Understanding the Basics of Diabetes Mellitus

By Adam Brochert, M.D.
PersonalMD.com, Medical Contributor

Diabetes is a condition characterized by abnormal glucose (sugar) levels in the blood. In the United States, more than 10 million people are affected. Diabetes can begin at almost any age, from childhood to late adulthood, and its consequences can be devastating.

The initial symptoms of diabetes include increased urination, increased thirst and fluid intake, increased food intake, weight loss and blurry vision. Oral (thrush) or vaginal yeast infections are also relatively common in patients before the diagnosis is made. The diagnosis of diabetes is usually made by checking the blood after an 8 hour fast to see if the glucose level is elevated.

The causes of diabetes are multiple and not all well understood. There are basically three types of diabetes  type I, type II and secondary diabetes. Type I diabetes usually occurs before the age of 30 and is due to a lack of insulin. Without insulin injections, type I diabetics will die. This type of diabetes accounts for only 10% of cases and its exact cause is unclear.

Type II diabetes causes 90% of cases and is usually seen in patients over the age of 30, however, onset in the pediatric population is increasing in frequency. With this type of diabetes, patients can make insulin, but it is not enough to meet their needs. This type of diabetes often runs in families and has a strong association (at least 75% of cases) with obesity. Secondary diabetes means elevated glucose levels secondary to another condition.

There are many causes, but the most common is probably diabetes caused by pregnancy (known as gestational diabetes). Because of the hormonal changes during pregnancy, patients who otherwise do not have diabetes may develop elevated glucose levels in the blood. This condition is important to recognize early, as it can cause problems for mother and fetus, including an increased risk of birth defects. Regular prenatal care and early treatment can help prevent these complications.

Other causes of glucose intolerance include diseases of the pancreas, other endocrine disturbances (like an overactive thyroid or adrenal gland) and medications such as corticosteroids, which are commonly prescribed for several conditions including asthma, emphysema and rheumatoid arthritis. Treatment of the underlying condition is often all that is needed.

The complications of diabetes are numerous. Diabetes is the number one cause of blindness in patients under the age of 40 (and a common cause in patients over 40). The number one cause for renal failure and limb amputation is diabetes. Along with hypertension, smoking, and high cholesterol, diabetes is one of the four main risk factors for atherosclerosis (clogging of the arteries), which can cause heart attacks and strokes. Poorly controlled diabetes can lead to a variety of serious complications and even directly to death due to an increased viscosity in the blood (called a hyperosmolar state, happens in type II diabetes) or a decreased pH in the blood (called diabetic ketoacidosis, happens in type I diabetes).

The good news, however, is that strict control of glucose levels and attention to ones overall state of health can delay and sometimes prevent the onset of most of these complications. Most people are aware of insulin, which is the only current medication for patients with type I diabetes.

Unfortunately, insulin is not available in a pill form and needs to be injected. For type II diabetics, however, there are many different medications that can be taken in pill form that can help control the glucose level. Also important to note is that in type II diabetes, no medication has been proven to be better at controlling diabetes than losing weight!

Doctors need their patients help in controlling diabetes. Patients are usually asked to monitor their glucose levels at home with an easy to use machine. Patients will also be asked to monitor what they eat and if overweight, to lose weight by beginning a proper diet and exercise program. Patients with diabetes often develop numbness in their feet, so patients are asked to inspect their feet regularly for ingrown toenails, sores or scabs.When caught early, these problems can be treated so they dont lead to overwhelming infection requiring amputation.

Diabetes is a common, yet sometimes devastating disease. With knowledge about the condition and a willingness to take control of their health, many patients are able to lead normal, healthy lives.

If you or someone you love has diabetes, make it your goal to become educated about the disease. It could make all the difference.

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