frequent urination (as often as every hour or so). Nighttime
awakening to urinate is common.
or persistent infections of the bladder, skin, or gums.
and tingling in feet and hands.
of hypoglycemia (see Hypoglycemia for
symptoms of hyperosmolar nonketotic states: extreme thirst, lethargy,
weakness, mental confusion, coma.
symptoms of diabetic ketoacidosis: nausea and vomiting, labored
breathing, mental confusion, coma.
When To Call Your Doctor
a doctor if you notice a sudden or gradual increase in hunger,
thirst, and urine output.
doctor if you have been diagnosed with diabetes mellitus and
an additional illness such as a cold or the flu causes blood
sugar levels to go out of control. Do not take over-the-counter
medications without first consulting your doctor.
ambulance if a person with diabetes loses consciousness. Inform
the doctor or the rescue worker that the person has diabetes.
For type 1 diabetes:
ambulance immediately if you develop symptoms of diabetic ketoacidosis;
these include dry mouth, dry and flushed skin, sweet or fruity-smelling
breath, labored breathing, vomiting, and abdominal pain, with
or without excessive urination and extreme thirst.
doctor right away if urine tests detect the presence of ketones
and the steps given by your doctor fail to control the problem.
For type 2 diabetes:
ambulance immediately if you develop symptoms of a hyperosmolar
nonketotic state; these include extreme thirst, lethargy, weakness,
and mental confusion.
What Is It?
Diabetes mellitus is a metabolic disorder with
abnormally high blood glucose levels (hyperglycemia) as its most
prominent feature. During intestinal digestion, carbohydrates
and proteins are broken down into simple sugars and amino acids,
respectively. The liver converts all of the sugars and some of
the amino acids into glucose, a simple sugar that is used for
energy by every cell in the body. Glucose passes from the bloodstream
into the cells with the help of insulin, a hormone produced by
the pancreas (a pear-shaped organ located just below the stomach).
By attaching to receptor sites on the surface membrane of a cell,
insulin promotes the movement of glucose-transport proteins from
the interior of the cell to its surface, where they bind with
glucose and carry it into the cell. In diabetes mellitus, several
problems may interfere with this process: pancreatic insulin
production may be partially or completely impaired, or body cells
may become unable to use normal amounts of insulin efficiently.
These underlying problems distinguish the two main
types of the diabetes. In type 1 diabetes, the pancreas produces
little or no insulin. Type 1 diabetes develops suddenly and most
commonly affects those under age 30; the average age of onset
is between 12 and 14. However, type 1 diabetes accounts for only
7 to 10 percent of cases of diabetes mellitus. In the much more
common type 2 diabetes, insulin production by the pancreas is
normal or only slightly reduced, but cells are unable to respond
efficiently to insulina condition referred to as insulin
resistance. The onset of type 2 diabetes is usually gradual and
tends to affect people over age 40, particularly those who are
overweight. Type 1 diabetes was once named insulin-dependent
or juvenile diabetes, while type 2 diabetes was formerly called
non-insulin-dependent or adult diabetes. These terms are no longer
used because some people with type 2 diabetes eventually require
insulin, and because there is a growing epidemic of type 2 diabetes
In both type 1 and type 2 diabetes, hyperglycemia
leads to excretion of glucose in the urine and an accompanying
increase in urine production. If inadequate amounts of insulin
are administered to patients with type 1 diabetes, unrestrained
release of fatty acids from adipose (fat) tissue leads to the
overproduction of ketone bodies in the liver. Accumulation of
ketone bodies can cause a life-threatening condition known as
diabetic ketoacidosis (DKA). DKA may occasionally affect those
with type 2 diabetes in periods when the body is highly stressed,
for example, during a severe infection.
People with type 2 diabetes are susceptible to
another life-threatening condition known as a hyperosmolar nonketotic
state, characterized by extremely high blood sugar levels. This
condition usually occurs in elderly persons with some other serious
underlying illness. An episode of either DKA or the hyperosmolar
state may be the first indication that someone has diabetes.
People with diabetes may also suffer from low blood
sugar (hypoglycemia) if too much insulin or oral hypoglycemic
medication is given for treatment (see Hypoglycemia for more information).
After 10 to 20 years of diabetes, patients are
likely to develop complications, such as vision disorders, kidney
damage, and peripheral nerve degeneration (see Peripheral
Neuropathies for more information). Strict control of blood
glucose can delay or prevent these complications. Loss of sensation
in the feet may allow injuries to go unchecked and become infected.
In addition, people with diabetes are at increased risk for developing
narrowing of the coronary arteries (see Coronary
Heart Disease for more information) as well as narrowing
of arteries supplying the brain and legs. The combination of
foot infections and decreased blood supply can lead to gangrene
(tissue death), which may require amputation. Diabetes mellitus
(and its complications) is the fourth leading cause of death
in the United States.
Treatment of type 1 diabetes requires between one
and four daily injections of insulin. (Insulin cannot be taken
orally, since digestive juices would destroy it.) In addition,
diet and exercise must be carefully planned to ensure that blood
glucose levels are neither too high nor too low. Type 2 diabetes
may be controlled with a combination of diet, exercise, and weight
loss, although medications (including insulin) are often necessary.
Treatment is largely a process of self-management. Although there
is no cure, almost all people with diabetes are able to control
their symptoms and lead full, productive lives.
What Causes It?
Type 1 diabetes
is an autoimmune disorder, resulting from a mistaken attack by
the immune system on insulin-producing cells in the pancreas.
are important in type 2 diabetes.
individuals to the development of type 2 diabetes.
such as corticosteroids or thiazide diuretics, may increase the
risk of type 2 diabetes.
such as hemochromatosis, chronic pancreatitis, Cushing's syndrome,
or acromegaly, may lead to diabetes. Surgical removal of the
pancreas may also lead to diabetes.
may develop diabetes mellitus (gestational diabetes), which may
disappear after childbirth; there is an increased risk that these
women will subsequently develop type 2 diabetes.
popular belief, eating lots of foods high in sugar does not promote
the development of type 2 diabetes, lose weight if you are more
than 20 percent overweight, and maintain weight within healthy
There is no
known way to prevent type 1 diabetes.
diabetes should get regular eye examinations to aid in early
detection and treatment of diabetes-related vision disorders
and physical examination are needed.
Diagnosis is made when fasting
blood tests show high glucose levels (126 mg/dL or greater).
When test results
are ambiguous, a glucose tolerance test may be done. A drink
containing 75 grams of glucose is swallowed and blood glucose
levels are measured every 30 minutes over a two-hour period.
may be analyzed for protein content.
is calculated as the average of blood glucose level readings
over the preceding two months.
How To Treat It
For type 1 diabetes:
of insulin are necessary. One
to four daily injections are required to control blood glucose
levels. Long-acting and rapid-acting insulin preparations are
available; a combination of the two kinds is often prescribed.
A strict diet
and schedule of meals are necessary to control blood glucose
levels. Your doctor may recommend a diet low in fat, salt, and
cholesterol and may advise you to see a nutritionist for dietary
exercise and insulin lower glucose levels, exercise and insulin
injections must be timed so that they do not combine to cause
a dangerous drop in blood sugar (hypoglycemia).
Strict adherence to the timetable
of injections, meals, and exercise is necessary for proper management
of the disease.
For type 2 diabetes:
A diet low
in fat and other calories, in addition to regular exercise, is
necessary to control weight.
drugs, such as chlorpropamide, glyburide, glipizide, or repaglinide
may be prescribed to increase insulin production by the pancreas,
if exercise and diet do not lower glucose levels sufficiently.
agents can reduce insulin resistance (metformin and rosiglitazone)
or slow the absorption of sugars from the intestine (acarbose).
may be necessary in more severe cases of type 2 diabetes or if
a patient with type 2 diabetes contracts an additional illness.
For both types of diabetes:
to measure glucose levels should be performed as your doctor
recommends, one to four times a day. Your doctor will recommend
a blood monitoring device to use at home.
must be paid to the risk factors for atherosclerosis because
of its increased occurrence with diabetes. Those suffering from
diabetes should not smoke, should reduce dietary saturated fat,
cholesterol, and salt, and should take any medications prescribed
for high blood pressure or high cholesterol levels.
diabetes should drink generous amounts of water when stricken
with another illness such as the flu. This replaces lost fluid
and prevents diabetic coma. When ill, people with type 1 diabetes
should test their urine for ketones every four to six hours.
diabetes should practice good foot care and check their feet
every day. Nerve damage from diabetes mellitus reduces sensation
in the feet, and small foot problems may turn into major infections.
to prevent the rupture of tiny blood vessels in the eye may be
used to prevent or treat vision problems due to diabetes mellitus
(diabetic retinopathy). Most patients with diabetes need an eye
examination by an ophthalmologist at least once a year to detect
the earliest manifestations of retinopathy.
artificial blood-filtering process, may be necessary to treat
kidney failure. In advanced cases a kidney transplant may be
advised (see Chronic Renal Failure for
or desipramine, medications usually used to treat depression,
may be prescribed to relieve pain in the limbs.
of blood glucose levels delays or prevents late complications
affecting the eyes, kidneys, and nerves.
can be slowed by controlling blood pressure and using ACE inhibitors.
Diabetes Association can provide information about support
groups in your area.
Hopkins Symptoms and Remedies, the complete home medical
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