By: Dr. S. Lawson MD and Dr. H. Boothe PharmD
Diabetes mellitus is a chronic illness that requires continuing medical care and patient self-management education, to prevent acute complications and to reduce the risk of long-term complications. The disease is characterized by excess glucose in the blood that leads to excessive urination and results from inadequate production and or utilization of insulin.
• The different types of diabetes include Type 1, Type 2, Gestational (GDM), and Pre-diabetes.
• Diabetes not only complicates every other disease condition, it can precipitate other diseases.
• 171 million world-wide suffer from diabetes. One in 13 people in the USA have diabetes.
• In the year 2005 a total of 20.8 million have diabetes, of these 6.2 million are undiagnosed. 80% - 90% of the diagnosed are obese when diagnosed.
• It reduces life expectancy by 5 to 10 years.
• Diabetes is associated with obesity, sedentary lifestyle, and an increase in the elderly population.
• The Hispanic, African American and Aboriginal population (with high numbers of poor people with poor diets and inadequate medical attention) are at increased risk to develop diabetes than the rest of the population.
• It is the number 6 leading cause of death in the USA.
• Individuals with diabetes have a 2-4 times the risk of developing cardiovascular disease.
• It is the leading cause of kidney failure, blindness, and non-traumatic amputation.
• Prediabetes is characterized by insulin resistance and a compensatory increase in blood glucose (hyperinsulinemia).
Approximately 1.2 million are diagnosed with Type 1 diabetes mellitus.These numbers will double by the year 2030.
• Type 1 diabetes (results from beta-cell destruction, usually leading to absolute insulin deficiency, it is of autoimmune origin that occurs in the adolescence period of life, usually before the age of 30. Type 1 diabetes presents with sudden onset weight loss, fatigue, irritability and was previously called insulin dependent diabetes.
• Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance, and is caused by inadequate insulin production by the beta cells in the pancreas, defective insulin, or resistance to insulin function at the insulin cell receptors. When insulin binds to its receptor on cell membrane, it allows glucose to enter the cell (i.e. muscle, liver, and fat cells); this is like the key that opens the lock to let glucose into the cell. When glucose is unable to leave the circulation, the blood glucose level rises above optimum level resulting in organ damage.
• Insulin, glucagons, adiponectin, amylin are hormones involved in glucose regulation. Glucagon accelerates the conversion of glycogen in the liver (and promotes the formation of glucose from lactic acid and certain amino acids).
• Insulin stimulates the release of glucose from the liver into the blood. And counteracts the action of glucagons by transporting glucose into cells. Insulin promotes the formation of fatty acids, increases the storage of glycogen, protein synthesis and DNA replication. Amylin is a hormone that acts like insulin.
• Human growth hormone, neurotransmitters, and regulatory peptides also play a role in glucose metabolism.
• In obese individuals, there is abnormal insulin activity (insulin resistance) at the muscles insulin receptors (sites on the muscle cells where insulin acts to pull glucose out of the blood into the cells).
• Cells use glucose as energy and when you have reduced production of insulin or the insulin is not working right glucose increases in the blood. If the cells don’t receive adequate supply of energy this sends message to the brain that results in increased hunger, at the same time, the blood becomes hyperosmolar( too thick) and absorbs water from tissue, this results in dehydration and increased thirst.
• Excess blood glucose destroys the kidney's filtering capability which results in excessive glucose and protein in the urine causing increased urination.
• In type1 diabetes there is a total destruction of the insulin producing cells by antibodies (an autoimmune dysfunction).
• Viral infection of the pancreas is implicated in this destructive mechanism.
• Type 1 diabetes mellitus (T1DM) requires insulin. Without insulin the body has to get its energy from fats. This results in Diabetic keto Acidosis (DKA) which leads to metabolic abnormalities. Treatment is Intravenous insulin and glucose. Type 1 diabetes is a result of the complete absence of insulin production in the pancreas, of viral etiology, genetic factors, presence of ketones in the blood (ketoacidosis), sudden onset and usually presents before age 30. These individuals with Type 1 diabetes usually have lean body composition. The diagnosis of Type 1 diabetes is made by detecting of antibodies and C-peptides in the blood.
These individuals usually do not have a family history of diabetes.
• Type2 diabetes mellitus (T2DM) frequently presents with poor wound healing, blurry vision, numbness and tingling in the hands and feet, recurring skin and gum infections, vaginal yeast infection, and urinary tract infection. Factors that predispose people to developing T2MD include obesity (waist to hip ratio) fetal malnutrition, gestational diabetes, children born prematurely, a positive family history of T2DM, cigarette smoking, hypothyroidism, trans fat, saturated fats, endothelial dysfunction, high levels of testosterones in women, decrease levels of sex hormones binding protein in men, HIV/AIDS.