Diabetes Mellitus

Diabetes mellitus

Diabetes mellitus is a group of diseases characterized by high levels of glucose in the blood resulting from defects in insulin production (insulin deficiency), insulin action (insulin resistance), or both. Insulin is a hormone produced by the pancreas. When eaten, foods are converted to a type of sugar called glucose that enters the bloodstream. Insulin is needed to move glucose into the body cells where it is used for energy, and excesses are stored in the liver and fat cells. Insufficient amounts of working insulin cause blood sugar levels to rise and large amounts of glucose are excreted in the urine. Consistently high levels of glucose in the bloodstream damage the nerves and blood vessels, and can lead to heart disease, stroke, high blood pressure, blindness, kidney disease, amputations, and dental disease.

The exact cause of diabetes is unknown, although genetics and environmental factors such as obesity and lack of exercise appear to play roles. Diabetes can be associated with serious complications and death, but people with diabetes can take an active role in controlling the disease and lowering the risk of complications.

Incidence of diabetes

Over 17 million people in the United States, or 6.2% of the population, have diabetes. More than one third of diabetes victims are unaware that they have the disease. Higher rates of diabetes occur in certain populations: 13% of African Americans, 10.2% of Latino Americans, and 15.1% of Native Americans have diabetes. Prevalence of diabetes increases with age. Approximately 151,00 people less than 20 years of age have diabetes, but nearly 20.1% of the U.S. population age 65 and older has diabetes. In the United States, 8.9% of all women and 8.3% of all men have diabetes. Over one million people are newly diagnosed with diabetes each year. Greater than 450,000 deaths each year in the United States are attributed to diabetes.

Types of diabetes

There are three major types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes was previously called insulin-dependent diabetes or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells that produce insulin. The body, in turn, produces little or no insulin, resulting in insulin deficiency. Without insulin, the body is unable to use glucose for energy and begins to break down fats for fuel. Ketones are formed when fat is burned for energy. Excess ketones build up in the blood and lower the blood pH value leading to ketoacidosis.

Symptoms of type 1 diabetes usually appear suddenly and include increased thirst, frequent urination, increased hunger, tiredness, and weight loss. Risk factors for type 1 diabetes include autoimmune, genetic, and environmental factors. Although it usually begins when people are under the age of 30, type 1 diabetes may occur at any age. Almost 10% of the United States diabetes population has type 1 diabetes.

Type 2 diabetes was previously called noninsulin-dependent or adult onset diabetes. It begins as insulin resistance, a disorder in which normal to excessive amounts of insulin is made by the body, but the cells cannot use insulin properly. The ability to make insulin gradually decreases with time due to the progressive nature of the disease. In its early stages, type 2 diabetes often has no symptoms. When they do occur, symptoms may initiate gradually and include fatigue, dry skin, numbness or tingling in hands or feet, frequent infections, slow healing of cuts and sores, problems with sexual function, and increased hunger and thirst. With type 2 diabetes, hyperosmolar coma can develop from blood glucose levels (often referred to as blood sugar) becoming dangerously high. If the elevated blood sugar is not adequately controlled, it can cause severe dehydration, a serious condition requiring immediate treatment. Type 2 diabetes is associated with obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. Type 2 diabetes is diagnosed in children and adolescents in increasing numbers. About 85% of the U.S. diabetes population has type 2 diabetes.

Gestational diabetes occurs during pregnancy and affects 4% of all pregnant women. During pregnancy, the placenta supplies the baby with glucose and water from the mother's blood. Hormones made by the placenta are needed for pregnancy, but can keep the mother's insulin from functioning effieciently. As the pregnancy continues, more of these hormones are manufactured. When the mother is not able to make enough insulin to compensate for the increased hormone levels and to maintain normal blood glucose, gestational diabetes develops. Treatment is required to normalize maternal blood glucose levels to avoid complications in the fetus. After pregnancy, up to 10% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20%-50% chance of developing diabetes in the next 5-10 years.

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