Diabetes mellitus is a condition where the body’s glucose regulation is affected thereby leading to high blood glucose levels. It is commonly referred to as ‘sugar diabetes’ due to the elevated blood glucose levels. High levels of glucose are managed by the hormone insulin secreted from the pancreas. In diabetes however, there is either insufficient glucose or the body becomes unresponsive to it. Abnormal levels of blood glucose can lead to serious health problems, affecting most organs and systems and even leading to death.
Diabetes mellitus can be subdivided into type 1 and type 2 diabetes.
- Type 1 diabetes – insulin dependent diabetes mellitus (IDDM) where the body does not produce and secrete enough insulin.
- Type 2 diabetes – non-insulin dependent diabetes mellitus (NIDDM) where the body does not respond to insulin.
Type 2 diabetes might be asymptomatic initially, whereas type 1 diabetes has rapid-onset and serious symptoms. Some common symptoms include:
- Increased thirst, hunger and frequency of urination
- Unexplained weight loss
- Presence of ketones in the urine
- Blurred vision
- Slow healing
- High susceptibility to bacterial or fungal infections
Type 1 diabetes typically appears during childhood or adolescence and was previously referred to as juvenile diabetes. However, this is misleading because it can occur in adults as well although uncommon. Type 2 diabetes can develop at any age and is more common than type 1 diabetes.
Glucose is obtained from the diet, is produced from breaking down other nutrients or stored in the liver for future use. The hormone insulin, secreted from the pancreas, is needed for glucose to enter the cells and work as fuel. When the glucose levels are too high, the pancreas secretes more insulin. The cells then take in more insulin and the liver slows glucose production.
Type 1 diabetes
In type 1 diabetes, the body’s immune system becomes overactive and starts attacking and destroying pancreatic cells that produce insulin. In the absence of insulin, glucose is not transported into the cells and builds up in the bloodstream. Hereditary factors and environmental factors may play a role in development of type 1 diabetes.
Types 2 diabetes
In type 2 diabetes, resistance to insulin occurs. Even increased pancreatic production of insulin is unable to overcome this resistance. As a result, blood sugar increases and the insulin levels are high initially. Hereditary factors and obesity are the two main risk factors that play a role in the development of type 2 diabetes.
Other risk factors for type 2 diabetes includes :
- sedentary lifestyle
- advancing age
- family history
- high blood pressure
- low levels of HDL
- high levels of triglycerides
Treatment involves controlling and reducing high blood sugar levels to relieve the symptoms and prevent associated complications. Treatment is directed at minimizing episodes of high blood sugar although there may be spikes and dips.
Diet and exercise are crucial for regulating blood glucose levels in both type 1 and type 2 diabetes.
- Insulin is necessary for type 1 diabetes patients. Type 2 diabetics may also require insulin as the disease progresses.
- Type 2 patients use blood glucose-lowering substances and insulin as well at a later stage in the disease.
A low glycemic index, low fat and calorie-restricted diet is important to assist diabetics in losing weight where necessary and preventing drastic changes in the blood glucose levels. The diet should be individually orientated for the patient by a registered dietitian.
Some oral or injected medications stimulate the pancreas to produce and release more insulin (repaglinide and nateglinide). Some drugs inhibit the production and release of glucose from the liver (metformin), thereby decreasing the requirement of insulin.
In type 1 diabetes, insulin is needed and has to be administered by the patient at regular intervals in a day. The drugs above may be used along with insulin in type 2 diabetics as well. Drugs called ACE inhibitors, aspirin, and statins are given to prevent complications, such as high blood pressure, blood clots and high blood cholesterol respectively.
Other treatments like a pancreas transplantation for type 1 diabetics or weight loss (bariatric) surgery for morbidly obese type 2 diabetics may also be considered but is rarely undertaken for the treatment and management of diabetes mellitus.