Diabetes? I Don't Think So!
Persons with newly diagnosed diabetes mellitus experience a wide range of emotions such as disbelief, fear, vulnerability, and depression. It is a fact that 7 percent of adults in the United States have diabetes mellitus. It is a condition in which the level of blood glucose (sugar) is elevated because of an abnormality in the way the body absorbs the glucose from the blood, or utilizes it. The level of glucose in the blood is regulated mostly by insulin, which is a hormone that is produced by the beta cells of the pancreas (an organ in the gastro-intestinal tract). Insulin lowers the level of glucose in the blood by causing it to be absorbed into the cells of organs that use it as a source of energy, and also to build up proteins. Elevated blood glucose (hyperglycemia), when it is persistent, results in the bad effect or complications of diabetes. The main effect of this is seen in the large blood vessels in the body where development of atherosclerosis (narrowing of the lumen of vessels) is accelerated. This also happens in small blood vessels that supply end organs such as kidneys, eyes, and nerves. Eventually blindness, kidney failure, lack of sensation in the feet, and subsequent development of infection may lead to amputation, increased risks of stroke, and heart attack.
Types of Diabetes
There are two main types of diabetes mellitus—type 1 and type 2. Type 1 diabetes is usually found in young adults and children. It makes up approximately 10 percent of all cases. It is more prevalent in Caucasians. In this entity, the pancreas produces little or no insulin as a result of auto-immune response. The person’s immune system is attacking the beta cells of the pancreas. This autoimmune response may be triggered by exposure to certain viruses or foods.
Type 2 diabetes accounts for 90 percent of all cases of diabetes. It is usually referred to as “adult onset.” It is precipitated when the pancreas produces insufficient amounts of insulin, and sometimes when the end organs in the body become resistant to normal levels of insulin. It is believed that a combination of genetic causes, environmental factors, diet, and activity level affect the development of type 2 diabetes. The increasing incidence of type 2 diabetes is closely associated with increasing obesity worldwide. Type 2 diabetes is most common in people of Hispanic, African, and Asian descent.
Symptoms
Persons with diabetes, especially type 1, may exhibit symptoms of hyperglycemia, such as excessive thirst, frequent urination, blurred vision, and dehydration. A potentially life-threatening condition called diabetes ketoacidosis, may result in coma, and may also develop into type 2 diabetes. In other persons, especially with type 2 diabetes, the symptoms may be insidious and not noticed until the complications of diabetes mentioned above have set in.
Diagnosis
The diagnosis of diabetes is made by measuring the level of glucose in the blood at various times. A person is considered normal when the fasting blood glucose is less than 100mg/dl (5.6mmol/L). Diabetes mellitus is diagnosed when the fasting blood glucose is 12mg/dl (7mmol/L) or higher, and when a random blood glucose is 200mg/dl (11.1mmol/L) or higher.
Treatment
A combination of dietary modifications, weight loss programs, exercise, and medication is utilized in managing diabetes mellitus. Medications that are used include insulin, which is administered by injection; this is most commonly used in type 1 diabetes. Oral hypoglycemics are pills that are also used to help lower the blood glucose. The goal is to keep the blood glucose level under control, thereby avoiding development of complications. Hemoglobin AIC, which measures the average blood glucose level during the previous two to three months, is useful in monitoring the adequacy of blood glucose control in diabetics. The condition is cured in persons with type 1 diabetes that undergo pancreatic transplantation, and in type 2 diabetics with associated morbid obesity who achieved significant weight reduction either by a weight loss program or by gastric bypass surgery. It is important to consult your health-care provider for further information as it relates to you.
MUYIWA ADEDOKUN, M.D., a board-certified general laparoscopic surgeon, writes from Murfreesboro, Tennessee.
References
CDC National Diabetes fact sheet: general information and national estimates on diabetes in the United States. 2005. http:www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf. Accessed November 14, 2006. Report of Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20:1183.
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