Diabetes mellitus

Diabetes mellitus- More commonly referred to

as "diabetes“, a chronic disease associated with
abnormally high levels of the sugar glucose in
the blood. Diabetes is due to one of two
mechanisms:
Inadequate production of insulin (which is
made by the pancreas and lowers blood
glucose), or
Inadequate sensitivity of cells to the action of
insulin.
When you eat a carbohydrate, your body turns it
into a sugar called glucose and sends that to your
bloodstream. Your pancreas releases insulin, a
hormone that helps move glucose from your blood
into your cells, which use it for energy.
When you have diabetes and don’t get treatment,
your body doesn’t use insulin like it should. Too
much glucose stays in your blood, a condition
usually called high blood sugar. This can cause
health problems that may be serious or even life-
threatening.
There’s no cure for diabetes. But with treatment
and lifestyle changes, you can live a long, healthy
life.
Diabetes comes in different forms, depending on
the cause.
There are two main types of
diabetes mellitus, which are
called type 1 diabetes and type 2
diabetes. Type 1 usually first
presents in children or in young
adults. Type 2 is more associated
with being overweight and most
often first presents in people
over the age of 40 years.
However, type 2 diabetes is
increasingly diagnosed in
children and in young adults.
Diabetes Mellitus
Type 1 Diabetes

Type 1 diabetes is also called insulin-dependent diabetes. It

used to be called juvenile-onset diabetes, because it often
begins in childhood.
Type 1 diabetes is an autoimmune condition. It happens
when your body attacks your pancreas with antibodies. The
organ is damaged and doesn't make insulin. Your genes might
cause this type of diabetes. It could also happen because of
problems with cells in your pancreas that make insulin. Many
of the health problems that can come with type 1 happen
because of damage to tiny blood vessels in your eyes (called
diabetic retinopathy), nerves (diabetic neuropathy), and
kidneys (diabetic nephropathy). People with type 1 also have
a higher risk of heart disease and stroke.
Type 2 Diabetes Type 2 diabetes used to be called non-insulin-dependent
or adult-onset diabetes. But it’s become more common in
children and teens over the past 20 years, largely because
more young people are overweight or obese. About 90%
of people with diabetes have type 2.
When you have type 2 diabetes, your pancreas usually
creates some insulin. But either it’s not enough or your
body doesn’t use it like it should. Insulin resistance,
when your cells don’t respond to insulin, usually
happens in fat, liver, and muscle cells.
Type 2 diabetes is often milder than type 1. But it can
still cause major health complications, especially in the
tiny blood vessels in your kidneys, nerves, and eyes. Type
2 also raises your risk of heart disease and stroke.
People who are obese -- more than 20% over their target
body weight for their height -- have an especially high
risk of type 2 diabetes and the health problems that can
follow. Obesity often causes insulin resistance, so your
pancreas has to work harder to make more insulin. But
it’s still not enough to keep your blood sugar levels
where they should be.
The pancreas makes insulin, but it
either doesn't produce enough, or the
insulin doesn't work properly. Nine out
of 10 people with diabetes have Type 2.
This type occurs most often in people
who are over 40 years old but can occur
even in childhood if there are risk
factors present. Type 2 diabetes may
sometimes be controlled with a
combination of diet, weight
management and exercise. However,
treatment also may include oral
glucose-lowering medications (taken by
mouth) or insulin injections (shots).
Gestational Diabetes
Pregnancy usually causes some form of insulin resistance. If
this becomes diabetes, it’s called gestational. Doctors often
spot it in middle or late pregnancy. Because a woman’s
blood sugars travel through their placenta to the baby, it’s
important to control gestational diabetes to protect the
baby's growth and development.
Doctors report gestational diabetes in 2% to 10% of
pregnancies. It usually goes away after birth. But up to 10%
of women who have gestational diabetes get type 2, weeks
or even years later.
Gestational diabetes is more of a risk for the baby than the
mother. A baby might have unusual weight gain before birth,
trouble breathing at birth, or a higher risk of obesity and
diabetes later in life. The mother might need a cesarean
section because of an overly large baby, or they might have
damage to their heart, kidney, nerves, and eyes.
Causes of Diabetes Mellitus
Type 1 Diabetes
Type 1 diabetes occurs when your
immune system, the body’s system for
fighting infection, attacks and destroys
the insulin-producing beta cells of the
pancreas. Scientists think type 1
diabetes is caused by genes and
environmental factors, such as viruses,
that might trigger the disease
Type 2 Diabetes
The most common form of diabetes—is caused by
several factors, including lifestyle factors and genes.
Overweight, obesity, and physical inactivity
You are more likely to develop type 2 diabetes if you
are not physically active and are overweight or
obese. Extra weight sometimes causes insulin
resistance and is common in people with type 2
diabetes. The location of body fat also makes a
difference. Extra belly fat is linked to insulin
resistance, type 2 diabetes, and heart and blood
vessel disease. To see if your weight puts you at risk
for type 2 diabetes, check out these Body Mass
Index (BMI) charts.
Insulin resistance

Type 2 diabetes usually begins with insulin resistance, a

condition in which muscle, liver, and fat cells do not use
insulin well. As a result, your body needs more insulin to
help glucose enter cells. At first, the pancreas makes more
insulin to keep up with the added demand. Over time, the
pancreas can’t make enough insulin, and blood glucose
levels rise.
Genes and family history
As in type 1 diabetes, certain genes may make you more likely to develop type 2 diabetes. The
disease tends to run in families and occurs more often in these racial/ethnic groups:
African Americans
Alaska Natives
American Indians
Asian Americans
Hispanics/Latinos
Native Hawaiians
Pacific Islanders
Genes also can increase the risk of type 2 diabetes by increasing a person’s tendency to become
overweight or obese.
Gestational Diabetes
Scientists believe gestational diabetes, a type of diabetes that
develops during pregnancy, is caused by the hormonal changes
of pregnancy along with genetic and lifestyle factors.
Insulin resistance
Hormones produced by the placenta NIH external link contribute
to insulin resistance, which occurs in all women during late
pregnancy. Most pregnant women can produce enough insulin
to overcome insulin resistance, but some cannot. Gestational
diabetes occurs when the pancreas can’t make enough insulin.
As with type 2 diabetes, extra weight is linked to gestational
diabetes. Women who are overweight or obese may already
have insulin resistance when they become pregnant. Gaining too
much weight during pregnancy may also be a factor.
Diagnosis
◦ Diabetes is diagnosed with fasting sugar blood
tests or with A1c blood tests, also known as
glycated hemoglobin tests. A fasting blood sugar
test is performed after you have had nothing to eat
or drink for at least eight hours. Normal fasting
blood sugar is less than 100 mg/dl (5.6 mmol/l).
You do not have to be fasting for an A1c blood test
Diabetes is diagnosed by one of the following
Type of test Normal Pre-diabetes Diabetes
 Your blood sugar level is equal to or
greater than 126 mg/dl (7 mmol/l).
Fasting Less than 100
glucose test ​ 100-125 126 or higher  You have two random blood sugar
Random tests over 200 mg/dl (11.1 mmol/l) with
(anytime) Less than 140 140-199 200 or higher
glucose test
​ symptoms.
 You have an oral glucose tolerance
Less than 6.5% or
A1c test 5.7% 5.7 - 6.4%
higher
test with results over 200 mg/dl (11.1
​
mmol/l).
 Your A1c test is greater than 6.5
An A1c test should be performed in a laboratory using a
method that is certified by the National Glycohemoglobin percent on two separate days.
Standardization Program (NGSP) and standardized to the
Diabetes Control and Complications Trial (DCCT) assay.
Diabetes Mellitus: Management and
Treatment
 There is no cure for diabetes, but it can be
treated and controlled. The goals of managing
diabetes are to:
◦ Keep your blood glucose levels as near to normal
as possible by balancing food intake with
medication and activity.
◦ Maintain your blood cholesterol and triglyceride
(lipid) levels as near the normal ranges as
possible.
◦ Control your blood pressure. Your blood pressure
should not go over 140/90.
◦ Decrease or possibly prevent the development of
diabetes-related health problems.
You hold the keys to managing your diabetes by:
Planning what you eat and following a balanced meal
plan.
Exercising regularly.
Taking medication, if prescribed, and closely following
the guidelines on how and when to take it.
Monitoring your blood glucose and blood pressure
levels at home.
Keeping your appointments with your healthcare
providers and having laboratory tests completed as
ordered by your doctor.
What you do at home every day affects your blood
glucose more than what your doctor can do every few
months during your check-up.
Diabetes Mellitus: Prevention
Although diabetes risk factors like family history cannot be
changed, there are other risk factors that you do have some
control over. Implementing some of the healthy lifestyle habits
below can improve these modifiable risk factors and help to
decrease your chances of getting Type 2 diabetes:

Eating healthfully.
Being physically active.
Lowering your stress.
Limiting alcohol intake.
Getting enough sleep.
Quitting smoking.
 Long-term complications of
high blood sugar levels
Retinopathy (eye disease): All patients with diabetes should see an
ophthalmologist (eye specialist) every year for a dilated eye examination. Patients
with known eye disease or symptoms of blurred vision in one eye or who have
blind spots may need to see their ophthalmologist more often.
 Nephropathy (kidney disease)
Urine testing should be performed every
year. Regular blood pressure checks are also
important because management of high
blood pressure is essential in slowing kidney
disease. Have your blood pressure checked
at every visit with your healthcare provider.
The American Diabetes Association
recommends keeping blood pressure below
140/90 for most adults. Persistent swelling
in the leg or feet also may be a symptom of
kidney disease and should be reported to
your doctor.
Neuropathy (nerve disease) Numbness or tingling in
your feet should be reported to your doctor at your
regular visits. Check your feet every day for redness,
calluses, cracks or breakdown in the skin tissue. If you
notice these symptoms before your scheduled visits,
notify your doctor immediately.
Other long-term complications may include:
Other eye problems, including glaucoma and
cataracts.
Dental problems.
High blood pressure.
Heart attacks and strokes.
Sexual health problems.
ABCDES of Diabetes Care