle East, or Asia. In the United States, approximately three people in 1,000 develop Type I diabetes. This form also is called insulin-dependent diabetes because people who develop this type need to have daily injections of insulin.

Brittle diabetics are a subgroup of Type I where patients have frequent and rapid swings of blood sugar levels between hyperglycemia (a condition where there is too much glucose or sugar in the blood) and hypoglycemia (a condition where there are abnormally low levels of glucose or sugar in the blood). These patients may require several injections of different types of insulin during the day to keep the blood sugar level within a fairly normal range.

The more common form of diabetes, Type II, occurs in approximately 3-5% of Americans under 50 years of age, and increases to 10-15% in those over 50. More than 90% of the diabetics in the United States are Type II diabetics. Sometimes called age-onset or adult-onset diabetes, this form of diabetes occurs most often in people who are overweight and who do not exercise. It is also more common in people of Native American, Hispanic, and African-American descent. People who have migrated to Western cultures from East India, Japan, and Australian Aboriginal cultures also are more likely to develop Type II diabetes than those who remain in their original countries.

Type II is considered a milder form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II diabetes, however, are the just as serious as those for Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat misleading. Many people with Type II diabetes can control the condition with diet and oral medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not working.

Another form of diabetes called gestational diabetes can develop during pregnancy and generally resolves after the baby is delivered. This diabetic condition develops during the second or third trimester of pregnancy in about 2% of pregnancies. In 2004, incidence of gestational diabetes were reported to have increased 35% in 10 years. Children of women with gestational diabetes are more likely to be born prematurely, have hypoglycemia, or have severe jaundice at birth. The condition usually is treated by diet, however, insulin injections may be required. These women who have diabetes during pregnancy are at higher risk for developing Type II diabetes within 5-10 years.

Diabetes also can develop as a result of pancreatic disease, alcoholism, malnutrition, or other severe illnesses that stress the body.

Causes and symptoms

Causes

The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families) and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the body's defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role.

In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work as effectively. Symptoms of Type II diabetes can begin so gradually that a person may not know that he or she has it. Early signs are lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes.

Individuals who are at high risk of developing Type II diabetes mellitus include people who:

• are obese (more than 20% above their ideal body weight)
• have a relative with diabetes mellitus
• belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
• have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg)
• have high blood pressure (140/90 mmHg or above)
• have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL
• have had impaired glucose tolerance or impaired fasting glucose on previous testing

Several common medications can impair the body's use of insulin, causing a condition known as secondary diabetes. These medications include treatments for high blood pressure (furosemide, clonidine, and thiazide diuretics), drugs with hormonal activity (oral contraceptives, thyroid hormone, progestins, and glucocorticorids), and the anti-inflammation drug indomethacin. Several drugs that are used to treat mood disorders (such as anxiety and depression) also can impair glucose absorption. These drugs include haloperidol, lithium carbonate, phenothiazines, tricyclic antidepressants, and adrenergic agonists. Other medications that can cause diabetes symptoms include isoniazid, nicotinic acid, cimetidine, and heparin. A 2004 study found that low levels of the essential mineral chromium in the body may be linked to increased risk for diseases associated with insulin resistance.

Symptoms

Symptoms of diabetes can develop suddenly (over days or weeks) in previously healthy children or adolescents, or can develop gradually (over several years) in overweight adults over the age of 40. The classic symptoms include feeling tired and sick, frequent urination, excessive thirst, excessive hunger, and weight loss.

Ketoacidosis, a condition due to starvation or uncontrolled diabetes, is common in Type I diabetes. Ketones are acid compounds that form in the blood when the body breaks down fats and proteins. Symptoms include abdominal pain, vomiting, rapid breathing, extreme lethargy, and drowsiness. Patients with ketoacidosis will also have a sweet breath odor. Left untreated, this condition can lead to coma and death.

With Type II diabetes, the condition may not become evident until the patient presents for medical treatment for some other condition. A patient may have heart disease, chronic infections of the gums and urinary tract, blurred vision, numbness in the feet and legs, or slow-healing wounds. Women may experience genital itching.

Diagnosis

Diabetes is suspected based on symptoms. Urine tests and blood tests can be used to confirm a diagnose of diabetes based on the amount of glucose found. Urine can also detect ketones and protein in the urine that may help diagnose diabetes and assess how well the kidneys are functioning. These tests also can be used to monitor the disease once the patient is on a standardized diet, oral medications, or insulin.

Urine tests

Clinistix and Diastix are paper strips or dipsticks that change color when dipped in urine. The test strip is compared to a chart that shows the amount of glucose in the urine based on the change in color. The level of glucose in the urine lags behind the level of glucose in the blood. Testing the urine with a test stick, paper strip, or tablet that changes color when sugar is present is not as accurate as blood testing, however it can give a fast and simple reading.

Ketones in the urine can be detected using similar types of dipstick tests (Acetest or Ketostix). Ketoacidosis can be a life-threatening situation in Type I diabetics, so having a quick and simple test to detect ketones can assist in establishing a diagnosis sooner.

Another dipstick test can determine the presence of protein or albumin in the urine. Protein in the urine can indicate problems with kidney function and can be used to track the development of renal failure. A more sensitive test for urine protein uses radioactively tagged chemicals to detect microalbuminuria, small amounts of protein in the urine, that may not show up on dipstick tests.

Blood tests

FASTING GLUCOSE TEST. Blood is drawn from a vein in the patient's arm after a period at least eight hours when the patient has not eaten, usually in the morning before breakfast. The red blood cells are separated from the sample and the amount of glucose is measured in the remaining plasma. A plasma level of 7.8 mmol/L (200 mg/L) or greater can indicate diabetes. The fasting glucose test is usually repeated on another day to confirm the results.

POSTPRANDIAL GLUCOSE TEST. Blood is taken right after the patient has eaten a meal.

ORAL GLUCOSE TOLERANCE TEST. Blood samples are taken from a vein before and after a patient drinks a thick, sweet syrup of glucose and other sugars. In a non-diabetic, the level of glucose in the blood goes up immediately after the drink and then decreases gradually as insulin is used by the body to metabolize, or absorb, the sugar. In a diabetic, the glucose in the blood goes up and stays high after drinking the sweetened liquid. A plasma glucose level of 11.1 mmol/L (200 mg/dL) or higher at two hours after drinking the syrup and at one other point during the two-hour test period confirms the diagnosis of diabetes.

A diagnosis of diabetes is confirmed if there are symptoms of diabetes and a plasma glucose level of at least 11.1 mmol/L, a fasting plasma glucose level of at least 7 mmol/L; or a two-hour plasma glucose level of at least 11.1 mmol/L during an oral glucose tolerance test.

Home blood glucose monitoring kits are available so patients with diabetes can monitor their own levels. A small needle or lancet is used to prick the finger and a drop of blood is collected and analyzed by a monitoring device. Some patients may test their blood glucose levels several times during a day and use this information to adjust their doses of insulin.

Treatment

There is currently no cure for diabetes. The condition, however, can be managed so that patients can live a relatively normal life. Treatment of diabetes focuses on two goals: keeping blood glucose within normal range and preventing the development of long-term complications. Careful monitoring of diet, exercise, and blood glucose levels are as important as the use of insulin or oral medications in preventing complications of diabetes. In 2003, the American Diabetes Association updated its Standards of Care for the management of diabetes. These standards help manage health care providers in the most recent recommendations for diagnosis and treatment of the disease.

Dietary changes

Diet and moderate exercise are the first treatments implemented in diabetes. For many Type II diabetics, weight loss may be an important goal in helping them to control their diabetes. A well-balanced, nutritious diet provides approximately 50-60% of calories from carbohydrates, approximately 10-20% of calories from protein, and less than 30% of calories from fat. The number of calories required by an individual depends on age, weight, and activity level. The calorie intake also needs to be distributed over the course of the entire day so surges of glucose entering the blood system are kept to a minimum.

Keeping track of the number of calories provided by different foods can become complicated, so patients usually are advised to consult a nutritionist or dietitian. An individualized, easy to manage diet plan can be set up for each patient. Both the American Diabetes Association and the American Dietetic Association recommend diets based on the use of food exchange lists. Each food exchange contains a known amount of calories in the form of protein, fat, or carbohydrate. A patient's diet plan will consist of a certain number of exchanges from each food category (meat or protein, fruits, breads and starches, vegetables, and fats) to be eaten at meal times and as snacks. Patients have flexibility in choosing which foods they eat as long as they stick with the number of exchanges prescribed.

For many Type II diabetics, weight loss is an important factor in controlling their condition. The food exchange system, along with a plan of moderate exercise, can help them lose excess weight and improve their overall health.

Oral medications

Oral medications are available to lower blood glucose in Type II diabetics. In 1990, 23.4 outpatient prescriptions for oral antidiabetic agents were dispensed. By 2001, the number had increased to 91.8 million prescriptions. Oral antidiabetic agents accounted for more than $5 billion dollars in worldwide retail sales per year in the early twenty-first century and were the fastest-growing segment of diabetes drugs. The drugs first prescribed for Type II diabetes are in a class of compounds called sulfonylureas and include tolbutamide, tolazamide, acetohexamide, and chlorpropamide. Newer drugs in the same class are now available and include glyburide, glimeperide, and glipizide. How these drugs work is not well understood, however, they seem to stimulate cells of the pancreas to produce more insulin. New medications that are available to treat diabetes include metformin, acarbose, and troglitizone. The choice of medication depends in part on the individual patient profile. All drugs have side effects that may make them inappropriate for particular patients. Some for example, may stimulate weight gain or cause stomach irritation, so they may not be the best treatment for someone who is already overweight or who has stomach ulcers. Others, like metformin, have been shown to have positive effects such as reduced cardiovascular mortality, but but increased risk in other situations. While these medications are an important aspect of treatment for Type II diabetes, they are not a substitute for a well planned diet and moderate exercise. Oral medications have not been shown effective for Type I diabetes, in which the patient produces little or no insulin.

Constant advances are being made in development of new oral medications for persons with diabetes. In 2003, a drug called Metaglip combining glipizide and metformin was approved in a dingle tablet. Along with diet and exercise, the drug was used as initial therapy for Type 2 diabetes. Another drug approved by the U.S. Food and Drug Administration (FDA) combines metformin and rosiglitazone (Avandia), a medication that increases muscle cells' sensitivity to insulin. It is marketed under the name Avandamet. So many new drugs are under development that it is best to stay in touch with a physician for the latest information; physicians can find the best drug, diet and exercise program to fit an individual patient's need.

Insulin

Patients with Type I diabetes need daily injections of insulin to help their bodies use glucose. The amount and type of insulin required depends on the height, weight, age, food intake, and activity level of the individual diabetic patient. Some patients with Type II diabetes may need to use insulin injections if their diabetes cannot be controlled with diet, exercise, and oral medication. Injections are given subcutaneously, that is, just under the skin, using a small needle and syringe. Injection sites can be anywhere on the body where there is looser skin, including the upper arm, abdomen, or upper thigh.

Purified human insulin is most commonly used, however, insulin from beef and pork sources also are available. Insulin may be given as an injection of a single dose of one type of insulin once a day. Different types of insulin can be mixed and given in one dose or split into two or more doses during a day. Patients who require multiple injections over the course of a day may be able to use an insulin pump that administers small doses of insulin on demand. The small battery-operated pump is worn outside the body and is connected to a needle that is inserted into the abdomen. Pumps can be programmed to inject small doses of insulin at various times during the day, or the patient may be able to adjust the insulin doses to coincide with meals and exercise.

Regular insulin is fast-acting and starts to work within 15-30 minutes, with its peak glucose-lowering effect about two hours after it is injected. Its effects last for about four to six hours. NPH (neutral protamine Hagedorn) and Lente insulin are intermediate-acting, starting to work within one to three hours and lasting up to 18-26 hours. Ultra-lente is a long-acting form of insulin that starts to work within four to eight hours and lasts 28-36 hours.

Hypoglycemia, or low blood sugar, can be caused by too much insulin, too little food (or eating too late to coincide with the action of the insulin), alcohol consumption, or increased exercise. A patient with symptoms of hypoglycemia may be hungry, cranky, confused, and tired. The patient may become sweaty and shaky. Left untreated, the patient can lose consciousness or have a seizure. This condition is sometimes called an insulin reaction and should be treated by giving the patient something sweet to eat or drink like a candy, sugar cubes, juice, or another high sugar snack.

Surgery

Transplantation of a healthy pancreas into a diabetic patient is a successful treatment, however, this transplant is usually done only if a kidney transplant is performed at the same time. Although a pancreas transplant is possible, it is not clear if the potential benefits outweigh the risks of the surgery and drug therapy needed.

Alternative treatment

Since diabetes can be life-threatening if not properly managed, patients should not attempt to treat this condition without medicial supervision. A variety of alternative therapies can be helpful in managing the symptoms of diabetes and supporting patients with the disease. Acupuncture can help relieve the pain associated with diabetic neuropathy by stimulation of cetain points. A qualified practitioner should be consulted. Herbal remedies also may be helpful in managing diabetes. Although there is no herbal substitute for insulin, some herbs may help adjust blood sugar levels or manage other diabetic symptoms. Some options include:

• fenugreek (Trigonella foenum-graecum) has been shown in some studies to reduce blood insulin and glucose levels while also lowering cholesterol
• bilberry (Vaccinium myrtillus) may lower blood glucose levels, as well as helping to maintain healthy blood vessels
• garlic (Allium sativum) may lower blood sugar and cholesterol levels
• onions (Allium cepa) may help lower blood glucose levels by freeing insulin to metabolize them
• cayenne pepper (Capsicum frutescens) can help relieve pain in the peripheral nerves (a type of diabetic neuropathy)
• gingko (Gingko biloba) may maintain blood flow to the retina, helping to prevent diabetic retinopathy

Any therapy that lowers stress levels also can be useful in treating diabetes by helping to reduce insulin requirements. Among the alternative treatments that aim to lower stress are hypnotherapy, biofeedback, and meditation.

Prognosis

Uncontrolled diabetes is a leading cause of blindness, end-stage renal disease, and limb amputations. It also doubles the risks of heart disease and increases the risk of stroke. Eye problems including cataracts, glaucoma, and diabetic retinopathy also are more common in diabetics.

Diabetic peripheral neuropathy is a condition where nerve endings, particularly in the legs and feet, become less sensitive. Diabetic foot ulcers are a particular problem since the patient does not feel the pain of a blister, callous, or other minor injury. Poor blood circulation in the legs and feet contribute to delayed wound healing. The inability to sense pain along with the complications of delayed wound healing can result in minor injuries, blisters, or callouses becoming infected and difficult to treat. In cases of severe infection, the infected tissue begins to break down and rot away. The most serious consequence of this condition is the need for amputation of toes, feet, or legs due to severe infection.

Heart disease and kidney disease are common complications of diabetes. Long-term complications may include the need for kidney dialysis or a kidney transplant due to kidney failure.

Babies born to diabetic mothers have an increased risk of birth defects and distress at birth.

Prevention

Research continues on diabetes prevention and improved detection of those at risk for developing diabetes. While the onset of Type I diabetes is unpredictable, the risk of developing Type II diabetes can be reduced by maintaining ideal weight and exercising regularly. The physical and emotional stress of surgery, illness, pregnancy, and alcoholism can increase the risks of diabetes, so maintaining a healthy lifestyle is critical to preventing the onset of Type II diabetes and preventing further complications of the disease.

Key terms

Cataract — A condition where the lens of the eye becomes cloudy.

Diabetic peripheral neuropathy — A condition where the sensitivity of nerves to pain, temperature, and pressure is dulled, particularly in the legs and feet.

Diabetic retinopathy — A condition where the tiny blood vessels to the retina, the tissues that sense light at the back of the eye, are damaged, leading to blurred vision, sudden blindness, or black spots, lines, or flashing lights in the field of vision.

Glaucoma — A condition where pressure within the eye causes damage to the optic nerve, which sends visual images to the brain.

Hyperglycemia — A condition where there is too much glucose or sugar in the blood.

Hypoglycemia — A condition where there is too little glucose or sugar in the blood.

Insulin — A hormone or chemical produced by the pancreas, insulin is needed by cells of the body in order to use glucose (sugar), the body's main source of energy.

Ketoacidosis — A condition due to starvation or uncontrolled Type I diabetes. Ketones are acid compounds that form in the blood when the body breaks down fats and proteins. Symptoms include abdominal pain, vomiting, rapid breathing, extreme tiredness, and drowsiness.

Kidney dialysis — A process where blood is filtered through a dialysis machine to remove waste products that would normally be removed by the kidneys. The filtered blood is then circulated back into the patient. This process also is called renal dialysis.

Pancreas — A gland located behind the stomach that produces insulin.

Resources

Periodicals

Crutchfield, Diane B. "Oral Antidiabetic Agents: Back to the Basics." Geriatric Times, May 1, 2003: 20.

"Gestational Diabetes Increases 35% in 10 Years." Health & Medicine Week, March 22, 2004: 220.

Kordella, Terri. "New Combo Pills." Diabetes Forecast, March 2003: 42.

"New Drugs." Drug Topics, November 18, 2002: 73.

"Research: Lower Chromium Levels Linked to Increased Risk of Disease." Diabetes Week, March 29, 2004: 21.

"Standards of Medical Care for Patients with Diabetes Mellitus: American Diabetes Association." Clinical Diabetes, Winter 2003: 27.

"Wider Metformin Use Recommended." Chemist & Druggist, January 11, 2003: 24.

Organizations

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. http://www.diabetes.org.

American Dietetic Association. 216 W. Jackson Blvd., Chicago, IL 60606-6995. (312) 899-0040. http://www.eatright.org.

Juvenile Diabetes Foundation. 120 Wall St., 19th Floor, New York, NY 10005. (800) 533-2873. http://www.jdf.org.

National Diabetes Information Clearinghouse. 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747. Ndic@info.niddk.nih.gov. http://www.niddk.nih.gov/health/diabetes/ndic.htm.

Other

Centers for Disease Control. 〈http://www.cdc.gov/nccdphp/ddt/ddthome.htm〉.

"Insulin-Dependent Diabetes." National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health, NIH Publication No.94-2098.

"Noninsulin-Dependent Diabetes." National Institute of Diabetesand Digestive and Kidney Diseases. National Institutes of Health, NIH Publication No.92-241.

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diabetes /di·a·be·tes/ (di″ah-be´tēz) any disorder characterized by excessive urine excretion. When used alone, the term refers to diabetes mellitus.

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adult-onset diabetes mellitus  type 2 d. mellitus.

brittle diabetes  type 1 diabetes mellitus characterized by wide, unpredictable fluctuations of blood glucose values and difficult to control.

bronze diabetes , bronzed diabetes hemochromatosis.

central diabetes insipidus  diabetes insipidus due to injury of the neurohypophyseal system, with a deficient quantity of antidiuretic hormone being released or produced, causing failure of renal tubular reabsorption of water.

gestational diabetes , gestational diabetes mellitus that with onset or first recognition during pregnancy.

growth-onset diabetes mellitus  type 1 d. mellitus.

diabetes insi´pidus  any of several types of polyuria in which the volume of urine exceeds 3 liters per day, causing dehydration and great thirst, as well as sometimes emaciation and great hunger.

insulin-dependent diabetes mellitus  (IDD) (IDDM) type 1 d. mellitus.

juvenile diabetes mellitus , juvenile-onset diabetes mellitus type 1 d. mellitus.

ketosis-prone diabetes mellitus  type 1 d. mellitus.

maturity-onset diabetes mellitus  type 2 d. mellitus.

diabetes mel´litus  (DM) a chronic syndrome of impaired carbohydrate, protein, and fat metabolism owing to insufficient secretion of insulin or to target tissue insulin resistance. It occurs in two major forms: type 1 d. mellitus and type 2 d. mellitus, which differ in etiology, pathology, genetics, age of onset, and treatment.

nephrogenic diabetes insipidus  inherited or acquired diabetes insipidus caused by failure of the renal tubules to reabsorb water in response to antidiuretic hormone, without disturbance in the renal filtration and solute excretion rates.

non–insulin-dependent diabetes mellitus  (NIDD) (NIDDM) type 2 d. mellitus.

preclinical diabetes  former name for impaired glucose tolerance.

renal diabetes  see under glycosuria.

subclinical diabetes  former name for impaired glucose tolerance.

Type I diabetes mellitus  type 1 d. mellitus.

type 1 diabetes mellitus  one of the two major types of diabetes mellitus, characterized by abrupt onset of symptoms (often in early adolescence), insulinopenia, and dependence on exogenous insulin; it is due to lack of insulin production by the pancreatic beta cells. With inadequate control, hyperglycemia, protein wasting, and ketone body production occur; the hyperglycemia leads to overflow glycosuria, osmotic diuresis, hyperosmolarity, dehydration, and diabetic ketoacidosis, which can progress to nausea and vomiting, stupor, and potentially fatal hyperosmolar coma. The associated angiopathy of blood vessels (particularly microangiopathy) affects the retinas, kidneys, and arteriolar basement membranes. Polyuria, polydipsia, polyphagia, weight loss, paresthesias, blurred vision, and irritability also occur.

Type II diabetes mellitus  type 2 d. mellitus.

type 2 diabetes mellitus  one of the two major types of diabetes mellitus, peaking in onset between 50 and 60 years of age, characterized by gradual onset with few symptoms of metabolic disturbance (glycosuria and its consequences) and control by diet, with or without oral hypoglycemics but without exogenous insulin required. Basal insulin secretion is maintained at normal or reduced levels, but insulin release in response to a glucose load is delayed or reduced. Defective glucose receptors on the pancreatic beta cells may be involved. It is often accompanied by disease of blood vessels, particularly the large ones, leading to premature atherosclerosis with myocardial infarction or stroke syndrome.

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diabetes mel·li·tus (m-lts, ml-)

n. Abbr. DM

1. A severe, chronic form of diabetes caused by insufficient production of insulin and resulting in abnormal metabolism of carbohydrates, fats, and proteins. The disease typically appears in childhood or adolescence and is characterized by increased sugar levels in the blood and urine, excessive thirst, frequent urination, acidosis, and wasting. Also called insulin-dependent diabetes, type 1 diabetes.

2. A mild form of diabetes that typically appears first in adulthood and is exacerbated by obesity and an inactive lifestyle. This disease often has no symptoms, is usually diagnosed by tests that indicate glucose intolerance, and is treated with changes in diet and an exercise regimen. Also called adult-onset diabetes, late-onset diabetes, non-insulin-dependent diabetes mellitus, type 2 diabetes.

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diabetes mellitus (DM)

[məlī′təs]

a complex disorder of carbohydrate, fat, and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the beta cells of the pancreas or resistance to insulin. The disease is often familial but may be acquired, as in Cushing's syndrome, as a result of the administration of excessive glucocorticoid. The various forms of diabetes have been organized into categories developed by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Diabetes Association. Type 1 diabetes mellitus in this classification scheme includes patients with diabetes caused by an autoimmune process, dependent on insulin to prevent ketosis. This group was previously called type I, insulin-dependent diabetes mellitus, juvenile-onset diabetes, brittle diabetes, or ketosis-prone diabetes. Patients with type 2 diabetes mellitus are those previously designated as having type II, non-insulin-dependent diabetes mellitus, maturity-onset diabetes, adult-onset diabetes, ketosis-resistant diabetes, or stable diabetes. Those with gestational diabetes mellitus are women in whom glucose intolerance develops during pregnancy. Other types of diabetes are associated with a pancreatic disease, hormonal changes, adverse effects of drugs, or genetic or other anomalies. A fourth subclass, the impaired glucose tolerance group, also called prediabetes, includes persons whose blood glucose levels are abnormal although not sufficiently above the normal range to be diagnosed as having diabetes. Approximately 95% of the 18 million diabetes patients in the United States are classified as type 2, and more than 70% of those patients are obese. About 1.3 million new cases of diabetes mellitus are diagnosed in the United States each year. Contributing factors to the development of diabetes are heredity; obesity; sedentary life-style; high-fat, low-fiber diets; hypertension; and aging. See also impaired glucose tolerance, potential abnormality of glucose tolerance, previous abnormality of glucose tolerance.

observations The onset of type 1 diabetes mellitus is sudden in children. Type 2 diabetes often begins insidiously. Characteristically the course is progressive and includes polyuria, polydipsia, weight loss, polyphagia, hyperglycemia, and glycosuria. The eyes, kidneys, nervous system, skin, and circulatory system may be affected by the long-term complications of either type of diabetes; infections are common; and atherosclerosis often develops. In type 1 diabetes mellitus, when no endogenous insulin is being secreted, ketoacidosis is a constant danger. The diagnosis is confirmed by fasting plasma glucose and history.

interventions The goal of treatment is to maintain insulin glucose homeostasis. Type 1 diabetes is controlled by insulin, meal planning, and exercise. The Diabetes Control and Complications Trial (DCCT), completed in mid-1993, demonstrated that tight control of blood glucose levels (i.e., frequent monitoring and maintenance at as close to normal as possible to the level of nondiabetics) significantly reduces complications such as eye disease, kidney disease, and nerve damage. Type 2 diabetes is controlled by meal planning; exercise; one or more oral agents, in combination with oral agents; and insulin. The results of the United Kingdom Prospective Diabetes Study, which involved more than 5000 people with newly diagnosed type 2 diabetes in the United Kingdom, were comparable to those of the DCCT where a relationship in microvascular complications. Stress of any kind may require medication adjustment in both type 1 and type 2 diabetes.

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diabetes mellitus

(mel´ts),
n a metabolic disorder caused primarily by a defect in the production of insulin by the islet cells of the pancreas, resulting in an inability to use carbohydrates. Characterized by hyperglycemia, glycosuria, polyuria, hyperlipemia (caused by imperfect catabolism of fats), acidosis, ketonuria, and a lowered resistance to infection. Periodontal manifestations if blood sugar is not being controlled may include recurrent and multiple periodontal abscesses, osteoporotic changes in alveolar bone, fungating masses of granulation tissue protruding from periodontal pockets, a lowered resistance to infection, and delay in healing after periodontal therapy. See also blood glucose level(s).

diabetes mellitus, amputation,

n a great number of limb amputations are caused by diabetes, especially amputations of the feet; blood infections in the feet can go unnoticed by the patient because of a lack of feeling caused by diabetic neuropathy.

diabetes mellitus, type 1,

n diabetes that usually includes patients requiring the administration of insulin to prevent ketosis. Previously called
insulin-dependent (IDDM), juvenile-onset diabetes, brittle diabetes, and
ketosis-prone diabetes.

diabetes mellitus, type 2,

n diabetes that includes patients who can maintain proper blood sugar levels within the administration of insulin. Previously called
non insulin-dependent (NIDDM), maturity-onset diabetes, adult-onset diabetes, ketosis-resistant diabetes, and
stable diabetes.

diabetes, phlorizin

(flor´zin),
n a condition of glycosuria caused by inhibition of phosphorylation of phlorizin. It is not related to an endocrine disturbance.

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diabetes mellitus

a broadly applied term used to denote a complex group of syndromes that have in common a disturbance in the oxidation and utilization of glucose, which is secondary to a malfunction of the beta cells of the pancreas, whose function is the production and release of insulin. Because insulin is involved in the metabolism of carbohydrates, proteins and fats, diabetes is not limited to a disturbance of glucose homeostasis alone.

Diabetes mellitus has been recorded in all species but is most commonly seen in middle-aged to older, obese, female dogs. A familial predisposition has been suggested. It is possible to identify two types of diabetes, corresponding to the disease in humans, depending on the response to an intravenous glucose tolerance test. Type I is insulin-dependent and comparable to the juvenile onset form of the disease in children in which there is an absolute deficiency of insulin—there is a very low initial blood insulin level and a low response to the injected glucose. This form is seen in a number of dog breeds, particularly the Keeshond, Doberman pinscher, German shepherd dog, Poodle, Golden retriever and Labrador retriever.

Type II is non-insulin-dependent, similar to the adult onset diabetes in humans due to pancreatic damage—there is a high or normal initial blood insulin level and no increase in insulin levels as a result of the glucose load. It is the form seen most often in cats.

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brittle diabetes mellitus

diabetes mellitus that is difficult to control, characterized by unexplained oscillation between hypoglycemia and diabetic ketoacidosis.

gestational diabetes mellitus

diabetes mellitus in which onset or recognition of impaired glucose tolerance occurs during pregnancy.

hyperosmolar diabetes mellitus

a syndrome of marked hyperglycemia and hyperosmolarity with central nervous signs, resembling diabetic coma.

insulin-dependent diabetes mellitus (IDDM)

due to deficient secretion of insulin by the beta cells of the pancreas. See diabetes mellitus type I (above).

juvenile diabetes mellitus

develops in the young; see diabetes mellitus type I (above).

non-insulin-dependent diabetes mellitus (NIDDM)

the secretion of insulin is unimpaired but the response of tissue receptors is diminished. See diabetes mellitus type II (above).

secondary diabetes mellitus

hyperglycemia may occur in association with pancreatitis, hyperadrenocorticism, acromegaly, and treatment with glucocorticoids or progesterone.

steroid diabetes mellitus

altered carbohydrate tolerance is induced by glucocorticoids and progestogens. Hyperglycemia and diabetes mellitus can be associated with the administration of such drugs or hyperadrenocorticism.

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diabetes mellitus

Endocrinology A chronic condition which affects ±10% of the general population, characterized by ↑ serum glucose and a relative or absolute ↓ in pancreatic insulin production, or ↓ tissue responsiveness to insulin; if not properly controlled, the excess glucose damages blood vessels of the eyes, kidneys, nerves, heart Types Insulin dependent–type I and non-insulin dependent–type II diabetes Symptoms type 1 DM is associated with ↑ urine output, thirst, fatigue, and weight loss (despite an ↑ appetite), N&V; type 2 DM is associated with, in addition, non-healing ulcers, oral and bladder infections, blurred vision, paresthesias in the hands and feet, and itching Cardiovascular MI, stoke Eyes Retinal damage, blindness Legs/feet Nonhealing ulcers, cuts leading to gangrene and amputation Kidneys HTN, renal failure Neurology Paresthesias, neuropathy Diagnosis Serum glucose above cut-off points after meals or when fasting; once therapy is begun, serum levels of glycosylated Hb are measured periodically to assess adequacy of glucose control Management Therapy reflects type of DM; metformin and triglitazone have equal and additive effects on glycemic control Prognosis A function of stringency of glucose control and presence of complications. See ABCD Trial, Brittle diabetes, Bronze diabetes, Chemical diabetes, Gestational diabetes, Insulin-dependent diabetes, Metformin, MODY diabetes, Nephrogenic diabetes insipidus, Non-insulin-dependent diabetes mellitus, Pseudodiabetes, Secondary diabetes, Starvation diabetes, Troglitazone.

Diabetes mellitus–Type 1 vs Type 2

Finding Type 1 Type 2

% of diabetics  10%  90%

Age of onset Usually < 35  Usually > 40

Weight Not overweight Overweight

Speed of onset Often abrupt/acute Asymptomatic, slower onset

Clinical findings ↑ Thirst, urine production Poorly healing cuts, paresthesias

 appetite; rapid weight loss of hands/feet; recurring skin, oral,

 fatigue  infections

Lab findings Ketonuria

www.diabetes-symptoms-resource.com/type-1-diabetes-mellitus.htm

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Patient discussion about Hypoinsulinaemia.

Q. What is most important to know when finding out you have diabetes? My 17 year old son has been feeling bad for 2 days now and today he fainted twice. My wife is with him in the hospital and they say he might have diabetes. I want to prepare. What do you guys think I need to know? any tips?

A. First thing you need to do is make an appt with your physician. That way he can explain the ins and outs of diabetes especially to someone as young as your son. HE needs to know what he can and cannot eat, and how to manage his diabetes. Many people don't understand the seriousness of this disease. It can affect many health issues down the road. There are many diabetes websites that can also answer questions for you. You may need to get a blood glucose monitor also to check his sugar several times a day.

Q. how to get rid of diabetes? My boyfriend is suffering from it and it's a real burden!!! How can he make it go away?? is it all about the food he puts in his mouth?

A. great videos!!! has anyone else watched it but me??

Q. What's the thing with having diabetes and flights? I heard that I might have problems with my feet and I should buy special socks.

A. Hello. I cannot answer anything about the "flights", but I can really attest to diabetes and feet pain. A lot of diabetics get what is called "Charcot foot". I have that now and am NOT diabetic, although I am learning that if a specific blood test called a "Hemoglobin A1C" is elevated, then it may be helpful to go thru the whole realm of glucose challenge tests, etc, just to have everything checked out. However, it is predominantly diabetics who suffer with Charcot foot. I am learning that in the beginning of the advanced stages, except for putting orthotics in your shoes, there is not too much that can be done, except soaking the feet (no more than 10 minutes a day in warm water only), wear good socks and perhaps get orthotics for your shoes. Initially I found a Sport/Ski shop that sold orthotics to put in ski boots that really helped, but now it is getting a little more complicated. Charcot is NOT fatal. It does affect 1 in about 2,500 people. D