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Diabetes mellitus is a group of metabolic diseasescharacterized by high blood sugar (glucose) levels, that

result from defects in insulin secretion, or action, or both.Diabetes mellitus, commonly referred to as diabetes (as itwill be in this article) was first identified as a diseaseassociated with "sweet urine," and excessive muscle loss inthe ancient world. Elevated levels of blood glucose

(hyperglycemia

) lead to spillage of glucose into the urine,hence the term sweet urine.

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. Normally, blood glucose levels are tightly

controlled by insulin, a hormone producedby the pancreas. Insulin lowers the bloodglucose level. When the blood glucoseelevates (for example, after eating food),

insulin is released from the pancreas tonormalize the glucose level. In patientswith diabetes, the absence or insufficientproduction of insulin causes hyperglycemia.Diabetes is a chronic medical condition,meaning that although it can be controlled,it lasts a lifetime

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Over time, diabetes can lead to blindness, kidney

failure, and nerve damage. These types of damageare the result of damage to small vessels, referredto as microvascular disease. Diabetes is also animportant factor in accelerating the hardening and

narrowing of the arteries (atherosclerosis), leadingto strokes, coronary heart disease and other largeblood vessel diseases. This is referred to asmacrovascular disease. Diabetes affectsapproximately 17 millionpeople (about 8% of the

population) in the United States. In addition, anestimated additional 12 million people in the UnitedStates have diabetes and don't even know it.

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Diabetes is the thirdabetes is the thirdleading cause of deathleading cause of death

in the United Statesin the United States

after heart diseaseafter heart diseaseandand cancercancer

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Insufficient production of insulin (either absolutely orrelative to the body's needs), production of defectiveinsulin (which is uncommon), or the inability of cellsto use insulin properly and efficiently leads tohyperglycemia and diabetes. This latter conditionaffects mostly the cells of muscle and fat tissues,

and results in a condition known as "insulinresistance." This is the primary problem in type 2diabetes. The absolute lack of insulin, usuallysecondary to a destructive process affecting theinsulin producing beta cells in the pancreas, is themain disorder in type 1 diabetes. In type 2 diabetes,

there also is a steady decline of beta cells that addsto the process of elevated blood sugars. Essentially,if someone is resistant to insulin, the body can, tosome degree, increase production of insulin andovercome the level of resistance. After time, ifproduction decreases and insulin cannot be released asvigorously, hyperglycemia develops.

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Glucose is a simple sugar found in food. Glucose is anessential nutrient that provides energy for the properfunctioning of the body cells. Carbohydrates are brokendown in the small intestine and the glucose in digested foodis then absorbed by the intestinal cells into thebloodstream, and is carried by the bloodstream to all the

cells in the body where it is utilized. However, glucosecannot enter the cells alone and needs insulin to aid in itstransport into the cells. Without insulin, the cells becomestarved of glucose energy despite the presence ofabundant glucose in the bloodstream. In certain types of

diabetes, the cells' inability to utilize glucose gives rise tothe ironic situation of "starvation in the midst of plenty".The abundant, unutilized glucose is wastefully excreted inthe urine.

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InsulinInsulin is a hormone that is produced by specialized cells (betacells) of the pancreas. (The pancreas is a deep-seated organ inthe abdomen located behind the stomach.) In addition to helping

glucose enter the cells, insulin is also important in tightlyregulating the level of glucose in the blood. After a meal, theblood glucose level rises. In response to the increased glucoselevel, the pancreas normally releases more insulin into thebloodstream to help glucose enter the cells and lower blood

glucose levels after a meal. When the blood glucose levels arelowered, the insulin release from the pancreas is turned down. Itis important to note that even in the fasting state there is a lowsteady release of insulin than fluctuates a bit and helps tomaintain a steady blood sugar level during fasting. In normal

individuals, such a regulatory system helps to keep blood glucoselevels in a tightly controlled range. As outlined above, in patientswith diabetes, the insulin is either absent, relatively insufficientfor the body's needs, or not used properly by the body. All ofthese factors cause elevated levels of blood glucose

(hyperglycemia).

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TwoTwo majormajor typestypes ofof diabetesdiabetes,

1.) Type 1 diabetes was also called insulininsulin dependentdependent diabetesdiabetes

mellitusmellitus (IDDMIDDM), or juvenilejuvenile onsetonset diabetesdiabetes mellitusmellitus.In typetype 11 diabetes, the pancreas undergoes an autoimmuneattack by the body itself, and is rendered incapable of makinginsulin. Abnormal antibodies have been found in the majority ofpatients with type 1 diabetes. Antibodies are proteins in the

blood that are part of the body's immune system. The patientwith type 1 diabetes must rely on insulin medication for survival.

In autoimmune diseases, such as type 1 diabetes, the immunesystem mistakenly manufactures antibodies and inflammatorycells that are directed against and cause damage to patients' own

body tissues. In persons with type 1 diabetes, the beta cells ofthe pancreas, which are responsible for insulin production, areattacked by the misdirected immune system. It is believed thatthe tendency to develop abnormal antibodies in type 1 diabetesis, in part, genetically inherited, though the details are not fully

understood.

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2.) Type 2 diabetes - nonnon--insulininsulin dependentdependent diabetesdiabetes mellitusmellitus (NIDDM), or

adultadult onsetonset diabetesdiabetes mellitusmellitus (AODM).

In type 2 diabetes, patients can still produce insulin, but do so relativelyinadequately for their body's needs, particularly in the face of insulin

resistance as discussed above. In many cases this actually means the

pancreas produces larger than normal quantities of insulin. A major

feature of type 2 diabetes is a lacklack ofof sensitivitysensitivity toto insulininsulin byby thethe cellscells

ofof thethe bodybody (particularly fat and muscle cells).In addition to the problems with an increase in insulin resistance, the

release of insulin by the pancreas may also be defective and suboptimal.

In fact, there is a known steady decline in beta cell production of insulin

in type 2 diabetes that contributes to worsening glucose control. (This is

a major factor for many patients with type 2 diabetes who ultimatelyrequire insulin therapy.) Finally, the liver in these patients continues to

produce glucose through a process called gluconeogenesis despite

elevated glucose levels. The control of gluconeogenesis becomes

compromised.

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WhileWhile itit isis saidsaid thatthat typetype 22 diabetesdiabetes occursoccurs mostlymostly inin individualsindividuals

overover 3030 yearsyears oldold andand thethe incidenceincidence increasesincreases withwith age,age, wewe areareseeingseeing anan alarmingalarming numbernumber patientspatients withwith typetype 22 diabetesdiabetes whowho areare

barelybarely inin theirtheir teenteen yearsyears.. InIn fact,fact, forfor thethe firstfirst timetime inin thethe

historyhistory ofof humans,humans, typetype 22 diabetesdiabetes isis nownow moremore commoncommon thanthan

typetype 11 diabetesdiabetes inin childhoodchildhood.. MostMost ofof thesethese casescases areare aa directdirect

resultresult ofof poorpoor eatingeating habits,habits, higherhigher bodybody weight,weight, andand lacklack ofofexerciseexercise..

WhileWhile therethere isis aa strongstrong geneticgenetic componentcomponent toto developingdeveloping thisthis

formform ofof diabetes,diabetes, therethere areare otherother riskrisk factorsfactors -- thethe mostmost

significantsignificant ofof whichwhich isis obesityobesity.. ThereThere isis aa directdirect relationshiprelationship

betweenbetween thethe degreedegree ofof obesityobesity andand thethe riskrisk ofof developingdeveloping typetype 22diabetes,diabetes, andand thisthis holdsholds truetrue inin childrenchildren asas wellwell asas adultsadults.. ItIt isis

estimatedestimated thatthat thethe chancechance toto developdevelop diabetesdiabetes doublesdoubles forfor everyevery

2020%% increaseincrease overover desirabledesirable bodybody weightweight..

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W Whilethereisastronggeneticcomponenttodevelopingthisformofdiabetes,thereareotherriskfactors

themostsignificantofwhichisobesity Thereisadirect

relationship

betw

een

the

degree

of

obesity

and

the

risk

of

developingtype 2 diabetes,andthisholdstrueinchildrenaswellasadults.Itisestimatedthatthechancetodevelopdiabetesdoublesforevery 20% increaseoverdesirablebody

weight.

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3.) GESTATIONALDIABETESDiabetes can occur temporarily during

pregnancy. Significant hormonal changes

during pregnancy can lead to blood sugarelevation in genetically predisposed

individuals. Blood sugar elevation duringpregnancy is called GESTATIONAL

DIABETES. Gestational diabetes usuallyresolves once the baby is born.

However, 25%-50% of women withgestational diabetes will eventually developtype 2 diabetes later in life, especially in

those who require insulin during pregnancyand those who remain overweight after theirdelivery. Patients with gestational diabetes

are usually asked to undergo an ORAL GLUCOSE TOLERANCE TEST

about six weeks after giving birth todetermine if their diabetes has persistedbeyond the pregnancy, or if any evidence

(such as IMPAIARED GLUCOSE TOLERANCE) is presentthat may be a clue to the patient's future risk

for developing diabetes.

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What are diabetes symptoms?

The early symptoms of untreated diabetes are relatedto elevated blood sugar levels, and loss of glucose in the urine.

High amounts of glucose in the urine can cause increasedurine output and lead to dehydration.

Dehydration causes increased thirst and water consumption.The inability of insulin to perform normally has effects

on protein, fat and carbohydrate metabolism. Insulin is ananabolic hormone, that is, one that encourages storage of

fat and protein. Weight loss despite an increase in appetite.fatigue, nausea and vomiting . prone to developing infections

of the bladder, skin, and vaginal areas. Fluctuations in\blood glucose levels can lead to blurred vision.

Extremely elevated glucose levels can lead to lethargy andComa.

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fungus

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