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Diabetes

Diabetes is a chronic metabolic disease characterized by high glucose (sugar) levels in the blood. Insulin, a hormone produced by the pancreas, regulates the amount of glucose in the blood.

Also see: Diabetes | Symptoms & Complications | Diabetes Treatment | Risk Factors & Prevention

In patients with diabetes, the body either does not produce enough insulin, or does not adequately respond to the insulin it is producing. This causes blood sugar levels to be higher than normal. Diabetes can be associated with serious complications such as heart disease, blindness, kidney failure, stroke and lower-limb amputations, but steps can be taken to control the disease and lower the risk of complications.

In the United States, diabetes affects 16.9 million, or 8.6% of adults (aged 20 or over) and costs the nation almost $100 billion each year. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 1999.

  • Type 1 diabetes: Type 1 Diabetes (previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes) develops when the body's immune system destroys pancreatic beta cells, which make insulin.

    Type 1 diabetes usually occurs in children and young adults, who must have insulin delivered by injections or a pump in order to survive. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors include autoimmune, genetic, and environmental factors.
     
  • Type 2 diabetes: Type 2 diabetes (previously known as non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) develops gradually, and is usually caused by a combination of impaired secretion of insulin and reduced sensitivity of the body's cells to insulin (insulin resistance). As a result, blood glucose levels become elevated.

    Type 2 diabetes usually occurs in adults, however it is increasingly being diagnosed in people at a younger age, even in childhood and adolescence. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes, and the prevalence is rising at an alarming rate throughout the world. This is believed to be due to increases in longevity, sedentary lifestyles and a dramatic upsurge in obesity.

    Type 2 diabetes can be controlled. Therapeutic lifestyle management such as following a careful diet and exercise program, and losing excess weight may help, though oral medications are often necessary. Risk factors include older age, obesity, a family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.

Other types:

  • Impaired Glucose Tolerance (IGT): Impaired Glucose Tolerance is an intermediate state between normal blood glucose control and type 2 diabetes. IGT is an early sign that a person's carbohydrate metabolism is impaired. It carries a high risk of progressing to type 2 diabetes. IGT (and type 2 diabetes) result from a combination of impaired secretion of insulin and reduced sensitivity of the body's cells to insulin (insulin resistance).
     
  • Gestational diabetes: Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy, but usually disappears after the mother gives birth. Treatment is required to normalize blood glucose levels to avoid complications in the infant. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latin Americans, and Native Americans. It is also more common among obese women and women with a family history of diabetes.
     
  • Secondary diabetes: Secondary diabetes can result from other conditions such as specific genetic syndromes, surgery, drugs, malnutrition, infections, and other damage to or diseases of the pancreas.

How is diabetes diagnosed?

Type 1: Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting. Urinalysis of an acutely ill type 1 diabetic patient will detect high glucose levels, and high levels of ketones. Ketones are produced by the breakdown of fat and muscle, and they are toxic at high levels. Ketones in the blood cause a condition called "acidosis" (low blood pH). Blood glucose levels are also high.
 

Type 2: Patients with type 2 diabetes develop symptoms over a longer period of time. Type 2 diabetes is diagnosed when:

  • The blood glucose is 126 milligrams per deciliter (mg/dl) or higher on two occasions after fasting (abstaining from food) for 8 or more hours; or
  • The blood glucose level is 200 mg/dl or higher at any time between meals with symptoms of diabetes, such as increased thirst, urination, and fatigue; or
  • A blood glucose level drawn two hours after drinking a 75-gram glucose solution is 200 mg/dl or higher.

Also see: Diabetes | Symptoms & Complications | Diabetes Treatment | Risk Factors & Prevention

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