Diabetes Mellitus

Diabetes is a metabolic disorder characterized by an abnormal increase in the level of sugar in the blood. There are different types of diabetes mellitus, but all of them have potentially disastrous effects. In developed countries diabetes mellitus is responsible for the majority of cases of end-stage renal failure, non-traumatic leg amputations and blindness.

Type 1 diabetes mellitus is due to an autoimmune destruction of the pancreatic cells that produce insulin. It usually develops in individuals under the age of 30, but older people can also develop it.
Type 2 diabetes mellitus is due to a mixture of insulin resistance, decreased insulin secretion and increased glucose production. It is usually seen in older people than type 1 diabetes mellitus and is associated with obesity.

Gestational diabetes mellitus is also seen in some women towards the end of pregnancy. Most women return to normal levels of blood sugar after delivery, but they have a higher risk of developing diabetes later in their life.

The most common presenting symptoms of diabetes are increased thirst, increased urine and weight loss. Many people however have no symptoms at all and in many cases diabetes mellitus may be present for up to ten years before a diagnosis is made.

Risk factors for type 2 diabetes mellitus are: a family history of diabetes, obesity (BMI > 25), sedentary lifestyle, previous gestational diabetes, hypertension, high cholesterol and polycystic ovarian syndrome.

It is interesting to know that before developing diabetes type 2, there is a prediabetic state that can be reversed. During this phase there is only a slight increase in blood sugar levels. It is known that if individuals start dieting and exercising for at least 30 minutes five times a week, they can prevent or at least significantly delay the onset of diabetes.

Diabetes mellitus has many complications that affect most organ systems. Here's a short list of the diseases diabetes predisposes to:

1. Blindness
2. Chronic renal failure
3. Nerve degeneration
4. Gastrointestinal dysfunction (constipation, diarrhea, anorexia, nausea, vomiting, bloating)
5. Genitourinary dysfunction (erectile dysfunction, female sexual dysfunction, urination problems)
6. Coronary artery disease
7. Myocardial Infarction
8. Sudden death
9. Peripheral vascular disease
10. Stroke
11. Lower extremity complications (foot infections and foot ulcers leading to amputation)
12. Higher frequency and severity of infections (eg. pneumonia, urinary tract infections, skin infections)

The risk of complications correlates with the duration of diabetes. The best way to prevent all these complications is to tightly control the blood sugar levels.

Treatment options include medications such as sulfonylureas, biguanides and different types of insulin. It is recommended to follow a diabetic diet and to exercise regularly. Recently, pancreas transplatations have been performed for some type 1 diabetics, but the technology is still under investigation.